DNR / DOA

Signs of Obvious Death

• Putrefaction

• Dependent lividity

• Rigor mortis

• Decapitation

The 6 Stages of Death

• Pallor Mortis

• Algor Mortis

• Rigor Mortis

• Livor Mortis

• Putrefaction

• Skeletonization

Pallor Mortis

• “Paleness”

Algor Mortis

• “Coldness”

• Glaister Equation- estimates hours since death using rectal temperature as linear function

• Environment, clothing, wind, relative humidity, etc

Rigor Mortis

• “Stiffness”

Livor Mortis (Dependent Lividity)

• “Bluish color”

Putrefaction

• Decomposition

What to do if someone shows an obvious sign of death?

• Do NOT start CPR• Do NOT disturb the body or scene• Observe and document: -Position of patient -Conditions at the scene -Statements from people on scene -Statements of patient/victim before

death

DNR

• Legal document which details person’s healthcare wishes

• DNR= physician order

• Instructs medical professionals to NOT provide care for a patient in cardiac arrest

Arriving on CPR scene, start CPR if…

• No obvious sign of death

• DNR is not present

• A DNR is present, but the document is unclear or you are unsure of its validity

Procedure for patient in cardiac arrest with DNR

1. Assess patient for absence of breathing and heart rate

2. If on scene without MICU, advise County to have paramedics to continue in for pronouncement

3. Cancel all responding members

Procedure for patient with DNR, but not in cardiac arrest

1. Assess patient.

2. Provide all appropriate treatment.

3. Provide transport to hospital if appropriate.

4. Honor the DNR if cardiac/respiratory arrest occurs during transport.

5. Provide copy of valid DNR to receiving hospital staff.

DNR Bracelet

• Optional instead of paper

• MUST

a. Be affixed to patient’s wrist or ankle

b. Display the patient’s name, physician name, date of DNR

c. Not have been cut or broken at any time

Frequently Asked Questions:

Q: The patient has a living will which states he/she doesn’t want CPR. Is this good enough?

A: NOQ: Does the patient need both the bracelet and

paper?A: NOQ: Can a nurse sign a DNR?A: NOQ: What if the patient has a DNR from another

state? Can we honor that?A: YES