Assessing patient to prounce death

[Ms.RN]

how do you assess a patient to prounce death of patient? do you listen to heart rate only? do you listen to carotid, breath sound? how long do you ausculate? when are you really sure that patient have passed? i was listening to heart beat over mitral area and i only heard murmmers but i was afraid patient was going to wake up or take another breath.

[Hospice Nurse LPN, BSN, RN]

hi!

i always listen to heart, carotid, and breath sounds. i'll listen for at least one minute. even after 8 years, i'm still afraid that one day, after pronouncing someone, they are going to start breathing again!

[saribeth]

We have a check list...absence of Pulse, Respirations, B/P, pupils fixed and dilated...even when the pt is cold with the waxy color I still go through the VS and really really listen for that heart...sometimes pts have the agonal rhythm that stops eventually...it is quite a responsibility! all the best!:uhoh21:

[paulla29]

....just want to add, that even though I trust my skills, this is one of those times that I call one of my coworkers to check also. I always have since day 1.

[Sabby_NC]

I have to add that one day after pronouncing a patient of mine. I was sitting with the HHA when there was a noise like a sigh. We honestly thought the pt took another breath (mind you this was an hour after she was pronounced). I still laugh because the HHA nearly vomited then we both slowly turned around and it was the pt's dog!! LOL

I always do Apex HR, check on pupils to be fixed and dilated, I look for blood pooling and obviously cold body if I was not there at the time of death.

Sometimes pt's will do agonal breathing for a while and I usually wait for that to stop, even though vitals are non existent.

I am never second guessing myself but am very sure when I pronounce the person has actually died. We are on our own when we got out to a death.