Lecture 4 - What Happens When A Person Dies?

Question 1

What decisions need to be made when emergency service discover an individual?

Answer 1

Determine whether individual is dead or whether medical intervention is appropriate

Is there a DNR order in place

Question 2

When may the police be involved with community deaths?

Answer 2

When death is suspicious, cant be explained, children, Next of Kin (NOK) not contactable, accidents , RTCs

Question 3

What is the legal requirement of GPs ad medical doctors in hospitals if an individual is found deceased and has used services in the last year?

Answer 3

GP must diagnose the mos likely cause of death to the best of their knowledge and belief

Question 4

What are the 8 steps to verify a death?

Answer 4

Identification
General inspection (signs of life? Respiratory effort?)
Verbal stimulus
Painful stimulus
Pupiliary light reflex
Carotid pulse
Heart sounds
Breath sounds

Question 5

How long do you check for signs of life?

Answer 5

5 mins

Question 6

What are the issues when a person dies in community and hospital?

Answer 6

Getting someone there to verify the death (community/hosptial)
Moving the body (community)

Question 7

What is the purpose of death certification?

Answer 7

Identify disease leading to mortality
Statistical information on deaths by underlying cause
Monitor health of the population
Identify areas where public health need to prioritise and evaluate interventions
Medical research and health services

Question 8

What is the role of the Medical Examiner?

Answer 8

Scrutinises medical information in regards to patients deaths

They safeguard public by ensuring independent scrutiny of all non coroner examined deaths

They direct appropriate deaths to the coroner

Question 9

When are deaths referred to the coroner?

Answer 9

Children
Trauma
Violent deaths
Poisonings, Drugs, Alcohol
Industrial Diseases
Unnatural deaths
Dead in hospital 24hrs following admission
Any medical intervention within last 12 months

Question 10

What quality of care improvements does the Medical Examiner provide?

Answer 10

Discuss and answer any questions about the death with the Next Of Kin (NOK)

Improve quality of death certification (agree cause of death and increase accuracy)

Question 11

What is the role of the Coroner?

Answer 11

Investigate the deaths that don’t seem natural, violent, or where cause is unknown

Question 12

What do the coroners investigate?

Answer 12

Who is dead?
Why is this person dead?
When did they die?
How did they die?

Question 13

What can a coroner decide?

Answer 13

No further investigations needed
Request a post-mortem examination (PM)
If the death is determined natural, they release the body and register the death

Question 14

What is an inquest?

Answer 14

Finding/establishing facts following a post mortem

Not to attribute blame or liability just to establish facts

Question 15

What are some examples of inquest verdicts?

Answer 15

Natural causes
Accident
Suicide
Unlawful or lawful killing
Industrial disease
Open (insufficient evidence)
Narrative (story of death)

Question 16

What is a post mortem?

Answer 16

Examination after death

Question 17

What normally happens with a hospital post mortem?

Answer 17

Relatives of deceased consent for PM is gained
Cause of death should already roughly be known

Seek implicit question/test a hypothesis E.g:
Did the antibiotics work effectively?
What was the cause of the haemorrhage?

Question 18

What happens in a coroners post mortem?

Answer 18

Full history and additional information reviewed

Confirm identity and external examination
Non Invasive (CTPM scan) then invasive if necessary

Question 19

How to formulate a cause of death on a Cause of Death form?

Answer 19

Cause of Death should be the top line 1a)
Other disease or condition that caused 1a) should be written in 1b)
Condition that caused 1b) written on 1c)

Question 20

Which line should the disease/condition that directly caused the death be written on in a Cause of Death form?

Answer 20

TOP Line 1a)

Question 21

Where should the condition that is thought to be the underlying cause of death be written of a Cause of Death form?

Answer 21

Last completed line of section 1

This will be the condition that will be have thought to have directly or indirectly be the cause of death