POLST Discordant Care
You are working at a community trauma center when an elderly male is brought to the ED after being struck by a car. The patient is complaining of right sided chest pain and is in respiratory distress. He has a patent airway, is breathing spontaneously and is normotensive. He is confused and not oriented to place or time. A chest x-ray does not reveal a pneumothorax, but does reveal 5 contiguous rib fractures. The patient is likely to require intubation due to the increased work of breathing. You review the patient's chart and note that he has a POLST on file indicating a DNR/DNI status as well as identifying his daughter as a medical power of attorney who may override the POLST. A nurse lets you know the patient’s family has arrived. You wonder how the presence of the POLST form will influence your conversation with the family.