Withholding and Ceasing Resuscitation

Question 1

Recite the Withholding and Ceasing Resuscitation Guideline

Answer 1

Question 2

Name five clinical signs that indicate obvious death.

Answer 2

• Injuries incompatible with life
• Rigor mortis
• Postmortem lividity
• Putrefaction/decomposition
• Death declared by a doctor who is/was at the scene.

These signs are critical for determining that a person is deceased without the need for further medical intervention.

Question 3

When can goals of care prevent resuscitation from being started?

Answer 3

If resuscitation is inconsistent with patient’s wishes as indicated by an
* Advance Care Directive
* or a Medical Treatment Decision Maker.

This emphasizes the importance of respecting patient autonomy in medical decisions.

Question 4

In a medical arrest, what HR value defines asystole or agonal rhythm?

Answer 4

HR < 20.

This criterion is essential for identifying the seriousness of the cardiac arrest situation.

Question 5

What are three exceptions where resuscitation should be commenced despite prolonged arrest?

Answer 5

• Bystander witnessed collapse within 10 minutes of AV arrival
• Paramedic witnessed arrest
• Defibrillation received prior to ambulance arrival

These exceptions highlight scenarios where resuscitation efforts may still be beneficial.

Question 6

What two trauma conditions define prolonged arrest?

Answer 6

• Arrest not witnessed by paramedics
• Initial presenting rhythm is asystole or agonal (HR < 20)

Recognizing these conditions helps in decision-making during emergencies.

Question 7

What defines an expected death?

Answer 7

Death expected due to the progression of a specific, advanced incurable disease.

Understanding expected death is crucial for appropriate medical and emotional support.

Question 8

What should you do if unable to immediately confirm the criteria for withholding resuscitation?

Answer 8

Commence resuscitation while continuing to gather information.

This approach ensures that no time is wasted in potentially life-saving efforts.

Question 9

If resuscitation is withheld, what three actions must be taken?

Answer 9

• Consult the AV Clinician if uncertain
• Confirm determinants of death and complete the Verification of Death form
• Provide bereavement support and referral if required

These actions ensure proper protocol is followed in the event of withholding resuscitation.

Question 10

When should resuscitation be commenced according to the flowchart?

Answer 10

If none of the criteria for withholding resuscitation are met.

Adhering to these guidelines is vital for effective emergency response.

Question 11

What is the minimum ALS resuscitation time for shockable rhythms (VF/VT)?

Answer 11

45 minutes.

This timeframe is critical for assessing the effectiveness of resuscitation efforts.

Question 12

What is the minimum ALS resuscitation time for non-shockable rhythms?

Answer 12

30 minutes.

This standard helps guide the duration of resuscitative efforts in different scenarios.

Question 13

What are the “no compelling reasons to continue”

Answer 13

• CPR induced consciousness
• Spontaneous respiratory effort
• POCUS shows cardiac contractility (if credentialed)
• ROSC periods
• Witnessed arrests with pre-arrival defib
• Normal or near-normal ETCO₂
• Persistent narrow complex PEA

Recognizing these signs is essential for making informed decisions about ceasing resuscitation.

Question 14

What three steps should be followed when ceasing resuscitation?

Answer 14

• Confirm determinants of death
• Consider and complete the Verification of Death form
• Provide initial bereavement support and referral if required

These steps ensure that the process is handled with care and respect for the deceased and their loved ones.