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Is the patient dead or alive?

Clearly patients do surprise us from time to time, even when they are dead

Editor's note: Two responders underwent a quality assurance review after an incident in Md. months ago when they declared a living man dead, and left him on an apartment floor without treatment. Editorial Advisor Art Hsieh reminds us of why this is more common than it would seem, and how to make sure you don't make the same mistake.

Updated May 26, 2015

Stories like this appear a couple of times every year.

It bears repeating that the appearance of death can be deceiving. Sure, if the brain is missing or full body rigor mortis has set in, that may be obvious. However, many expired patient do not have the obvious signs.

A patient can breathe as little as four breaths per minute, yet maintain adequate gas exchange to the brainstem, perhaps for some time.

If you think about it, that is one breath every 15 seconds, which from the view point of a snap judgment, is long enough to escape scrutiny.

Keep the following guidelines in mind:

1. Follow protocol.

Many systems require confirmation of systole by EKG in the presence of death determination. Not doing it may be a shortcut that doesn't pay off.

2. Assess the patient.

Really check for the presence of a pulse or breathing. It may take more than five or 10 seconds. Consider that hypothermic tissue becomes very stiff to the touch, and very difficult to palpate through. If the patient is trapped, or even simply presents prone, do what you can to gain access to the patient's airway so it can be assessed adequately.

3. Check for signs of life.

Make certain that the patient has no signs of life. You may have to simply sit and observe the patient for a minute or more. Consider documenting your findings in the presence of the body, keeping an eye open.

Seems like doing a lot for something "obvious", but clearly patients do surprise us from time to time, even when they are dead.

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