Pronouncing Death

Every now and then, I'd get a page from the ICU or the floor to pronounce a patient's death. I know people who absolutely hate it; but hey, if you think of it as the rare time when you are 100% certain of your diagnosis, it doesn't really sound like a bad task!

The strange thing about pronouncing death is that it is usually not taught in medical school. It's one of those things that you somehow just know eventually, and everyone comes up with his or her own style after a few runs. As easy as it sounds, to legally pronounce a patient dead requires a systematic approach to avoid the 1 in a million chance that the "dead" patient is still alive and kicking!

When there is no one accompanying the patient, I usually start by greeting the patient by his name. Then I usually examine the patient in this order:
- Watch for spontaneous breathing
- Auscultate for heart beats and lung sounds
- Palpate for carotid and/or radial pulses
- Check pupils and negative "doll's eye sign"
- Apply pressure to sternum for response (I usually skip this if family members are present)

The above should be suffice to pronounce a patient, unless for brain death cases. It may not be comfortable alone with a dead patient, but knowing that the patient's suffering with sickness has ended may come as a relief.