Pronouncing a patient

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shelvpower

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Hi guys I just have a basic level 3 first aid course (South Africa) behind my name and Im just wondering when does one declare someone dead... is it after a certain time of doing CPR on the patient? It probably depends on the situation as well... for example if the person is decapitated etc etc. As a first aider Im trained to do CPR till a Emt arrives and then he can pronounce the patient. Of course it is also dependant on the situation.
 
You said it yourself, continue CPR until higher level of care arrives. Without obvious signs of death, decapitation, rigor, dependant lividity, you can't pronounce death.
Also, CPR alone is not going to bring a patient back from the dead, but it will improve their chance of resuscitation with ALS and rapid transport.
 
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LACoGurneyjockey said:
Also, CPR alone is not going to bring a patient back from the dead, but it will improve their chance of resuscitation with ALS and rapid transport.
Click to expand...

Actually, I think it bears stating that early, quality CPR and early defibrillation are much more predictive of successful resuscitation than ALS.

ALS is assistive / adjunctive to BLS when it comes to cardiac arrest, not the other way around.
 
The protocols I have say if they have injuries that aren't compatable with sustaining life, or have signs of death --rigor mortis, liver mortis, no body temperature, dependent lividity, persistant asystole after ALS involvement... Generally, if the pt is warm, we will start CPR.

Exceptions are noted in cases of extreme hypothermia (probably not a huge MOI in South Africa), but we are not allowed to call a hypothermic patient in the field here. (unless their airways is full of ice) Extreme hypothermic patients can present with a pulse that is so slow and weak, it's undiscerable by oscultating and palpation. They can be rewarmed in a controlled enviornment and brought out of their coma. Especially children. Kids are such superhuman little things.

SIDS cases are always touchy. Some think that attempting resusitation gives the family false hope, some think it helps to give the family closure.
 
my protocol in maine says that 20 minutes without a shockable rhythm we can pronounce. New protocol starting in december also says that if a pt is pulseless and apneic when we arrive on scene, and there is trauma involved, we can declare them without even starting compressions.
 
Our EMTs cannot pronounce. They can withhold resuscitation attempts until ALS gets there for the following:

A. Gross dismemberment of the body.
B. Decapitation.
C. Completely charred body without any detectable signs of life.
D. Obvious mortal wounds/conditions (injuries inconsistent with life – i.e.,
crushing injuries of the head and/or chest)
E. At least one hour of submersion documented by the licensed health care
professional after arrival on the scene.
F. Putrefied, decayed, or frozen bodies and/or lividity with rigor mortis
G. Blunt or penetrating traumatic arrest found pulseless and apneic (without
agonal respirations) without organized electrical activity (must be asystolic or other rhythm with rate less than 40/min). Patients with ventricular fibrillation, ventricular tachycardia or organized rhythms greater than 40/min should have resuscitation initiated. Patients not meeting these criteria should have full resuscitation and prompt transport initiated. Special attention should be taken so mechanism of injury is consistent with condition of the patient.
H. Patient has a valid “Do Not Resuscitate” identification bracelet or order.

Exceptions are those struck by lightening, cold water drowning a with a submersion time less that 1 hour, and hypothermia.

As an ALS provider if none of those are present, we must work the patient for 30minutes before we can call for a pronouncement.
 
I can not pronounce, however I can call our medical direction, or coroner, tell them what we have done, see, smell, observe and they can tell us to cease all efforts and they will send out an examiner or whatever. They can call it over phone if we have certain signs
 
There is "pronounce death", which is a legal action, and "cease care" which is a medical one. We tend to mix them mentally.

Usually the person to declare death has some sort of legal standing such as a medical examiner, doctor, law enforcement officer (sometimes THAT doesn't work out too well). A TECHNICIAN (and everyone except MD's and nurses on the scene are technicians) generally cannot DECLARE death.

Cessation of treatment in the field can be due to exhaustion, obvious death (rotting, decapitated, or similar), lack of vitally necessary supplies, impending danger to rescuer, relief by competent caregivers, delivery to a receiving facility.

Particular states may have their own protocols. (As always...<_< ).

Pragmatically, even just considering CPR: perfect CPR is no more than 30% effective and dwindles fast as you tire; without defibrillation (even AED) every minute is supposed to mean a 10% loss of the likelihood for recovery. Without resuscitation or respiration clinical, death ensues in 3 min, biological death at 5, absolute biological death at 10.
 
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