On Call: Death
Definitions
Definitions
- Cardiac Death: Irreversible Cessation of Cardiac Activity
- Most Common
- Brain Death: Irreversible Cessation of All Brain Functions, Including the Brainstem
Lazarus Phenomenon/Lazarus Syndrome
- Autoresuscitation (Spontaneous Return of Circulation) After Failed CPR/Pronouncement of Death
- Possible Causes:
- Release of Pressure, Previously Built-Up by CPR, Triggers Cardiac Electrical Activity
- Hyperkalemia
- High-Doses of Epinephrine
Pronouncing Death
Pronouncing Cardiac Death
- Observe for At Least 2 Minutes for Signs of Life
- Examination:
- No Response to Tactile Stimuli
- Apnea
- Absent Skin Perfusion
- Absent Heart Sounds
- Absent Pulse
- Relationship to Cardiopulmonary Resuscitation (CPR)
- Pronouncement Should Be Decoupled from Cessation of CPR
- Simultaneous Declaration at the Time of CPR Cessation Can Be Associated with Autoresuscitation & Cause Trauma for Family & Staff
- Patients Should Be Observed for ≥ 10 Minutes After CPR Cessation Before Formal Pronouncement is Made
- Once Pronounced – Record Date & Time of Death
Pronouncing Brain Death
End-of-Life Care
Delivering Bad News
End-of-Life Care