🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Death and dying

Specialties > Palliative care & EoL care

Differential Diagnosis Schema 🧠

Natural Causes

  • Cardiovascular disease: Sudden cardiac death due to myocardial infarction, arrhythmias, or heart failure; common in elderly or those with known heart disease
  • Respiratory failure: Often seen in end-stage chronic obstructive pulmonary disease (COPD), pneumonia, or pulmonary embolism, presenting with hypoxia and respiratory distress
  • Cerebrovascular accident (stroke): Sudden loss of consciousness, hemiplegia, and potentially death; common in individuals with hypertension or atrial fibrillation
  • Cancer: Advanced malignancies leading to death through organ failure, cachexia, or complications such as infection
  • Sepsis: Widespread infection leading to multi-organ failure and death, particularly in immunocompromised individuals or those with chronic illness
  • Renal failure: End-stage renal disease leading to electrolyte imbalances, acidosis, and ultimately death, especially in those refusing or unable to receive dialysis
  • Liver failure: Advanced cirrhosis leading to hepatic encephalopathy, coagulopathy, and death, often associated with alcohol misuse or viral hepatitis
  • Neurodegenerative diseases: Conditions such as advanced dementia or motor neuron disease, where progressive decline leads to death, often through respiratory failure or infection
  • Gastrointestinal hemorrhage: Massive bleeding due to peptic ulcer disease, esophageal varices, or malignancy, leading to hypovolemic shock and death
  • Diabetes complications: Severe hypoglycemia, hyperglycemic hyperosmolar state, or diabetic ketoacidosis leading to coma and death if untreated
  • Infections: Acute severe infections like meningitis, encephalitis, or endocarditis leading to rapid deterioration and death
  • Trauma: Major trauma causing hemorrhage, shock, and death, particularly in road traffic accidents or falls
  • Pulmonary embolism: Acute onset of severe dyspnea, chest pain, and possible sudden death, often in patients with risk factors such as immobility or thrombophilia
  • Aspiration pneumonia: Common in elderly or debilitated patients, leading to respiratory failure and death

Sudden or Unexpected Death

  • Myocardial infarction: Sudden chest pain, diaphoresis, and possible cardiac arrest, especially in those with coronary artery disease.
  • Pulmonary embolism: Sudden onset of dyspnea, chest pain, and hypoxia, with rapid progression to death.
  • Aortic dissection: Sudden severe chest or back pain, often described as tearing, with rapid deterioration.
  • Subarachnoid hemorrhage: Sudden severe headache (“thunderclap headache”), neck stiffness, and rapid loss of consciousness.
  • Epilepsy (sudden unexpected death in epilepsy, SUDEP): Unexplained death in individuals with epilepsy, often occurring during sleep.
  • Accidental overdose: Rapid death due to respiratory depression, particularly with opioids, benzodiazepines, or alcohol.
  • Anaphylaxis: Sudden onset of respiratory distress, hypotension, and death following exposure to an allergen.
  • Suicide: Intentional self-harm leading to death, often by overdose, hanging, or asphyxiation.
  • Drowning: Sudden death due to asphyxiation in water, often associated with accidental immersion or lack of supervision.
  • Homicide: Death due to violence inflicted by another.

Key Points in History 🥼

End-of-Life Care Planning

  • Advance care planning: Documentation of patient wishes regarding resuscitation (DNACPR), preferred place of death, and treatment preferences
  • Lasting Power of Attorney (LPA): Legal document appointing someone to make decisions on behalf of the patient if they lose capacity
  • Advance decisions: Legally binding decisions made by the patient regarding refusal of specific treatments in certain circumstances (e.g., refusal of ventilation in terminal illness)
  • Symptom management: Pain relief, management of breathlessness, nausea, and other distressing symptoms at the end of life
  • Communication with family: Ensuring that the family is aware of the patient’s wishes and the likely course of the illness, providing emotional support
  • Multidisciplinary team involvement: Coordination of care involving palliative care specialists, GPs, nurses, and social services to ensure comprehensive end-of-life care
  • Bereavement support: Providing information and support to the family after the death of the patient
  • Spiritual and cultural considerations: Respecting the patient’s and family’s beliefs and practices around death and dying, including rituals, prayer, and other needs

Recognizing the Dying Patient

  • Gradual decline: Worsening of underlying condition(s), increasing frailty, and loss of function over weeks to months
  • Decreased oral intake: Reduced appetite, refusal of food and fluids, often due to nausea, weakness, or loss of interest
  • Reduced level of consciousness: Increasing sleepiness, drowsiness, or coma in the final stages of life
  • Changes in breathing: Irregular breathing patterns, Cheyne-Stokes respiration, or periods of apnea, indicating imminent death
  • Peripheral shutdown: Cold, cyanotic extremities, mottling of the skin, indicating poor perfusion and impending death
  • Loss of sphincter control: Incontinence of urine and stool as the body begins to shut down
  • Changes in communication: Withdrawal, difficulty speaking, or non-verbal communication, indicating a nearing end of life
  • Terminal agitation: Restlessness, confusion, or agitation in the final days or hours, sometimes requiring sedation
  • Altered circulation: Drop in blood pressure, weak pulse, and reduced urinary output, indicating multi-organ failure
  • Absent responses: Unresponsiveness to verbal or physical stimuli, indicating deep coma or death

Possible Investigations 🌡️

Assessment of Capacity

  • Mental Capacity Act (MCA) assessment: Determine if the patient can understand, retain, and weigh up information to make decisions, and communicate their wishes
  • Best interest decision: If the patient lacks capacity, decisions should be made in their best interests, considering their known wishes, values, and beliefs
  • Involvement of family and LPA: Consult with the patient’s family and any appointed LPA when making best interest decisions
  • Formal capacity assessments: Carried out by a healthcare professional trained in MCA assessments, particularly for complex or contentious decisions
  • Documenting decisions: Ensure all assessments and decisions are thoroughly documented, including the rationale and those involved in the decision-making process

Post-Mortem Considerations

  • Verification of death: Clinical confirmation of death, including absence of pulse, heart sounds, breath sounds, and fixed pupils
  • Death certification: Completion of the Medical Certificate of Cause of Death (MCCD) by a qualified doctor, including the cause of death
  • Referral to the coroner: Necessary in cases of sudden, unexplained, or suspicious deaths, or where the cause of death is unknown
  • Organ donation: Discussion with the family about organ donation if appropriate, following national guidelines
  • Post-mortem examination: May be required by the coroner to establish the cause of death, particularly in sudden or unexplained deaths
  • Communication with family: Informing the family of the death, providing support, and discussing next steps, including funeral arrangements
  • Documentation: Completion of all necessary legal and medical documentation, including notification of death to relevant authorities and updating medical records
  • Funeral arrangements: Providing information and guidance to the family regarding funeral directors and the process of arranging a funeral
  • Support services: Referral to bereavement services or counseling for family members, particularly in cases of sudden or traumatic death
  • Ethical considerations: Respecting the wishes of the deceased and their family regarding religious, cultural, and personal preferences for post-mortem care

No comments yet 😉

Leave a Reply

Palliative care & EoL care