1. DNR / DOA

2. Signs of Obvious Death Putrefaction Dependent lividity Rigor mortis
Decapitation

3. The 6 Stages of Death Pallor Mortis Algor Mortis Rigor Mortis
Livor Mortis
Putrefaction
Skeletonization

4. Pallor Mortis
“Paleness”

5. Algor Mortis “Coldness”
Glaister Equation- estimates hours since death using rectal temperature as linear function
Environment, clothing, wind, relative humidity, etc

6. Rigor Mortis
“Stiffness”

7. Livor Mortis (Dependent Lividity)
“Bluish color”

8. Putrefaction
Decomposition

9. 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

10. 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

11. 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

12. Procedure for patient in cardiac arrest with DNR
Assess patient for absence of breathing and heart rate
If on scene without MICU, advise County to have paramedics to continue in for pronouncement
Cancel all responding members

13. Procedure for patient with DNR, but not in cardiac arrest
Assess patient.
Provide all appropriate treatment.
Provide transport to hospital if appropriate.
Honor the DNR if cardiac/respiratory arrest occurs during transport.
Provide copy of valid DNR to receiving hospital staff.

14. DNR Bracelet Optional instead of paper MUST
Be affixed to patient’s wrist or ankle
Display the patient’s name, physician name, date of DNR
Not have been cut or broken at any time

15. Frequently Asked Questions:
Q: The patient has a living will which states he/she doesn’t want CPR. Is this good enough?
A: NO
Q: Does the patient need both the bracelet and paper?
Q: Can a nurse sign a DNR?
Q: What if the patient has a DNR from another state? Can we honor that?
A: YES