Page 249 - 2023 SMOG Digital

WITHHOLD RESUSCITATION

Signs and Symptoms: Differential Diagnosis:
• Unresponsive • Medical vs. Traumatic Arrest
• Apneic • Dysrhythmia
• Pulseless

Evaluate for Criteria for
Death/No Resuscitation
YES NO

Withhold Resuscitation Attach Monitor/Defibrillator
Begin BLS/CPR

Criteria for Death/No Resuscitation: Assess Rhythm
• Presence of decay/lividity/rigor mortis
• Decapitation
• Incineration TRAUMA ARREST
• Massively deforming head/chest trauma
Appropriate ACLS guideline

CARDIAC ARREST BRADYCARDIA with PULSE TACHCARDIA with PULSE

Pearls:
• As with all ALS protocols – concentrate on adequate compressions.
• Minimize interruptions in compressions, including if/when placing advanced airway.
• Early defibrillation associated with greatest success in early cardiac arrest.
• Survival rate for traumatic arrest approaches zero.
• Cardiac arrest in MASCAL situations requires frequent re-triage to apply care where it will be
most effective.
• Lack of response alone does not equal death–always check for pulse/cardiac activity.
o If available, cardiac US can be helpful in determining if continued efforts will be helpful. If
there are no signs of cardiac movement on US and there is no other known reversible
cause, the likelihood of ROSC and recovery with continued resuscitative efforts in the out-
of-hospital setting is incredibly unlikely.

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