Introduction: Andy Dufrayne

Andy Dufrayne is a 79 year old man admitted to A&E with pneumonia. He has a 2 year history of moderate to severe COPD, and suffers from dementia. He was seen at the clinic a year ago and discharged to his GP. Spirometry confirmed the diagnosis of COPD at the time.

He has a cough, fever and a right mid zone shadow on the chest X-ray. O2 saturation is slightly reduced, but his CO2 is normal.

You are the admitting consultant in geriatric medicine. The patient is accompanied by his only adult son, who has come to visit his father from Canada. The son, as trained paramedic, says he wants to be involved in decisions about his father"s care and has asked to see you straight away to discuss making his father not for resuscitation.

As you are reviewing Mr Dufrayne's notes, your registrar says to you "What do you think his DNAR status should be? He's pretty sick." Although there is some uncertainty at this early stage of admission, you agree that the patient's prognosis is poor.

What should you, the consultant, do next?