Protocol 27 Withholding Resuscitation 12/15/2022

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Questions and Answers

What must be documented in the Narrative Section of the Patient Care Report when resuscitation is withheld or terminated?

The criteria used to withhold or terminate resuscitation (correct)

The medical history of the patient

The family’s wishes regarding medical treatment

The patient's social history

Which of the following conditions is NOT indicative of irreversible biological death?

Rigor Mortis with warm air temperature

Fixed and dilated pupils

Venous pooling of blood in dependent body parts

Pulselessness (correct)

In which situation can resuscitation efforts be terminated immediately?

When a valid Do Not Resuscitate Order is presented (correct)

After 45 minutes of unsuccessful resuscitation

Upon the arrival of advanced medical personnel

When family members request to stop

Which of the following is a presumptive sign of cardiac arrest that typically does not justify withholding resuscitation?

All of the above Signup and view all the answers

What must be confirmed in at least 2 EKG leads to consider withholding resuscitation?

Asystole Signup and view all the answers

Which of the following describes livor mortis?

Pooling of blood leading to skin discoloration that does not blanch Signup and view all the answers

What does the presence of trismus indicate in a patient?

A need for immediate airway intervention Signup and view all the answers

What is the primary reason to initiate resuscitation procedures despite apparent signs of death in a patient?

Any reasonable doubt about patient viability Signup and view all the answers

Which condition necessitates the termination of resuscitation efforts?

The patient has an advanced airway in place and an ETCO2 reading < 10 after 20 minutes. Signup and view all the answers

What is NOT considered a definitive sign of death at the scene?

An EKG reading with a PEA rhythm. Signup and view all the answers

In the event of multiple casualty situations, under what condition should CPR be discontinued?

When the patient has a documented DNRO that contradicts CPR. Signup and view all the answers

What should be documented when terminating resuscitation efforts?

The criteria used for the decision in the narrative section. Signup and view all the answers

Which of the following is a characteristic of livor mortis?

Non-blanching purple discoloration of the skin. Signup and view all the answers

Which scenario allows for an EMS Field Supervisor to approve termination of resuscitation efforts?

In extraordinary circumstances after 20 minutes of resuscitation efforts. Signup and view all the answers

Which condition can still warrant resuscitation efforts despite apparent unresponsiveness?

Patients experiencing hypothermia, drowning, or electrocution. Signup and view all the answers

What must be present for resuscitation to be warranted during a non-witnessed cardiac arrest?

The patient should not have any ROSC after 20 minutes. Signup and view all the answers

What is the significance of mottling compared to lividity?

Mottling indicates a milder change seen in severe shock. Signup and view all the answers

Study Notes

Cardiopulmonary Resuscitation (CPR) Guidelines

CPR is initiated for all patients experiencing cardiopulmonary arrest, excluding those with clear signs of irreversible biological death or valid Do Not Resuscitate Orders (DNRO).
Resuscitation efforts cannot be stopped without a valid DNRO or evident irreversible biological death.

Documentation and Caution

Document reasons for withholding or terminating resuscitation in the Patient Care Report's Narrative Section.
Exercise extreme caution when deciding to withhold CPR; initiate resuscitation if patient viability is uncertain.

Presumptive Signs and Symptoms of Cardiac Arrest

Patients may show multiple signs: unwitnessed, pulseless, apneic, discolored, cool and pale, fixed and dilated pupils, trismus, and asystole.
These signs do not justify withholding resuscitation; follow Protocol 9.A for procedures.

Guidelines for Withholding or Terminating CPR

CPR may be withheld if there is no pulse, no spontaneous respiration, and EKG shows asystole in at least 2 leads, along with definitive signs:
- Tissue decomposition.
- Rigor Mortis (fixed and non-reactive pupils, muscle rigidity).
- Livor Mortis (purple skin discoloration that does not blanch).
Specific criteria for traumatic cardiac arrests include:
- Obvious fatal injuries (e.g., decapitation).
- Tissue decomposition, rigor mortis, and livor mortis as mentioned above.

Absence of Respiration and DNRO Considerations

In multiple casualty scenarios, if no spontaneous respiration is observed after airway repositioning, CPR may be withheld.
If CPR is started against a patient's documented wishes (DNRO), it should be discontinued.

Procedures for Death on Scene (DOA)

Inform law enforcement for proper procedures in confirmed cases of death on the scene.
Ensure scene stability before clearing the unit once law enforcement is on-site.

Termination of Resuscitation Efforts

Resuscitation may be stopped if:
- The arrest was unwitnessed.
- EKG remains non-shockable throughout.
- No Return of Spontaneous Circulation (ROSC) occurs after 20 minutes.
- ET Tube is in place with an ETCO2 reading below 10 post-20 minutes.
Document criteria used for decisions on CPR initiation or termination in the ePCR's narrative section.
All equipment used during resuscitation efforts must stay in place after resuscitation is terminated.

Special Considerations

Irreversible biological death may be hard to assess in cases of hypothermia, drowning, or electrocution; these patients may still benefit from resuscitation.
Transfer deceased patients when necessary due to environmental concerns, advising law enforcement as needed.
EMS Field Supervisors can approve the termination of efforts after 20 minutes of attempted resuscitation, even if not all criteria are met; the rationale must be documented.

Documentation for Major Trauma Cases

In severe trauma (e.g., decapitation), EKG readings are not required; focus on detailed documentation of injuries and physical assessments in the narrative section.

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Description

Test your knowledge on the criteria and protocols for initiating and terminating cardiopulmonary resuscitation (CPR) in patients. Understand the significance of Do Not Resuscitate Orders and the documentation required during resuscitation efforts. This quiz is essential for healthcare professionals involved in emergency care.