Death & Dying

Week 11

What is a chronic illness?

Conditions which last 1 year or more and require ongoing medical attention or limit activities of daily living or both (diabetes, COPD)

What is a terminal illness?

Disease which can’t be cured or adequately treated, which is expected to end in the death of the patient (Cancer, dementia)

What is palliative care? | 3

• Care provided to patient living with incurable illness to provide comfort and improve quality of life

• Not dependent on time left to live (pts receive care months to years before death)

• Patient may still be receiving treatment and wishes to be resuscitated 

What is end of life care?

• Final phase of life when patient has only hours, days or weeks to live

• Non-essential medications stopped/reduced, focus is on comfort no active treatment

• May occur in home, hospice, or LTC

• Patients should have paperwork to prevent resuscitation

When should you announce time of death

3 minutes after vsa

What should you do in a expected death in the home?

Write all info on separate paper and leave it with physician to complete on legal paperwork

What happens as a patient approaches natural death? | 5

• Activity level decreases significantly

• Interest in surroundings fade

• Desire for food and drink ceases

• Bowel and bladder changes

• Body temperature decreases

• Vital signs change (become irregular)

• Pain and skin breakdown

• Consciousness fades

• Sensory changes (illusions)

• Near death awareness (see dead loved ones, god, etc)

What does natural death include? | 3

• Terminal secretions (death rattle)

• Cheyne stokes breathing

• Agonal gasps

What is terminal secretions (death rattle)? | 2

• Can be retained in mouth if patient is unable to swallow causing gurgling

• Doesn’t indicate pain or suffering

What is Cheyne Stokes breathing? | 3

• Irregular breathing pattern with rapid breathing followed by pauses

• Pauses gradually lengthen

• Can spend minutes or hours in this phase

What are agonal gasps?

Similar to cheyne stokes breathing but without a pattern

What patients meet the deceased patient standard? | 5

• Obviously dead

• Medical certificate of death presented to crew appears to be completed and signed

• VSA and valid DNR

• VSA and received TOR from BHP

• VSA and received withhold resuscitation order from BHP

What do you do if you receive TOR on the way to hospital?

Advise CACC/ACS to contact coroner and continue to destination

What do you do in the case of an expected death? | 4

Contact the responsible person, palliative team member, police or coroner can find someone to take responsibility of deceased patient

What do you do if patient has DNR and dies unexpectedly?

Wait for police to facilitate next steps or the coroner

What is a sudden (medical) cardiac arrest? | 3

• Occurs quickly, drops to the floor

• Cardiac related, may have agonal gasping

• May be CPR-induced consociou-nos (mentate) not common

What is a trauma cardiac arrest | 3

• Result of blood loss, sharp or blunt

• Cardiac arrest from blunt trauma is not usually survivable and pt is eligible for TOR

• Sharp force trauma must be transported

What can hypoxia cause? | 2

Combativeness and air hunger

What are the indications for medical TOR? | 4

• >16yrs

• LOA is altered

• HR, RR, SBP is n/a

• Arrest not seen by paramedic, no ROSC after 20mins, no shock delivered

What are the contraindications for medical TOR? | 5

• Reversible cause of arrest unable to be addressed

• Pregnancy assumed >20 weeks gestation

• Suspected hypothermia

• Airway obstruction

• Non-opioid drug overdose

What are the indications for trauma TOR? | 4

• >16yrs

• LOA is altered

• HR, RR, SBP is 0

• No pulse, no shock delivered, asystole, been vsa since fully extricated OR no signs of life when fully extricated with closest ED > 30mins OR pea with closest ED > 30mins

What are the contraindications for trauma TOR? | 5

• <16 yrs

• Shock delivered

• Signs of life at any time since fully extricated

• PEA and closest ED <30mins

• Patient with penetrating trauma to torso/head/neck and lead trauma hospital <30mins

What should you do before getting a TOR? | 4

• Talk to crew about resuscitation efforts and next steps

• Go into another room to get TOR

• Can talk to family before or after TOR is given

• Ask family if they want to see patient always explain situation and what they will look like

What to do after you get the TOR | 5

• Write name of BHP and time of death (police wants this and your name and DOB)

• Advise crew to stop resuscitation (unplug monitor and don’t check pulse)

• Leave IVs and airway management in 

• Cover body in ambulance blankets

• Put clothes back together and tidy up

Dependent lividity is also known as | 3

Dependent/postmortem lividity, hypostasis and postmortem staining

How to give death notifications

Be clear and direct: dead or has died

What is the survivors grieving process | 5

Shock and denial, anger, bargaining, depression/pain/guilt, acceptance