Confirmation of Death - Simulation

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when a person dies a number of steps

need to be completed to allow legal

registration of the death and for a

funeral to take place the first is the

verification of the death this is

sometimes known as a recognition of life

extinct or pronouncing death or

declaration of death the process of

verification of death is defined as

deciding whether a patient is actually

deceased it does not necessarily require

a medical practitioner to undertake this

verification for example there are

certain nursing staff inserts an

ambulance staff that can also undertake

the verification however it is necessary

for a medical practitioner to undertake

the certification of death the guidance

in this video is taken from the Oxford

Handbook for the foundation program the

first step when declaring death is to

ensure that you have identified that you

have got the correct patient by using

patient identifiers after this you

should check for any reaction to voice

and pain this is done by undertaking a

sternal rub or pressure on the

supraorbital nerve the next step is to

check for pupilary reflexes pupils will

be fixed and often dilated often they

will also have a dry appearance as well

next assess for absence of a central

pulse for one minute this can either be

a carotid or femoral pulse

after assessing absence of a pulse move

on to assess for absence of heart sounds

for one minute through auscultation

this assess for respiratory effort and

sounds by listening to both sides of the

chest for 30 seconds each using your

stethoscope do bear in mind you might

still hear gastrointestinal sounds don't

confuse these four respiratory sounds

it is also helpful to know that there is

a pacemaker present in the patient and

then you need to make a written

documentation of the declaration of

death this should be timed and dated in

the notes and should contain the

following information that there is no

response to pain that the pupils are

fixed and dilated and that there is no

carotid pulse

no audible heart sounds and no audible

breath sounds for 60 seconds each

you should then make a statement that

declares the death has occurred at a

particular time on that particular date

and it's also useful to know whether

there is a pacemaker palpable or not

finally sign the entry with your full

name signature designation and a contact

number or contact bleep the next step of

course is then to decide whether this

patient needs referral to the coroner

and there will be further education on

this subject at another time in your

medical training it's also of course

important to ensure that you speak to

the family and inform other members of

the medical team and nursing team with

the patient's death