THERE IS NO EVIDENCE THAT WE DIE ION A FEW MNINUTE; OUR BRAIN CAN HOLD
VERY LONG AND CAN REVIVE; ALL HEART, KIDNIES AND LUNGS CAN FORN LOCAL
SUBCYCLE TO KEEP BODY ALIVE - THAT IS PROBABLY HOW IT IS REPORTED THAT
NAILS GROW VERY FAST, AFTER SUCH PRONAUNCEMENT:

THESE PHENOMENA COULD BE USED BY MEDICAL PROFESSION TO PREVENT DEAD
BUT NO - INTEAD THE PERSON GIVES OUT ORGANS THUS OFFENDERS ARE
MOTIVATED TO PRONOUCE MORE SUCH DEATHS.

              FROM THE SOURCE - CRIMINALS MUST HAVE PRONOUCED ME DFEAD
AT LEAST 30 TIMES
              FALSE; OF WHICH IN THE CLIMICAL AND NOT FINAL DEATH; AND
THEY KEEP  GOING
              EVERY NIGHT STILL BY THE REPUTABLE PENETTA - THERE IS
NOBODY YET
                TO STOP THE VILLAINS



published lecture byCharlotte Heidenreich, MD
David E. Weissman, MD
Submitted to EPERC



Death Pronouncement and Death Notification: What the Resident Needs to
Know
Educational Objectives:
At the conclusion of this module, the resident will have the knowledge
to:
1. Plan for and complete a humane death pronouncement
2. Recognize the need for additional team members to become involved
in the process
(e.g., organ procurement staff, nursing, clergy, etc.)
3. Document a complete death notification
Suggested use:
This module was designed to facilitate a didactic presentation and
discussion among residents
and precepting faculty. Ideally, group size should be 7-10 residents
in order to promote a more
interactive experience.
The lecture notes will assist faculty in leading a conference or small
group discussion on death
pronouncement. The pre-discussion questions can be used as an
opportunity for more detailed
discussion of the content of the module, as the group discusses the
answers. The format
should be open to encourage residents to share their individual
experiences in death
pronouncement.
Please note: different institutions and states may have specific
policies/laws that differ from the
information in this material; please check with your local officials.
G:\EducationalServices\EPERC\Transition\static EPERC\Educational
Materials\Death Pronouncement.doc
Pre-discussion Questions: Death Pronouncement
True or False Questions:
1. In order to pronounce death, a physician should complete the
following examination(s):
a. Listen for the absence of heart sounds
True or False
b. Look and listen for the absence of spontaneous respirations
True or False
c. Perform and document a complete neurological examination
True or False
d. Ascertain that the patient is not responsive to painful maneuvers
such as sternal
pressure or nipple twisting
True or False
2. The physician who pronounces death may only ask the patient’s next
of kin if they are
willing to consent for organ donation if the physician is a designated
requestor for
organ/tissue donation.
True or False
Choose the Single Best Answer:
3. Medical record documentation of the death pronouncement includes
the following
information:
a. Discussion with attending
b. Discussion with family
c. The date and time of death
d. The findings of physician examination
e. All of the above
4. In most states, which one of the following deaths must be reported
to a coroner/medical
examiner:
a. 80 y/o women living at home falls, breaks femur, is hospitalized,
develops a
Pulmonary Embolus three days post-op and dies.
b. A metastatic cancer patient dying from hypercalcemia, hospitalized
for seven
days.
c. A patient with alcoholic cirrhosis who is admitted with massive GI
bleeding and
dies in 48 hours.
d. A dementia patient on tube feeding aspirates, is hospitalized and
dies of
pneumonia after 5 days.
G:\EducationalServices\EPERC\Transition\static EPERC\Educational
Materials\Death Pronouncement.doc
Answers:
1. a. and b. are true.
c. False. It is not necessary to perform and document a complete
neurological
examination to pronounce death.
d. False. Overtly painful maneuvers are never indicated in death
pronouncement.
2. True. Only designated requestors or organ procurement organization
(OPO) staff may
obtain consent for organ donation from next-of-kin.
3. e. All of the above are true regarding documentation of death
pronouncement.
4. a. Of the four scenarios, only the death of a patient that occurs
as a complication of a
recent accident comes under the jurisdiction of the Medical Examiner
in most states
(check with your own state for applicable laws).
G:\EducationalServices\EPERC\Transition\static EPERC\Educational
Materials\Death Pronouncement.doc
Death Pronouncement and Death Notification:
What the Resident Needs to Know
Death pronouncement is more than the actual declaration of death.
Residents usually learn
about death pronouncement by watching a senior resident perform this
responsibility. However,
residents have traditionally had little training in examining patients
to determine death, notifying
families, and in recording proper documentation.
First Steps – The Phone Call: “Please come and pronounce this patient”
1. Find out the circumstances of the death – expected or sudden?
2. Ask if the family is present?
3. Ask the patient’s age and major diagnosis.
4. Other emergencies take precedence over a pronouncement; however, do
not postpone
as the time of death is legally the time at which you pronounce the
patient dead.
When you get to the floor – Preparation Before You Enter the Room
1. Get the details on the circumstances of death from the RN.
2. Find out if the attending physician has been called. In general,
see the patient before
you call the attending, unless there are unusual details surrounding
the death that you
should discuss prior to seeing the patient or family members in the
room.
3. Has the family requested an autopsy?
4. Determine if the death has been reported to your state or regional
Organ Procurement
Organization to determine suitability for donation.
5. Review the chart for important medical (length of admission, case
of death) and family
issues: (who is family?, faith?, is there a clergy contact?) – this
will help you put the
patient’s death into a context of the hospitalization.
In the Room
1. You may want to ask the nurse or a chaplain to accompany you,
particularly if family
members are present; they can give support to both you and the family.
2. Introduce yourself (including your relationship to the patient) to
the family if they are
present.
3. Empathetic statements are appropriate,
a. I’m sorry for your loss…”
b. This must be very difficult for you…”
4. Avoid overpersonalization; examples of statements not to make
include:
a. “I know how hard this is …”
b. “I would also be upset …”
5. Explain what you are there to do. Tell the family they are welcome
to stay, if they wish,
while you examine their loved one.
6. Ask if they have any questions. If you cannot answer questions,
call someone who can,
e.g., the attending.
7. Assess the emotional state of the family; Ask if you can contact
anyone for them, e.g.
other family, clergy; ask if there is anything else you can do.
G:\EducationalServices\EPERC\Transition\static EPERC\Educational
Materials\Death Pronouncement.doc
The Pronouncement – What you need to do
1. Identify the patient by the hospital ID tag
2. Note the general appearance of the body
3. Ascertain that the patient does not rouse to verbal or tactile
stimuli. Avoid overtly painful
stimuli especially if family members are present. Nipple or testicle
twisting, or deep
sternal pressure are absolutely inappropriate.
4. Listen for the absence of carotid pulse.
5. Look and listen for the absence of spontaneous respirations.
6. Record the position of the pupils and the absence of pupillary
light reflex.
7. Record the time at which your assessment was completed—this is the
official time of
death.
Documentation in the Medical Record
1. Called to pronounce (name).
2. Chart findings of physical examination.
3. Note date and time of death.
4. Note if family and attending physician were notified.
5. Document if family declines or accepts autopsy
6. Document if the coroner/medical examiner was notified.
The Coroner’s / Medical Examiner Case—What is a reportable death?
(Note: state/county rules about reportable deaths may vary)
1. If the patient was in the hospital less than 24 hours
2. If the death was unexpected or under unusual circumstances
3. If the death was in any way associated with trauma or a procedure
(e.g. death resulting
from complications of a recent hip fracture).
4. Death occurring during surgery or anesthesia
5. Other—check with your state/county coroners office
Notification by Telephone
1. Notify the attending physician if you have not already done so.
Decide together whether
an autopsy would be appropriate.
2. Notify relatives. Next of kin should be notified as soon as
possible after you have
pronounced the patient dead and notified the attending physician. The
family will want
to hear this news from someone they know.
3. If neither you nor the attending know the patient, spend a few
minutes familiarizing
yourself with the patient’s medical history and circumstances of
death. This news is
always best delivered in person, but when necessary, you may need to
give telephone
news:
a. Identify yourself
b. Ask the person you are speaking to identify themselves, and their
relationship to the
patient
c. Ask to speak to the next of kin
d. Deliver the message: “Mrs. Smith, I am sorry to inform you that
your husband died
at 8:30 this evening.” Avoid euphemisms for death (e.g., passed on,
expired).
e. Offer words of comfort (see above)
f. Ask if they would like to come to the hospital to see the patient.
Inform the nurse in
charge of this decision
g. Refer questions pertaining to funeral arrangements or personal
belongings to
administrative personnel on the floor
G:\EducationalServices\EPERC\Transition\static EPERC\Educational
Materials\Death Pronouncement.doc
Organ Donation – What is Your Role?
1. All hospital deaths must be reported to the hospital’s organ
procurement organization
(OPO) (Federal Law).
2. Only a trained designated requestor can discuss organ/tissue
donations. A designated
requestor or donation coordinator must be contacted for discussions of
organ/tissue
donation; they should be called by the nurse, or other administrative
personnel, caring
for the deceased patient.
3. Your role is to ensure that there is an opportunity to discuss
organ/tissue donation and to
support the family in making decisions