Lecture 7 - Death and Dying PDF

⚰️ Lecture 7 - Death and Dying Resuscitation → Decision made in seconds → Implied Consent → Withholding vs. discontinuation of resuscitation → Patient Wishes → Ethical (i.e it would be unethical to resuscitate someo...

⚰️ Lecture 7 - Death and Dying Resuscitation → Decision made in seconds → Implied Consent → Withholding vs. discontinuation of resuscitation → Patient Wishes → Ethical (i.e it would be unethical to resuscitate someone for practice), Legal and cultural factors → Principle of autonomy (have the right to pre-decide) Futile (pointless) Resuscitation → Principle of Futility → Irreversible Death → Patch to BHP for TOR (termination of resuscitation) → Communicate to family/ Provide emotional support → Reduces unnecessary transport ( if it’s futile resuscitation, don’t transport pt) 1. Resuscitation doesn’t work than 2. Notify the family - “I’m sorry, they died, we had to stop resuscitation” 3. Obtain medical information 4. your focus shifts from unalive pt to alive pt (you give reassurance and support to family) Lecture 7 - Death and Dying 1  Advanced Directives → Patient Self Determination → Advanced Directive: ⦁ Legal binding document ⦁ Communicates thoughts, wishes or preferences for healthcare decision that might need to be during periods of incapacity ⦁ Can be verbal or written ⦁ May not have DNR Living Will (effective in hospital) → Provides written direction to healthcare providers about care that the individual approves should they become terminally ill and unable to make decisions → Affects the care received DNR Order → Allows a “natural” Death → Defined as “ the existence of a current plan of treatment that reflects a patient’s expressed wish when capable, or the consent of a SDM when the patient is incapable, that CPR not be included in the treatment plan” → Paramedics and Fire - valid for these two → A copy of DNR is valid as well as the original When NOT to Resuscitate → DNR applies to people without pulse → Criteria for not starting CPR: ⦁ ROSC (Return of Spontances Circulation) - they are not dead ⦁ Danger to you Lecture 7 - Death and Dying 2  ⦁ Obvious Death ⦁ Valid and Signed DNR ⦁ Order to withhold or Terminate Resuscitation obtained from BHP DNR has a unique 6# Serial Number - and the # goes into ACR DNR confirmation number How to know a DNR is valid = has the correct name of pt, the front page is completely correct. Who can sign a DNR = physician (M.D), Registered Nurse (R.N), R.N in the extended class (R.N(EC)- ‘extended class) or registered practical nurse (R.P.N) ⦁ DNR has to be on scene w/ pt or else they will get resuscitated Valid DNR Confirmation Form → Pre-printed Serial number → Patient’s name → Tick box checked for ‘decision-maker’ (Pt vs MD) → Tick box checked for professional designation → Printed name of HCP → Signature of HCP → Date form was signed DNR and the Paramedic → Must See the form → HCP who completed form does not have to be on scene → ID patient (if possible) → Validate form Lecture 7 - Death and Dying 3  → Standardizes the process → Saves healthcare $$ On-Scene Directive → If VSA → DNR → If not VSA → palliative care → Non-medical Escort - (if pt dies in ambulance + has valid DNR = notify dispatch + let the family member/ non-medical escort what is gonna happen next) Transport Directives → VSA en route → Minimum of 3 min. from time of arrest → No CPR → Document TOD, advise CACC → Continue Transports Code 6 Honouring The DNR → Consider DNR’s intent → What if someone else started CPR? = tell them to stop, than you take over until you get a valid DNR (paper) → What if you started CPR? → Verbal DNR? - Not valid Defining “Death” → Obviously dead (called code 5 criteria) → Subject of a medical Certificate of Death (pt signed a death certi - you were just called to transport pt) → VSA → DNR Lecture 7 - Death and Dying 4  → VSA → TOR → VSA → WRO (withhold Resuscitation Order) Obviously Dead 1. Legally Dead 2. Obvious Signs of Death (Code 5) ⦁ Decapitation ⦁ Transection - cut in half ⦁ Visible Decomposition ⦁ Putrefaction - decay or rotting → “Otherwise”: defined as Absence of Vital Signs AND ⦁ Grossly Charred ⦁ Open head or torso wounds with gross outpouring or cranial or visceral contents ⦁ Gross rigor mortis - stiffness post death ⦁ Dependent Lividity (livor Mortis) - blood pools to areas of body Know the Unexpected Death and Expected Death in slides. Reporting Requirements → Corner’s Act (R.S.O. 1990), S.10 → Must Report all deaths that occur: ⦁ Under suspicious circumstances ⦁ By unfair means - like unnatural death ⦁ During/ Following pregnancy ⦁ Suddenly/ unexpectedly ⦁ From untreated diseases ⦁ Any cause other than disease Lecture 7 - Death and Dying 5  ⦁ Circumstances requiring investigation ⦁ At a construction or mining site ⦁ In Custody Interference with the body → S.11 of Act → If death appears to fall under S.10 → Cannot interfere with or alter the body or its condition in any way until directed by the coroner → Moving the deceased → Medical equipment Coroner’s investigation → S.15 of Act → if coroner believes that person died in any of the circumstances in S.10 → Takes possession of body, performs an investigation → Determine whether an inquest is necessary (if there is an inquest there is an autopsy) → Collect and analyze information to prevent future deaths Powers Of the Coroner → S.16 of the Act → Examine and/ or take possession of any dead body → Enter & inspect any place where a dead body is or was removed from → Inspect & extract information from any records or writings → Seize anything believed to be material to the investigation Lecture 7 - Death and Dying 6  Coroner’s Inquest → S.31 of the Act → Jury of 5 Persons (chosen from society) → Determine circumstance of death → Does not result in finding of legal responsibility (Doesn’t produce a verdict, or sentence, but can only make recommendation (i.e. what should be fixed) → May make recommendations directed to avoidance of death in similar circumstances → People of Standing = (are i.e. people that were there, boss of a peace) Lecture 7 - Death and Dying 7