I would ask the nurse for a brief history of the background to the death - find out who discovered him/witnessed it
I am checking that full attempts at reversal of any contributing factors have been made
I would also confirm that the patient was not for resuscitation
I would also like to read the patient's medical notes and drug chart and recent diagnosis and past medical history
At the patient's side...
Draw the curtain around the model to ensure privacy
I am confirming the patient's identity by checking the wristband with the name and hospital number
I am exposing the patient adequately, and inspecting
I am looking to see if there is any increased muscle tone (rigor mortis)
I am commenting on the absence of respiratory movements
I am looking at the colour and lack of physical movement
Response...
I am seeing whether the patient is responsive to pain eg trapezius squeeze, sternal rub, pressure on orbits
Eyes...
I am inspecting the eyes with a pen torch to see if the pupils are fixed and dilated
Checking for a light response, direct and consensual reflex and noting their absence
I am inspecting the fundi with an ophthalmoscope to see if there is segmentation of the retinal blood columns (only present in 30%), also looking for tracking/rail roading of the retinal veins
Pulses...
I am palpaing the major pulses - confirm that no pulses can be palpated - check on both sides for a minute
I am palpating the carotid pulse on either side
I am palpating both femoral pulses on either side
Precordium...
Look for pacemaker scar
I am auscultating the praecordium for heart sounds for 1 minute, and commenting on their absence.
I am auscultating the chest for any breath sounds for 3 minutes, and commenting on their absence.
Finishing Off...
I am washing my hands
I am documenting in the notes my findings, and the date and time of death
e.g.
Pupils fixed and dilated
No spont resp effort
No response to deep stimuli
Absent heart and breath sounds for 3mins
Time of death: 0000
Date of death 12/12/12
NOTE pt has pacemaker - therefore cannot cremate
Plan
a) fill out death certificate/contact coroner
b) contact family
c) arrange for patient to be moved to morgue
d) contact GP
Signature and date
Printing it with designation and bleep number
I am asking the nurses to contact the deceased's next of kin
NB!!
Conditions that can mimic death
- hypothermia
- hypoglycaemia
- alcohol/drug overdose
- adrenaline use at cardiac arrest can cause dilated pupils
- rigor mortis does not appear until 3hrs after death
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