From medical student to junior doctor: care of the deceased patient
In the fifth article of our series, Richard Beasley and colleagues explain why the death of a patient should not be considered the point of cessation of care and describe what you should be aware of after your patient dies
By necessity, medical training focuses on caring for living patients, which leaves some junior doctors unsure of what to do when a patient dies. Far from being the end of the job, there is a considerable amount of work to be done when a patient dies and often difficult decisions still need to be made.
The first thing to be done when a patient dies is to confirm death. Although this is one of the easiest diagnoses to make in medicine, the process should not be treated with complacency.1 The absence of a pulse or respiration at a specific point is not always consistent with death. Profound hypotension can result in the loss of a radial pulse, and conditions such a hypothyroidism and hypothermia can slow the pulse rate considerably. Cheyne-Stokes breathing (alternating periods of apnoea and hyper-apnoea) is commonly seen in the preterminal phase (the period shortly before death)