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Advance Directives in Pre-Hospital Resuscitation

Three Part Question

For [patients in cardiac arrest without written Advance Directives] do [verbal Do Not Resuscitate instructions compared to no instructions] affect whether [pre-hospital providers resuscitate]?

Clinical Scenario

You receive an emergency call to a 75 year old male in a nursing home who is terminally ill. On examination you find the patient is peri-arrest with an irregular pulse and hypotensive at 57/35 and the nursing home staff state that the patient has a DNAR order but they are unable to produce the relevant documentation. You commence oxygen therapy, gain iv access and start fluid resuscitation before rapidly transporting to hospital. Afterwards you wonder what you would have done had the patient gone into cardiac arrest in the absence of a written Advance Directive.

Search Strategy

OVID interface on the world wide web. 1966 – July 2000

The details of the search are as follows:

[exp pre-hospital OR prehospital] AND [exp resuscitation OR resuscitated] LIMIT to human and english language