9. Cardiac or Respiratory Arrest/Death - OBDE

Question 1

OBVIOUS DEATH (B-1, D-2)

Answer 1

Local Medical Control must define and authorize any of the patient conditions below before this determinant can be used:
a: Cold and stiff in a warm environment
b: Decapitation
c: Decomposition
d: Incineration
e: NON-RECENT death
f: Severe injuries obviously incompatible with life

Question 2

EXPECTED DEATH (O-1, D-2)

Answer 2

x: Terminal Illness
y: DNR (do not resuscitate) Order

Question 3

Cardiac Arrest Pathway

Answer 3

Local Medical Control must authorize one of the following compression pathways for the treatment of adult cardiac arrest of suspected cardiac origin (non-respiratory etiology):
* C 1st: 600 initial compressions followed by 2 breaths/100 compressions sequence
* C only: Continuous compressions until responder arrival

Question 4

DNR (Do Not Resuscitate) Order

Answer 4

Physician’s order directing medical personnel to not attempt to revive a patient using CPR or other extraordinary means

Question 5

INEFFECTIVE BREATHING

Answer 5

Barely breathing, can’t breath, fighting for air, not breathing, turning purple, turning blue

Question 6

AGONAL BREATHING

Answer 6

Gasping for air, just a little, making funny noises

Question 7

Rule 1

Answer 7

If the caller believes the DNR should be ignored or is uncertain if the DNR is valid or in place, an appropriate response and resuscitation attempt should be made

Question 8

Rule 2

Answer 8

Healthy child (or young adult) found in cardiac arrest is considered to have foreign body airway obstruction until proven otherwise.

Question 9

Rule 3

Answer 9

Unconscious person whose breathing cannot be verified by a 2nd party caller (with the patient) considered to be in cardiac arrest until proven otherwise

Question 10

Rule 4

Answer 10

When complaint description is seizure, go to Protocol 12 regardless of consciousness and breathing status

Question 11

Rule 5

Answer 11

M-T-M-only instructions may be provided for patients with INEFFECTIVE BREATHING when a health care provider insists that the patient has a pulse or if the patient has an implanted Left Ventricular Assist Device (LVAD) or other circulatory support device

Question 12

Axiom 1

Answer 12

“Funny noises” reported by caller generally means the patient is unconscious with an uncontrolled airway and often represents AGONAL (dying) respirations at the beginning of a cardiac arrest

Question 13

Axiom 2

Answer 13

AGONAL respirations can be confused with “still breathing” before they fade away during an arrest

Question 14

Axiom 3

Answer 14

Automated external defibrillators might also be called “shock boxes”. Other local names may be used.

Question 15

Axiom 4

Answer 15

Left Ventricular Assist Devices (LVADs) are most common type of several circulatory support devices designed to increase cardiac output in heart failure patients. Chest compressions are contraindicated with most but not all of these machines due to the risk of catheter displacement and subsequent hemorrhage. Additionally, the device may be functioning without producing a pulse. Most of these devices have backup systems that caregivers have been trained to use if the primary machine fails.

Question 16

Axiom 5

Answer 16

Patients awaiting a more permanent therapy for certain cardiac arrhythmias may wear an external defibrillator fitted into a vest. This device produces a loud, audible warning prior to defibrillation. CPR is appropriate when advised by the machine or when no warning is audible.

Question 17

Brock’s Law

Answer 17

The presence of AED does not ensure its use-the EMD does