Your stop for everything having to do with EMS. KIK: ouremssite
I’m going to start this by saying the answer is going to vary widely based on your location, state laws and your provider’s protocols. That being said, in the state of Texas a DNR becomes binding as soon as a person becomes apneic and pulseless. If you began doing CPR as a modified Heimlich maneuver and the patient died you would then have to honor the DNR, in my opinion. Now I am not saying this is a catch all, the best course of action in my opinion would be to continue CPR and call for medical direction. In all likelihood they would tell you to honor the DNR since they would have to honor it as soon as you arrive at the ER. Some doctors are funny though.
I had a situation where I had a doctor and all the immediate family telling me not to go invasive on a patient that was deteriorating fast from a nursing home. We had him on high flow CPAP but the doctor was adamant that we were not to intubate or provide advanced treatment in the event the patient died. The family was aware of the situation and due to the patient’s medical history they were asking no heroic measures be done. No DNR was available yet. As soon as the patient was placed inside the ambulance he went into cardiac arrest. I contacted the receiving facility and explained our situation. The ER doctor gave us explicit instructions to do CPR only and not go invasive. In our service cardiac arrests are typically brought in with IO, IV, hypothermic therapy, Lucas devices for CPR and Carevents. As soon as we arrived the doctor from the nursing home had contacted the ER and given the advanced directives over the phone.
One more thing, you said patches are attached and no shock was advised. I take it by it that you are using an AED and not a monitor. Now I have no problem with lower levels calling DNR’s and DOS’s due to dependent lividity and rigor mortis. Care should be taken when calling out asystole on an AED, remember a non-shockable rhythm is anything other than ventricular tachycardia and V-fib. PEA and even some bradycardia rhythms that would be hard to feel can be called non-shockable by an AED.
Hope some of this helped, if you have any other questions feel free to ask.
If you have any other questions feel free to ask. I am working on some stuff for ecg recognition for a student that is doing some rotations in my company. I may post links to some youtube videos that I found, they are very simple to understand and you can go over most of the common rhythms easily.
Patient who doesn’t know our laws (via cloud-wing)