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Flashcards in Physiology-Death Deck (17)
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What trajectories of death are shown below?

Black = cancer, Red = organ failure, Blue = physical/cognitive frailty. Green = sudden death


Early dying changes (1-3 months prior)

Attention span decreases, fatigue, muscle weakness, decreased appetite (a result of fatigue, dyspnea, surgeries, medications), social/emotional withdraw


How does artificial hydration affect the dying process?

Dehydration is not painful, artificial hydration prolongs the dying process


Mid stage (1-2 weeks prior) changes before death

Cognition declines (hallucinations, confusion), sleeping 20-24 hrs, minimal appetite (ice chips), social impairment (speaking stops)


Causes of near death experiences

Patient feels like they’re dying in their cortex -> Dreaming of who they may see when they die -> Reticular Activating System impaired by medications -> Wakeful dreams


Active stage (72 hours prior) of death

Cognition is minimal, sleep is constant, no muscle control, no nutrient intake (IV not effective) and obtunded


Neurologic homeostatic deficits in the last 72 hours of life

Obtunded or minimally responsive (higher brain function ceases), body temperature fluctuates (hypothalamic axis not functioning properly), Cheyne-stokes breathing, loss of muscle control (ileus, loss of swallow reflex causing tracheal congestion, “death rattle")


How do you treat the death rattle?

Stop fluids, elevate the head of the bed, put them on their side, give Lasix/Levsin drops/sublingual atropine…this is only to appease the family.


Circulatory changes in the last 72 hours of life

BP decreases, HR increases, extremities get cyanotic and blood shunts centrally. Note that the radial pulse is one of the last ones to go (24-48 hours prior).



Blue-purple blotchy hue on knees, lips and nail beds and blood shunts centrally.


Respiratory changes in the last 72 hours of life

Abdominal breathing, short/shallow breathing, accessory neck muscles and stacked breathing (Cheyne-Stokes). Note that the Cheyne-Stokes breathing looks like gasping, but its just breaths on top of each other and they’re not gasping (agonal breathing).


5 things families should say to their dying relatives

Please forgive me, I forgive you, thank you, I love you and goodbye.


Changes that occur with active dying (hours to weeks)

Patients can live for weeks w/o food/fluids


Final stages of death in dialysis patients? Stroke patients?

They get hyperkalemic and they die suddenly. Stroke patients first become obtunded, and then organs shut down 2 weeks later. Explain to the patient that there are 2 deaths, loss of person and actual death.


2 pathways to dying

M6G and M3G metabolites from morphine do not get excreted and have significant side effects to complicate dying


How does dying in kids differ from that in adults?

They spend longer amounts of time in each stage of death


What happens when physiologic death occurs?

No respirations/heart beat. Loss of sphincter control. No response to verbal commands or painful stimuli. Eyelids slightly open, pupils fixed. Jaw relaxed and mouth slightly open. Skin turns waxen pallor as blood settles.