Withholding Resus CPG Notes Flashcards
(26 cards)
What are the two primary care objectives in this guideline?
Identify patients who will not benefit from resuscitation or where a legal requirement exists to withhold it
Provide guidance for cessation of resuscitation following an unsuccessful attempt
Which patient group is this guideline intended for?
Patients aged ≥ 16 years presenting in medical or traumatic cardiac arrest
What should paramedics do when uncertain whether to withhold resuscitation?
Commence resuscitation while gathering more information
Name at least three signs of obvious death.
- Injuries incompatible with life (e.g. decapitation, incineration)
- Rigor mortis
- Postmortem lividity
- Putrefaction/decomposition
- Death declared by a doctor at the scene
Do paramedics have a legal obligation to follow an Advance Care Directive (ACD)?
Yes
What can paramedics act on in good faith in regard to an ACD?
Verbal confirmation that an ACD exists and reflects the patient’s wishes
What if an ACD requests unethical or unclear treatment?
Paramedics are not required to follow it
How should a medical treatment decision maker be determined?
As per CPG A0111 Consent and Capacity
What is the survival rate of asystolic/agonal rhythm patients at initial AV presentation?
Less than 1%
What are the only three exceptions when you might start resuscitation in a prolonged arrest?
- Prior defibrillation
- Bystander-witnessed arrest and paramedics commence within 10 minutes
- Paramedic-witnessed arrest
Is bystander CPR or normal temperature a reason to commence resuscitation?
No
What does ‘initial presenting rhythm’ refer to?
The first rhythm analysis by any provider (e.g. PAD, EMR, AV)
What heart rate defines agonal PEA?
HR < 20 bpm
When can resuscitation be withheld due to expected death?
If death was due to a specific, advanced, incurable disease with known deterioration
What should paramedics do in case of uncertainty or family disagreement?
Consult the AV Medical Advisor via the AV Clinician
What frailty score suggests unlikely survival from arrest?
Frailty score ≥ 7
Name three comorbidities that reduce the likelihood of recovery.
- Severe COPD
- Chronic renal failure
- Advanced dementia
What must always be present in a Voluntary Assisted Dying (VAD) case attended by AV?
A documented Advance Care Directive for ‘no resuscitation’
Can AV paramedics assist in administering VAD medication?
No
Can AV provide clinical interventions like oxygen in VAD cases?
No—only comfort measures such as positioning are allowed
What guideline may override normal resuscitation protocols in Mass Casualty Incidents (MCIs)?
CPG F0026 – AV Emergency Management Unit guidance
When can resuscitation be ceased during air transport?
If arrest follows severe injury, reversible causes are excluded, and compressions are impractical
What should be offered to family before stopping resuscitation?
The option to view resuscitation efforts (if safe and appropriate)
What are the key principles of communicating death?
- Speak slowly and clearly
- Use ‘death/dying/died’ rather than euphemisms
- Pause between statements
- Repeat as needed
- Be non-judgemental
- Provide practical next steps
