DEATH

Kate Allen FY1

To be covered
DNACPR Confirming death Certifying death
Referral to the coroner

DNACPR
Consider AS EARLY AS POSSIBLE When is DNAR appropriate?
cardiac or respiratory arrest is an expected part of the dying process and CPR will not be successful CPR might be successful, but not clinically appropriate because of the likely clinical outcomes
Benfits, burdens, risks

Patient has capacity and refuses

DNACPR
Discuss with:
patient relative members of the healthcare team

May require assessment of capacity Do not make assumptions about quality of life

DNACPR
Document carefully all discussion surrounding DNAR
If there has been no discussion with the patient document this and the reason

DNARCPR
DNACPR decision applies only to CPR
does not imply that other treatments will be withdrawn or withheld

should not override clinical judgement if the patient experiences arrest from a reversible cause
e.g. induction of anaesthesia during a planned procedure

DNACPR
Emergencies
If there is no time to make a proper assessment, not sufficient evidence that it is against the patients wishes, or would be futile... RESUSCITATE

DNACPR
On the form... Demographics Select from parts A-D Include information about co-morbidities rendering CPR futile Document name of relative discussed with If it is necessary that a junior doctor signs the form, it must be countersigned by registrar or above as soon as possible.

Confirming death
Usually an FY1 job if patient is expected to die / on the LCP Note the time you are first called Check whether relatives are there / want to be Take:

Confirming death
Check identity (wristband) Check for response Check for light response in pupils Feel for central pulse 1 min Listen to chest for heart sounds and breath sounds 3 mins Expose body to look for signs of trauma / haemorrhage / pacemaker

Confirming death
01/08/2013 10.00

FY1 ALLEN

Asked by RN Jackson to confirm death at 09.45 RN Jackson present No response to voice No pupillary response No carotid pulse felt (1 min) No heart sounds (3 mins) No breath sounds (3 mins) No pacmaker in situ Patient confirmed dead at 10.00am on 01/08/2013 RIP ALLEN #6146 GMC: 7271122

KAllen

Certifying death
ALL DEATHS MUST BE DISCUSSED WITH THE TREATING CONSULTANT
Be prepared with the notes Note the time you have the discussion

Do you need to have seen the patient in life? Do you need to have seen the person in death?

The Coroner
ALL deaths within 24 hours of admission cause of death unknown violent / unnatural / suspicious suicide due to an accident self-neglect / neglect by others industrial / occupational disease / poisoning patient detained under MHA during an operation / before recovery from anaesthetic detention in police or prison custody

Cause of death
1a) disease or condition leading directly to death
This cannot be a MODE e.g. cardiac arrest Cannot be unspecified organ failure

1b) intermediate cause of death

That which led to 1a)

1c) underlying cause of death

Which led to 1b)

2) one or more conditions that have contributed but are not part of the main causal sequence

Cause of death
Patient A died following a major intracerebral haemorrhage. She had a known bronchial squamous cell carcinoma, which had metastasized to her brain. She also suffered from diabetes mellitus, suffered from angina, and had had a left sided knee replacement 2 years ago

Cause of death
1a) intracerebral haemorrhage 1b) cerebral metastases 1c) squamous cell carcinoma of the bronchus 2) diabetes mellitus, ischaemic heart disease

Cause of death
Patient B died following a major ischaemic stroke. PHM: HTN, BPH, CKD, AF, DMII, IHD

Cause of death
1a) ischaemic stroke 1b) atrial fibrillation 1c) essential hypertension and ischaemic heart disease 2) diabetes mellitus, chronic kidney disease

Thank you