New - DNR and Cease Resuscitation

Question 1

Adult medical patients may have resuscitation withheld when what conditions are met?

Answer 1

a. Rigor mortis
b. Decomposition
c. Down time > 20 minutes and no CPR and initial rhythm of asystole (2 leads)
d. A valid DNR is produced

Question 2

Adult trauma patients may have resuscitation withheld when what conditions are met?

Answer 2

a. Decapitation
b. Incineration
c. Normothermic patients with any of the following:
i. Evidence of severe head trauma/brain injury with asystole or PEA < 40bpm
ii. Blunt trauma with associated asystole or PEA < 40bpm
iii. Submersions for > 30 minutes – consider resuscitation in cold-water

Question 3

EMS may terminate resuscitation when ALL the following are met:

Answer 3

a. The patient is 18 years or older
b. Responders have provided over 30 minutes of CPR
c. Initial rhythm is asystole (2 leads), fine V-fib, PEA or deemed not shockable by an
AED
d. Rhythm remains in asystole or PEA throughout (no coarse V-Fib or V-Tach)
e. No ROSC
f. EMS did not witness the arrest
g. A secure airway is confirmed by waveform capnography
h. EtCO2 value is less than 10 mmHg despite effective CPR
i. The H’s & T’s of suspected reversable causes have been addressed