The Doctor Will See You Now [Non-Fiction]

Chapter 23: General

Confirmation of death.

Usually, we get a call when a patient has died (expected death). Usually, we don't get there to confirm death for another hour or more because the other, living patients get prioritised, although without death confirmed, the body cannot be moved to the morgue and the room can't be cleaned and readied for the next patient. (On two occasions I have heard of bed pressures being so severe that the body had already been moved to the morgue before verification... but that is a reportable practice and not allowed.)

Usually, we don't rush there anyway, because if the patient is actually almost -- but not quite -- dead, we can't verify the death and there is nothing we can do to prevent the outcome so we'll have to return later. This also gives the family some alone time with the patient until they're ready to leave the hospital.

When we verify death, the process is as follows (in the UK, this can be done by any doctor and certain nurses):

1) Expected death? DNACPR in place?

2) Patient responsive to vocal/painful stimuli? (Squeeze trapezius muscle or sternal rub or periorbital pressure)

3) Any efforts to breathe? (Place face near patient's mouth, facing down their body. Can you feel breaths on your cheek? Is their chest moving or attempting to move up and down?) Check for at least 1 minute.

4) Any breath sounds? Any heart sounds? (Place the end of stethoscope on the chest and leave it there; place the earpieces in your ears. Don't put your hand on the auscultating end because thumb pulses can be transmitted and mistaken for a beating heart) Check for at least 1 minute.

5) Any palpable carotid pulse? Check for at least 1 minute.

6) Pupils fixed and dilated? (Check with flashlight)

7) Palpable pacemaker? (Important for documenting before transfer to the morgue because if the patient gets cremated, the pacemaker explodes...)

Document the above, including time/date of death (the nurses can usually tell us that -- NOT the time/date verified. This is important because on night shifts it can mean the patient 'died' a day later than they actually did) and once death is confirmed, the patient can be moved to the morgue.