To withhold resuscitation in lividity or rigor, which combination of findings must be present?

• A. Absent respirations for at least 30 seconds, absent carotid pulse for at least 30 seconds, absent lung sounds bilaterally for at least 30 seconds
• B. Absent respirations for at least 30 seconds, absent carotid pulse for at least 30 seconds, absent lung sounds bilaterally for at least 30 seconds, and non-reactive pupils
• C. Absent respirations for 15 seconds, absent carotid pulse for 30 seconds, absent lung sounds bilaterally for 30 seconds, and reactive pupils
• D. Absent respirations for at least 60 seconds, absent carotid pulse for at least 60 seconds, absent lung sounds bilaterally for 60 seconds, and non-reactive pupils

Answer: (B)

When deciding to withhold resuscitation, you confirm death by showing multiple definite signs that life is not present and cannot be reversed. The most reliable combination includes absence of breathing, an absent central pulse, no breath sounds, and a lack of pupil reaction to light. These together strongly indicate that the patient is dead and resuscitation would be inappropriate. The time frames used are typically at least about 30 seconds to be sure the signs aren’t transient.

So, the best match is no respirations for at least 30 seconds, no carotid pulse for at least 30 seconds, no lung sounds bilaterally for at least 30 seconds, and non-reactive pupils. The other options either omit a sign that must be present (like non-reactive pupils), use a shorter or longer observation period, or include a sign that would argue against death (such as reactive pupils).