End of Life

Question 1

define the phase of active dying

Answer 1

final hours to days

Question 2

Most common signs of death imminent in hours - from early to late

Answer 2

death rattle -> resp. with mandibular movement -> cyanosis -> weak radial pulse

Question 3

neurological signs of impending death (<3d)

Answer 3

non reactive pupils
cheyne stokes breathing
apneas
decr. LOC

Question 4

neuromusclar signs of impending death (<3d)

Answer 4

grunting of vocal cords
death rattle
mandibular movement with respiration
neck hyperextension

Question 5

how do most people die (which type of arrest)

Answer 5

respiratory (20%)
cardiac (80%)

Question 6

what are the common themes of end of life visions / dreams

Answer 6

readiness to go
comforting presence
unfinished business
loved ones waiting / engaging with deceased

sometimes distressing experiences

Question 7

What bloodwork abnormalities correlate with imminent death (weeks to months)?

Answer 7

CRP - elevated
lymphopenia
leukocytosis
thrombocytopenia

Question 8

causes of terminal secretions

Answer 8

loss of swallow
loss of cough/gag reflex
edema (pulm)
aspiration
infection

Question 9

most common indication for palliative sedation

Answer 9

delirium

Question 10

when must a medical examiner be notified in an event of death

Answer 10

• unknown cause
• accident, violence, poisoning, suicide
• negligence suspected (medical or other)
• not under care of a physician
• death soon after injury/fracture
• 10 days within operative procedure

Question 11

3 signs of impending death (4-7d) in Hui 2015 study

Answer 11

PPS <20
RASS -2
dysphagia to liquids