of CPR in Children
Overview
Introduction
Learning
Objectives
Ethical principles
Ethical considerations in medical decision making
Do Not Attempt Resuscitation (DNAR) orders
Family presence during resuscitation
Introduction
Goals of CPR
and ALS
To preserve life
To restore health
To relieve suffering
To limit disability
Guiding
Principles
and Considerations
Ethical Principles
Introduction
Definitions of
Ethical
Principles
Definition
Be fair in the distribution of healthcare
therapies among people
Seek to benefit the patient
Respect the self-determination of
persons with capacity for decision
making
Avoid inflicting unnecessary harm
Beneficence
as the
Governing
Principle for
the Pediatric
Patient
Decisions to
Stop or
Withhold CPR
on the Basis
of Futility
Obligation to
Provide Care
Requested by
Patients or
Families
Criteria for
Not Starting
CPR
Terminating
In-Hospital
Resuscitative
Efforts
Terminating
Out-ofHospital
Resuscitative
Efforts
Summary
10
Competent
Patients
11
Authority to
Treat a Minor
Emancipated
Minor
Mature Minor
Marriage
Pregnancy
Economically self-supporting
Parenthood
Active duty military
12
Rules of
Sevens
Legal Capacity
No capacity
Rebuttal presumption of incapacity
Rebuttal presumption of capacity
Medical
Decision
Making and
the Older
Child
13
Withholding
LifeSustaining
Treatment
Handling
Conflict
14
Once the decision has been made that CPR would not be
appropriate for a patient in the event of a respiratory or cardiac
arrest, the attending physician should write a DNAR order in the
patient's chart. The physician should include a note in the chart
explaining the rationale for the DNAR order and any other
15
Scope of a
DNAR Order
Communication to All
Healthcare
Providers
Involved
16
DNAR Orders
in the Out-ofHospital
Setting
Under certain circumstances DNAR orders may apply to out-ofhospital care of terminally ill patients when appropriate
documentation is provided to the local EMS service. Some state
laws, however, prevent out-of-hospital personnel from honoring
a hospital DNAR order for a child. Out-of-hospital DNAR
protocols must be clear to all involved (eg, physicians, patients,
family members, loved ones, and out-of-hospital healthcare
providers).
In-Hospital
Considerations
17
Out-ofHospital
Considerations
18
References
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