Which of the following is not a sign that a patient's heartbeat and breathing may have stopped?

The sign that the skin is hot does not indicate that a patient's heartbeat and breathing have stopped. In a situation where a patient’s vital signs are absent, symptoms usually align with physiological changes reflecting the cessation of circulation and respiration. The lack of chest expansion typically signifies that there is no effective breathing taking place, while enlarged pupils can indicate a severe lack of oxygen or the effects of life-threatening conditions, commonly seen in scenarios where heart and respiratory failure occurs. Unconsciousness can accompany such critical conditions as well, making it a valid indicator. However, hot skin could suggest a variety of issues, ranging from fever to external heat exposure, and does not specifically correlate to a stoppage of cardiac and respiratory functions.