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Discussion

Back to life

Hi All,

Im a fairly new palliative nurse. I have a patient who has pretty much passed away, she has stopped breathing, theres no rise and fall of chest, no heartbeat on auscultation, shes gone cold, colour has gone from her body, unresponsive, pupils are fixed and dilated. So youd think shes passed away yeah??

Now youre going to probably think im crazy here but she actually still has a pulse which can be felt on palpitation. Its a very irregular and slow pulse rate, maybe 10 per minute. There have been several nurses who have examined her and have felt she still has a pulse but cannot explain it, no ones ever seen this happen before. Weve kept her on the ward for comfort measures because shes not yet clinically deceased.

Shes been like this for almost 24 hours.

So im wondering if anyone has ever experienced something like this before? Ive tried searching on google but nothing even related to whats going on comes up.

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    • Featured Replies

    Turn off the pacemaker?????

    I really don't know, it is the only thing I can think of!

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    Please tell me a medical provider is aware of this situation....

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    2 hours ago, AnnieNP said:

    Turn off the pacemaker?????

    I really don't know, it is the only thing I can think of!

    This is all I can think of as well. Even if it wasn’t reported to you that she has one, I’d get the magnet and put it on there. Just in case.

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    I think people assume the line between 'life' and 'death' is a lot crisper and cleaner than it actually is.

    I can't say that I've seen the slow idioventricular rhythm phase of the dying process last 24 hours, but I have seen it last through a full 12 hour shift, where every other clinical assessment was consistent with death, except for the occasional idioventricular beat which as audible by apical pulse auscultation.

    Depending on the sequence of the dying process, cardiac contractility may persist for an extended period of time if all other major organs have already shut down and their cells have stopped metabolizing, therefore are not removing oxygen from the blood or adding CO2, this means the heart won't fully stop until it's metabolized enough of the O2 to CO2 in the small amount of blood it's able to move to cause it to fully stop.

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    • Author
    6 hours ago, AnnieNP said:

    Turn off the pacemaker?????

    I really don't know, it is the only thing I can think of!

    She doesnt have a pacemaker...

    6 hours ago, JKL33 said:

    Please tell me a medical provider is aware of this situation....

    They are, theyve advised us to let nature take its course

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    What would be the alternative to letting nature take it's course?

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    10 minutes ago, Undercat said:

    What would be the alternative to letting nature take it's course?

    Come on. ?

    The alternative would be that the physician/provider might have wished to assess the patient him/herself, and may have agreed or disagreed with the assessment. It sounds as though the provider agreed with the assessment and so advised to continue current care, as opposed to what the usual care would be if the provider disagreed and pronounced the patient.

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