Certification of Death

Certification of Death

·        Confirm identity of patient

·        Signs of death:

o   No circulation: no carotid pulse or heart sounds over 1 – 3 minutes

o   Absent respiration: no movement or fogging of a mirror

o   Unreactive pupils

o  „Railroading' of retinal blood vessels – rows of RBCs settling out

o  Absence of pattern on EEC or ECG

·        Signs of brain death (ie on respirator)

o  Fixed dilated pupils

o  No corneal reflex

o  No tracheal reflex (ie tug on ET tube)

o  No eye movements on putting cold water in ear

o  No Cranial nerve response to pain (eg supra-orbital pressure)

o  No respiratory response to hypercapnea

·        Problems when deeply unconscious: near drowning, hypothermia, epilepsy, drugs (eg barbiturate poisoning)

·        Suspicious injuries on a dead person: bruise, abrasion, laceration, incised wounds (suicide look for tentative cuts, assault look for defence injuries), stab wounds (go deeper than the length of the blade, always check), pattern wounds

·        Person certifying death should have no conflict of interest

·        Death Certificate:

o  If you‟ve attended a patient must issue a certificate or report to the coroner, if you are „available‟

o  Are now able to sign for eg GP partner if you‟ve reviewed notes and seen body 

o  Different form for infants over 20 weeks gestation or > 400 gm and < 28 days old. Can be filled in by midwife

·        Other forms:

o  Need an additional form before cremation, which is then cleared by the Medical Referee 

o  Certificate of Life Extinct: police form to say the person is dead – eg if being referred to the Coroner. Does not include cause of death. Always take your own careful notes

·        Changes following death:

o  Rigidity – „rigor mortis‟.  Linking of actin and myacin fibres following ATP depletion.  Lasts from

o   6 – 8 hours after death to about 36 hours.

o  Lividity – bloods seeps downwards – red congestion on downside of body 

o  Temperature – indicator of time elapsed since death. Depends on temperature at death, BMI, clothing, etc

o  Decomposition

o  Rough guide to time of death:

§  Warm    Flaccid      < 3 hours

·       Warm    Stiff   3       –       8 hours

·       Cold      Stiff   8       –       36 hours

·       Cold      Flaccid      > 36 hours

·        Homicide:

o  = Killing another, either directly or indirectly, or by accelerating death

o  Murder = intent to kill or cause serious injury or to facilitate another crime

o  Infanticide = death of child under 10 by a mother who has given birth or lactating

o  Can be hard to distinguish murder from suicide or accident in MVA, fire, drowning, or cot death