Question: This question is a follow-up to clarify between two questions previously asked- specifically, regarding advanced resuscitation in the setting of DNR, and treatment of FBAO in the setting of DNR. In the most recent question the DNR validity form is quoted as stating that chest compressions should not be initiated on patients with a valid DNR, while in the earlier question it was stated that DNR does not preclude treatment for choking. Should we come across this situation, would we then only administer 'Heimlich'-like abdominal thrusts and not proceed to chest compressions when the patient goes unresponsive, or should chest compressions be initiated until the heart has arrested and then discontinued (i.e. not proceeding to true CPR)?
On Jan 19, 2012, Ask MAC said "The duty of all paramedics and front line providers is to assist patients. A valid DNR does not preclude a paramedic from attempting to assist a patient who is choking. However, once a patient has suffered a cardiac arrest -for whatever the reason- and this patient has a valid DNR, then the DNR is to be followed as described". So following CPR guidelines, perform abdominal thrusts while responsive, and chest thrusts when unresponsive to attempt to clear the airway. But once in cardiac arrest, honour the DNR and stop all treatment.