Decisions Relating to Resuscitation

To discuss:• The ethical and legal implications of the duty of

care in regard to resuscitation• The implications of ‘Do Not Attempt

Resuscitation’ orders and ‘Advanced Directives’• The involvement of relatives in witnessing

resuscitation attempts and bereavement• The considerations involved in the decision to

stop a resuscitation attempt

Learning outcomes

Case Studies

Case study 1

A colleague states that she does not want to be resuscitated if she ever has a cardiac arrest. The next week she sustains a cardiac arrest in front of you.

• Do you start resuscitation?

Case study 1

A colleague states that she does not want to be resuscitated if she ever has a cardiac arrest. The next week she sustains a cardiac arrest in front of you.

• Do you start resuscitation?

You find out that she was diagnosed last week with cancer and is taking anti-depressants.

• Do you continue resuscitation?

Case study 1

A colleague states that she does not want to be resuscitated if she ever has a cardiac arrest. The next week she sustains a cardiac arrest in front of you.

• Do you start resuscitation?

You find out that she was diagnosed last week with cancer and is taking anti-depressants.

• Do you continue resuscitation?

Her partner arrives and asks you to reverse your decision.

• What do you do?

Case study 2

An 82-year-old woman falls and sustains a fractured neck of femur. She lives in sheltered housing, is prone to forgetfulness, and has been unwell for the last 2 days. A resuscitation decision needs to be made.

• Who should be involved with this decision?

Case study 2

An 82-year-old woman falls and sustains a fractured neck of femur. She lives in sheltered housing, is prone to forgetfulness, and has been unwell for the last 2 days. A resuscitation decision needs to be made.

• Who should be involved with this decision?• What makes a ‘Do Not Attempt Resuscitation’ order

valid?

Case study 3

It is 3 am and 54-year-old Albert Jones is recovering from a routine hernia operation when he collapses, is unsuccessfully resuscitated, and dies.

• How do you contact the relatives who live an hour away?

Case study 3

It is 3 am and 54-year-old Albert Jones is recovering from a routine hernia operation when he collapses, is unsuccessfully resuscitated, and dies.

• How do you contact the relatives who live an hour away?

• How do you receive them as they arrive on the ward?

Case study 3

It is 3 am and 54-year-old Albert Jones is recovering from a routine hernia operation when he collapses, is unsuccessfully resuscitated, and dies.

• How do you contact the relatives who live an hour away?

• How do you receive them as they arrive on the ward?

• Who should discuss the collapse with them and how?

Case study 4

In the Emergency Department, a 42-year-old man is brought in by his wife suffering from a suspected MI. They are in the resuscitation room together when he collapses in VF.

• What do you do with his wife?

Case study 4

In the Emergency Department, a 42-year-old man is brought in by his wife suffering from a suspected MI. They are in the resuscitation room together when he collapses in VF.

• What do you do with his wife?• She wants to stay – what support do you offer

her?

Case study 4

In the Emergency Department, a 42-year-old man is brought in by his wife suffering from a suspected MI. They are in the resuscitation room together when he collapses in VF.

• What do you do with his wife?• She wants to stay – what support do you offer

her?• Should relatives be present during resuscitation?

Case study 5

A 48-year-old man collapses in a public place as you are driving past.

• Would you stop to assist?

Case study 5

A 48-year-old man collapses in a public place as you are driving past.

• Would you stop to assist?• Would you start resuscitation if needed?

Case study 5

A 48-year-old man collapses in a public place as you are driving past.

• Would you stop to assist?• Would you start resuscitation if needed?• What is the legal and professional view in this

situation?

Case study 5

A 48-year-old man collapses in a public place as you are driving past.

• Would you stop to assist?• Would you start resuscitation if needed?• What is the legal and professional view in this

situation?

The Ambulance Service arrive and, on monitoring, he is found to be asystolic and remains in this rhythm.

• When do you decide to stop?

Case study 6

Your elderly next door neighbour has not been seen out today. You find him on the floor, collapsed, not breathing, but with a weak pulse. There are a number of empty drug and brandy bottles around him. Pinned to his chest is a note saying “DO NOT RESUSCITATE”.

• What do you do?

Any questions?

Summary

• It is important to commence resuscitation promptly and effectively

• Know when such measures are contraindicated• Know when resuscitation attempts should cease• Decisions relating to CPR should be made

carefully, recorded fully, and communicated effectively and appropriately

• Decisions relating to CPR should not prevent patients from receiving any other treatment needed

Advanced Life Support Course Slide set

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