29. Doctor at the scene of death

Question 1

What is the difference between somatic and cellular death?

Answer 1

Somatic death is clinical death: irreversible loss of circulation, respiration
In cellular death not all cells die at same time

Question 2

What does cellular death of an organ depend on?

Answer 2

Susceptibility to oxygen deprivation

Question 3

What does a diagnosis of a brain stem death allow?

Answer 3

Withdrawal of futile treatment eg. artificial ventilation

Question 4

What things must be present to diagnose brain stem death?

Answer 4

Must be in a coma with a fully established cause
Complete absence of brain stem reflexes
Patient must not be in CV shock and metabolic and endocrine disturbances should be corrected
Must not be hypothermic
Toxicology screen must be done

Question 5

Name the tests that must be completed to diagnose brain stem death

Answer 5

1. Fixed pupils unresponsive to light
2. No corneal reflex
3. No motor response to painful stimuli
4. No gag or cough reflexes
5. Doll’s eye phenomenon
6. No vestibulo-ocular reflex
7. No respiratory movements when the ventilator is removed

Question 6

Describe the process of taking a brain stem dead patient off a ventilator

Answer 6

First give 100% oxygen for 10 minutes
Disconnect for 10 minutes
CO2> 60 mg and a lack of respiratory movements needed to diagnose brain stem death

Question 7

Who can diagnose brain stem death?

Answer 7

2 doctors, both registered for >5 years, one a consultant

Not from the transplant team

Question 8

When should tests for brain stem death be done?

Answer 8

On 2 occasions
6 hours apart in adults
12-48 hours apart in children

Question 9

What change can be seen in the eyes when dead?

Answer 9

Fixed dilated pupils
Clouding of the cornea
Segmentation of the retina: fundi

Question 10

What should the doctor do if their patient dies by a known cause of death?

Answer 10

Issue a certificate of the medical cause of death

Question 11

What additional reasons for a death in the community require the coroner to be called?

Answer 11

GP isn’t available to give a death cert

Patient hasn’t been seen for 28 days before their death

Question 12

Who is the pronouncing physician?

Answer 12

The one that certifies person is legally dead

Question 13

Who is the certifying physician?

Answer 13

Certifies cause of death and issues medical certification of cause of death

Question 14

What are the conditions for issuing a a medical certificate of cause of death?

Answer 14

Must be registered medical practicioner
Attended person during their last illness within the same month
Definite cause of death