Declaring death - a question...

[Fyre522]

Good afternoon!

I am hoping someone can explain this to me:

Pt., aged 82 years, had been hospitalized for approximately 4 months. Pacemaker implanted in 1983/1984 and had a trach put in 6 weeks prior to death.

In roughly 48 hours before her death, staff was informed that she was just extremely sedated due to IV Morphine being administered. Later examination of her records showed that the Morphine was never given to her, even though it had been ordered. Thus leading me (and a few others) to believe that she had in all actuality slipped into a coma, and was not sedated into such a state.

On the morning of her death, her Attending went into the room, merely shined a light into her eyes looking for ocular response, and then proceeded to pronounce TOD and subsequently turned off her trach vent and walked away.

My question is: How can one effectively declare a patient dead by only shining a light into their eyes and not checking any other functions or performing any additional testing (apnea, etc.) Is it possible that she was still alive but in a severe comatose state when he called TOD? Please explain.

[Fyre522]

6 months... has it been that long already with Jahi McMath? My heart goes out to her family. It's hard to lose someone that you love or care about, but having to face the mortality of your own child is just... something far more devastating than I can even imagine. I would have guessed that the decomposition of her body wouldn't have began because of the life support system giving her respiratory and cardiac care, which theoretically would then provide the circulation needed to keep the organs functioning, albeit not on their own. But on the flip side of things, I'm guessing even on artificial means, the cells in the brain would begin to deteriorate regardless?

And there's not a standard "cut-off" time for using mechanical equipment to halt further use of life support to a Pt. who has already been declared brain dead? Especially in cases of whole brain death (such as in the McMath case)? That surprises me, especially since there are other Pts. who could end up needing the vent and other life support equipment but might not be able to receive the treatment they need b/c it's being used on someone else who has been declared months ago. Wow.

Thank you again for taking the time to help me understand all of this. I do appreciate it.

[mcubed45]

6 months... has it been that long already with Jahi McMath? My heart goes out to her family. It's hard to lose someone that you love or care about, but having to face the mortality of your own child is just... something far more devastating than I can even imagine. I would have guessed that the decomposition of her body wouldn't have began because of the life support system giving her respiratory and cardiac care, which theoretically would then provide the circulation needed to keep the organs functioning, albeit not on their own. But on the flip side of things, I'm guessing even on artificial means, the cells in the brain would begin to deteriorate regardless?

And there's not a standard "cut-off" time for using mechanical equipment to halt further use of life support to a Pt. who has already been declared brain dead? Especially in cases of whole brain death (such as in the McMath case)? That surprises me, especially since there are other Pts. who could end up needing the vent and other life support equipment but might not be able to receive the treatment they need b/c it's being used on someone else who has been declared months ago. Wow.

Thank you again for taking the time to help me understand all of this. I do appreciate it.

One of the tests we sometimes do when assessing for brain death is what's called a cerebral blood flow study. It's a type of imaging that lets us see how much blood is actually flowing into the brain. After brain death, typically all blood flow stops to the the brain. Once blood flow ceases, the remaining brain tissue dies and continues to decompose. The CBF test offers further confirmation that a patient has progressed to brain death. In some circumstances a clinically brain dead patient may still have some residual cerebral circulation, so the test isn't used as diagnostic tool, just as additional data.

In the McMathi case, a CBF study was done and it showed no cerebral blood flow.

In an absolute failure of our legal system, courts ordered the hospital to keep the body alive while this drama played out over national news for several months. And yes this was a huge waste of medical resources that may have prevented a living patient from receiving the care they needed.

[ghillbert, MSN, NP]

I find it difficult to participate in explaining things when posters are clearly deceptive from the first post and conceal important facts.

But one FYI - warfarin does not lower your PT/INR, it elevates them.