Verification of Death - Dr. James Gill

Jul 9, 2024

Verification of Death

Introduction

  • Lecturer: Dr. James Gill
  • Topic: Verification of death (clinical skill/OSCE station)
  • Note: Sensitive content regarding death. Skip if recently affected by a family member's death.

Legal Context (UK Law)

  • Verification of Death:
    • Not required to be performed by a doctor
    • Can be done by paramedics, certain nurses, and allied healthcare professionals
  • Doctor's Responsibilities:
    • Not required to view the body after death or report the death has occurred
    • Doctor's role: Provide death certificate (usually the doctor involved in the patient's recent care)
    • Report to coroner if the cause of death needs investigating

Criteria for Verification of Death

  • Four key features confirming death:
    1. Apneic (no longer breathing)
    2. Unconscious (unresponsive)
    3. Absence of circulation
    4. Irreversibility of the above

Communication and Sensitivity

  • Importance of Communication Skills:
    • Family members might be present
    • Explain your role and offer them to stay or leave
    • Show respect and talk to the patient even if deceased (especially in front of family)

Examination Process

  1. Confirm Identity:
    • Verify with ward staff and ID bracelet (name, date of birth, hospital ID)
  2. Check Responsiveness:
    • Call out to patient
    • No response to voice
  3. Pupil Response:
    • Use pen torch; pupils should be fixed and dilated
  4. Negative Stimuli Test:
    • Apply supraorbital pressure (no response to pain)
  5. Check Pulse:
    • Use large bore artery (carotid or femoral)
    • Check both sides for one minute
  6. Check Heart and Breath Sounds:
    • Use stethoscope; listen for absence of heart and breath sounds (30 seconds on each lung)
  7. Pacemaker Check:
    • Look for pacemaker over clavicle and chest

Documentation

  • Record:
    • Name and date of birth
    • Time and date of death
    • Verifier's details for contact

Key Points Recap

  • Confirmed features: apnea, unconsciousness, fixed and dilated pupils, absence of pulse
  • Verification of death is irreversible and includes thorough documentation

Additional Notes

  • Special Settings: In ITU, brain stem death confirmation requires additional skills (beyond this lecture)
  • If questions arise, contact the medical school for further guidance. Share the lecture if found useful.