Download Rigor mortis

 Notification
of a Death
 Record of Death C120002
 Cremation cert
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Notification; the registered nurse is
responsible for notifying family, medical
staff, telephone officer and mortality coordinator or the Duty Nurse Manager after
hours
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Registrar or house officer for patients team
is responsible for reporting to and discussing
death with the consultant
Registrar or house officer for the team are
responsible for completing the record of death
for every patient death
Registrar or house officer notify the
patient’s GP
If coroner takes jurisdiction s/he will notify
the Police to attend
Cremation certificate filled in for every
patient unless they are definitely for burial
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 Medical
staff
must examine the
patient and
ascertain that
life is extinct
and record this
before the
patient is
transferred to
the Mortuary
If the patient dies away from their home ward
negotiate with the NIC of the ward to ascertain
the most appropriate place for the family & the
deceased patient to spend time prior to
mortuary transfer
Enter information on PMS
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Staff may not contact funeral directors
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Extinction of life
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No palpable carotid pulse for a minimum of two
minutes
No heart sounds heard for a minimum of two
minutes
No breath sounds heard for a minimum of two
minutes
No response to centralised stimuli
Fixed and dilated pupils (no pupil response to
light)
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 Pallor
mortis
 Livor mortis
 Rigor mortis
 Algor mortis
Pallor mortis; a paleness of the body
begins almost immediately due to lack of
blood circulation
 Livor mortis; dependent lividity caused
by gravity influenced blood pooling that
becomes fixed.
 Rigor mortis;
complex chemical
reactions cause a gradual stiffening of
the muscles, voluntary and involuntary
(may cause an involuntary exhalation of
air) rigor is influenced by pre morbid
factors such as drugs, exhaustion,
illness & infection. Rigor passes
between 24 – 72 hours
 Algor mortis; death chill at about 8
hours the body starts cooling rapidly
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 Lie
the patient flat on top of
mortuary sheet, straighten
limbs & close eyes
 Ensure
the deceased is
identified by two legible
bracelets on an arm & a leg
 Ask
the family if there are
any special instructions
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Chemotherapeutic alerts; biotoxic agents
within 48 hours body bag + biohazard sticker
Radioactive Isotopes alerts; contact physicist
on call to check radiation levels before
release to mortuary
Biotech alerts; pacemaker, implanted
defibrillator, spinal stimulators
Consider a body bag if the person: has an
infectious disease or is leaking copious
fluids
Cover wounds with op site
Prepare the deceased with hygienic & aesthetic
consideration
Dress the deceased
Place patients dentures
Prepare the deceased for the family to spend
time with them if appropriate
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Nursing notes must include:
If deterioration & death were sudden
Notification of medical staff timeline
Notification & presences of whanau
Treatment immediately prior to death
Time of death
Time & name of last person to see the
patient alive
• Details of disposition of patient property &
valuables
• Documentation of extinction of life by RMO
All notes accompany the deceased person to
the mortuary
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 Spiritual
maters
 Patient jewellery
 Relatives contact the Funeral
Director
 Post mortem or consent for
organ donation is the
responsibility of the medical
officer
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Offer religious / spiritual support with
chaplaincy service
Identify and document jewellery which is to
stay with the deceased
Property must be recorded and if returned to
relatives documented in the clinical notes,
or bagged labelled and delivered to lodge
(via ward) it may be collected from the
orderlies lodge at any time
Damaged / cut clothing can be discarded but
must be documented in the clinical notes
No medications are to be returned with the
belongings of the deceased
Valuables are released from the revenue
office during office hours, money will be
returned in form of a cheque
Valuables & money record on deceased patient
property book and place in valuables
envelope E10 0830-1700 deliver to revenue
office out of hours > duty manager for
placement in duty office safe
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The coroner will usually
insist on jurisdiction in
cases where death was:
• a person admitted from
outside custodial care
• from an unknown cause
• suicide or poisoning
• a direct or subsequent
effect of injury
• during or as a delayed
result of surgery or
anaesthesia or procedure
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Once the coroner has taken jurisdiction no-one may visit the
person without the coroners consent
Death within 24 hours of admission is not alone a prerequisite for
coronal enquiry
The body is in the Coroner’s ‘possession’ from the time of death;
removal of some devices may significantly obscure the outcome of
the coronial or criminal investigation so if unsure leave it
The coroner is a lawyer and may have no medical expertise therefore
if advice is needed contact the forensic pathologist or an
independent senior medic. In general all lines and drains are left
in situ plus ETT & fluids.
Deaths that must be reported under section 14(2) Coroners Act 2006;
Without known cause; suicide, or unnatural or violent
Medical staff feel unable to sign death certificate
During medical surgical or dental operation or treatment
Occurring while woman was giving birth or as result of pregnancy
Detained in intuitions under section 9 (alcoholism & drug addiction
act 1966)
Placed in residence under children, young person and their families
act
Child or young person in custody of an iwi or cultural social
service, child and family support service
Patient in section 2(1) compulsory assessment and treatment; Mental
health act 1992
Patient in section 3(1) compulsory care and rehabilitation ;
Intellectual disability act 2003
Prisoner section 3(1) corrections act 2004
Custody of police
Control of security officer section 3(1) corrections act 2004
 Any
death likely to become a
Coroner’s Case, do not alter or
absent anything from the body
• Leave all drains, lines & catheters,
tubes in-situ
• Retain contents of drains and
catheter bags
• Spigot all lines
& tubes
Manage excess blood & body fluids
Secure all lines in-situ
Ensure all fluid volumes are recorded
accurately
 Endotracheal tube
 ? Severe gas or air embolism requires
urgent consultation with the Forensic
Pathologist on call
 Arrange for transfer to the Mortuary
using the mortuary trolley via the
orderlies
 Escort the deceased to the mortuary
 Support
relatives viewing the
deceased in the Mortuary Viewing room
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 Auckland
& Christchurch are the
national sites for the
performance of high
risk Post Mortems
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The deceased is to be
transported in a body bag
Following post mortem either
burial or routine cremation
are appropriate
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CJD, hep b & c, SARS, HIV, TB
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A nurse must escort all patients to the
mortuary
 The orderlies will arrange the Mortuary
trolley or bed as appropriate
 Transfer to be conducted discretely via
quieter corridors for the dignity of the
deceased & whanau
 Transfer to the mortuary is required
within four hours of death
 At the mortuary the nurse verifies the
deceased against the case notes with the
orderly and records in the mortuary
receipt book
 Babies may be carried to the mortuary
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 Pronouncing Life Extinct
 Routine forms required
• Record of Death Form
• Death Certificate
• Cremation Certificate
 Other forms which may be required
• Deceased Person Certificate
• Certificate for Coroner as to Cause of
Death
• Requisition for a Hospital Post Mortem
Forms
• Incident form
Pronouncing Life Extinct: registered medical officer
must attend the patient to pronounce life extinct.
Including appropriate examination and documentation of
such, including time of notification, time of
examination
The patient must not be transferred to the mortuary
until this has been completed
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Routine forms required:
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Record of Death Form: must be completed for all CH
deaths, required as a medico-legal receipt and
indicates due consideration of Coroner referral has
occurred
Death Certificate: must be completed for all noncoronial cases where the medical practitioner is
satisfied that the death was a natural consequence of
the death concerned
Cremation Certificate: completed for patients who are
for cremation. The certificate is double sided and
the RMO completing this certificate must have seen
the patient before and after death and be the
same
doctor who fill out the death certificate
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Other forms which may be required:
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Deceased Person Certificate: this is a police form
required to be completed by the RMO from the treating
team if the Coroner takes jurisdiction
Certificate for Coroner as to Cause of Death:
infrequently used certificate used when a coroner
takes jurisdiction over a case but dose not require a
post-mortem
The certificate in lieu of Post-mortem should be
completed by a senior registrar or consultant
Requisition for a Hospital Post Mortem Forms: may
only be completed for clinical autopsies (noncoronial) where the doctor is required to complete
all death certificate forms before the autopsy. The
family must give written permission on the Consent
Form ref 0235
Clinical notes: document to accurately reflect what
occurred in a manner that can stand up to scrutiny.
A chronological record of care that must continue to
be useful long after the care event.
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 When
death occurs in theatre
the theatre staff must assume
the Coroner will take
jurisdiction over the body
Burwood: no mortuary
TPMH: mortuary
CH & CWH: city mortuary
CWH: 2x garden rooms
for infants (3rd & 5th
floors)
Coronial autopsies are carried out by
the Coroner’s Pathologist where the
Coroner takes jurisdiction
 The police attend as the Coroner’s
agent & sign the body into the
mortuary
 The police require someone to
identify the body
 Team doctor
complete a Deceased
Person Certificate for the police
 A body under Coronial jurisdiction
cannot be released until the autopsy
is complete and a signed Coroner’s
Order for Disposal is obtained
together with a Certificate for
Cremation after Post mortem obtained
by the attending pathologist
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