Diagnosing death Flashcards
Termination of resuscitation
- In patients with cardiac-pulmonary arrest, vigorous resuscitation attempts must be undertaken whenever there is a chance of survival.
- It is possible to identify patients in whom there is no chance of survival; and where resuscitation would both futile and distressing.
- NWAS resuscitation procedures specify when not to start resuscitation, when to terminate resuscitation, and what to do after death has been diagnosed, including dealing with a suspicious death.
Condition unequivocally associated with death:
The following conditions are unequivocally associated with death in all patients including children can be diagnosed by a paramedic, EMT 2, AND EMT 1 (Not EMT 1 probationer).
A- decapitation
b- massive cranial and cerebral destruction.
C- Hemicorporectomy (traumatic dissection of the lower half of the body) or similar injuries, which are incompatible with life.
D- incineration - The presence of full-thickness burns with charring of greater than 95% of the body’s surface.
E- Decomposition/ putrefaction - Where tissue damage indicates that the subject has been dead for some hours, days, or longer.
F - Hypostasis = The pooling of blood in congested vessels in the dependent part of the body in the position in which it lies after death.
G- Rigor Mortis - The stiffness occurring after death from the post-mortem breakdown of enzymes in the muscle fibers.
H - confirmed submersion non-icy water > 60 minutes - the only exception to this is when there is evidence that the patient has been submerged in a pocket of air, such as a vehicle, or if the patient is submerged in icy water.
when resuscitation should be attempted and the patient transported.
I- confirmed submersion in icy water >90 minutes. The only exception to this is when there is evidence that the patient has been submerged in a pocket of air, such as in a vehicle when resuscitation should be attempted and the patient transported.
- Despite the unequivocal nature of these presentations it is appropriate in all cases other than decapitation to confirm no pulse is present and to check for breathing before a diagnosis is made.
Termination of resus
- If following the ALS interventions the patient has been persistently and continuously asystole for 30 minutes (JRCALC, 2022)
In order to terminate resuscitation all of the following must be present:
- No signs of respiration
- No palpable pulse
- No pupillary light reflexes
- Sustained Asystole following >30 minutes of ALS.
Exceptions of termination of resus.
- Exceptions to these are:
= Pregnant females
= Hypothermic patients
= Drug overdose/poisoning
= Infants, children, and adolescents (all of the above <18 years of age).
These patients should be transported to the nearest facility with ongoing resuscitation unless the circumstances would make transportation futile. In this case, senior clinical advice must be sought before any decision is taken to terminate the resuscitation attempt.
ROLE: Recognition of life-extinct documentation.
-The respect process creates a summary of personalized recommendations for a person’s clinical care in a future emergency in which they do not have the capacity to make or express choices. Such emergencies may include death or cardiac arrest but are not limited to those events.
RESPECT: Recommended summary plan for emergency care and treatment
RESPECT forms are not legally binding but are recommendations to guide immediate decision-making by health and care professionals who respond to a person in a crisis. However, they should have and be prepared to justify valid reasons for overriding the recommendation on a RESPECT form.
Advanced Decision to refuse treatment (ADTRT)
- Commonly known as a living will
- An advanced decision to refuse treatments lets healthcare professionals know your wishes if you are not able to communicate them.
An advanced decision enables someone 18 and over while still capable to refuse specified medical treatment for a time in the future when they may lack the capacity to consent to or refuse that treatment.
WHAT IS AN ADVANCED DECISION?
A decision you can make now to refuse a specific type of treatment at some time in the future.
- Lets your family, carers, and health care professionals know your wishes about refusing treatment if you are unable to make or communicate those decisions yourself.
- The treatment you’re deciding to refuse must all be named in the advanced decision.
- You may want to refuse treatment in some situations but not others. If this is the case you need to be clear about all the circumstances in which you want to refuse treatment.
- Deciding to refuse treatment is not the same as asking someone to end your life or help end your life. Euthanasia and assisted suicide are legal in England.
An advanced decscion is legally binding as long as it has:
- complied with the mental capacity act (2005)
- is valid
- applies to the situation
- If your advanced is binding it takes precedence over decisions made in your best interests by other people.
- You are age 18 or over and had the capacity to make understand and communicate- your decision when you made it.
- You specifiy clearly which treatment you wish to refuse.
- You explain the circumstances in which treatments you wish to refuse.
- Its signed by you (and by a witness if you want to refuse life-sustaining treatment).
- You have made the advanced decision of your own accord without any harassment by anyone else.
- You have not said or done anything that would contradict the advanced decision since you made it (for example: saying that you have changed your mind).
Advanced statement
- An advanced statement is a written statement that sets down your preferences, wishes, beliefs, and values regarding your future care.
- Can cover any aspect of your future health or social care needs including:
- How do you want any religious or spiritual beliefs to be reflected in your care?
- Where you would like to be cared for - for example at a home or in a hospital, nursing home, or hospice.
- How you would like to do things: for Example do you prefer to shower instead of a bath?
DNACPR - DO NOT ATTEMPT CPR
-Policies and documents recording decisions about CPR have been established within many areas of the UK. The purpose of DNACPR decisions is to provide immediate guidance to those present. (Usually healthcare professionals) on the best action to take (or not take) should the person supper a cardiac arrest or die suddenly.
- It is important that all are acceptable methods for recording and communicating resuscitation decisions providing the following criteria:
- The DNACPR must be specific to the patient and their clinical circumstances.
- Must be signed and dated by a senior clinician (normally GP or consultant)
- If a review date is specified then it must be within the review period (DNACPRS are often not for review and may state ‘indefinite’).
-Letters must be on formal-headed and typed paper. - there must be clear instructions on what care is not to be provided.
-MUST BE AN ORIGINAL COPY, AND CAN NOT BE PHOTOCOPIED.
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Document summary
document type - Preferred priorities for care.
- A general record of the individual’s wishes and preferences in relation to their end-of-life care.
Are the preferred priorities for care legally binding? NO
Document summary
Document type -RESPECT
-Agreed realistic clinical recommendations that a record including a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stops.
-Is the RESPECT document Legally binding? NO
Document summary
Document type - Advanced decisions to refuse treatment.
- Allows an individual to identify any treatments that they do and do not want to receive in the future. The treatments the individual has decided to refuse must all be named in the advanced decision. The individual may want to refuse treatment in some situations but not others. This must be clearly stated in the document.
-Are Advanced decisions to refuse treatment legally binding? NO
Document summary
Document Type - DNACPR
- A tool to communicate to the healthcare professionals involved in care of the individual that CPR should not be attempted.
Are DNACPR Legally Binding? NO
Document summary
Document Type- Allow natural death
- Allowing natural death is meant to allow the dying process to occur as naturally as possible with only one comfort measure being provided.
-Are AND’s legally binding? NO
