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Pronouncing Death - Not Just a Medical Event A. REED THOMPSON, MD Associate Professor

Pronouncing Death - Not Just a Medical Event A. REED THOMPSON, MD Associate Professor Donald W. Reynolds Department of Geriatrics University of Arkansas for Medical Sciences. Legal Definition of Death. Complete cessation of breathing and heartbeat Whole brain death. Pronouncing Death.

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Pronouncing Death - Not Just a Medical Event A. REED THOMPSON, MD Associate Professor

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  1. Pronouncing Death - Not Just a Medical Event A. REED THOMPSON, MD Associate Professor Donald W. Reynolds Department of Geriatrics University of Arkansas for Medical Sciences

  2. Legal Definition of Death • Complete cessation of breathing and heartbeat • Whole brain death

  3. Pronouncing Death • One of the important rituals in our culture • A task traditionally relegated to the least experienced housestaff physician • Not felt to be important by physicians • Can be very important for a family

  4. Components of Pronouncing Death • Medical • Humanitarian • Clerical • Legal

  5. Medical ComponentReceiving the Call • There is usually no reason to rush to the bedside • The longer a patient is dead the easier it is to be certain of the death

  6. Medical ComponentPrepare Yourself • Familiarize yourself with the medical facts in the case • Check current medications (opioids, barbiturates) • Discuss the situation with the nursing staff before entering the room - Was the death anticipated? - Who is present? • Prepare yourself internally

  7. Medical ComponentIn the Room • Introduce yourself as you enter the room with a nurse • Examine the patient • Remember this is an important medical ritual

  8. Medical ComponentAt the Bedside • Identify the patient by hospital I.D. tag • Check pupillary light reflex • Check carotid pulse • Listen for heart sounds (1-3 minutes) • Check fundi for “rail-roading” • Say something, such as, “Mr./Mrs.___is dead”.

  9. Humanitarian Component • Console the family with an empathetic statement - “I’m sorry for your loss” - “I know this is very hard for you” • Observe silence in the presence of the bereaved • Touching the bereaved may be appropriate • Ask if there are any questions

  10. Clerical Component • Document the time of death in the chart • Chart physical findings (absence of pulse, heartbeat, etc.) • Document that the attending physician was notified (or not) • Notify ARORA • Document if an autopsy was discussed (or not)

  11. Document if the coroner was notified • Dictate a death summary for the medical record • Notify morgue and mortuary personnel of contagious conditions • Complete the death certificate in a timely manner

  12. Legal component • Arkansas Code Ann. 12-12-315 requires any person with knowledge of a death that appears to be caused by violence, drugs, poisons, MVA, or criminal abortion to notify the coroner. • Arkansas Code 12-12-315 requires all hospital deaths within 24 hours of admission be reported to the coroner

  13. Arkansas law (Act 499 of 1999) requires that all deaths in nursing home residents transferred to a hospital, who die within 5 days of the hospital admission, be referred to the coroner for investigation • Arkansas law (Act 499 of 1999) requires all nursing home deaths be reported to the coroner

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