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Confirmation of Death Death Certification Cremation Form 4

Confirmation of Death Death Certification Cremation Form 4. Dr Sarah Jones. Learning Objectives:. Know HOW to confirm death and what to write in the notes Know how (and how not) to fill in the MCCD Know how to fill in CR 4 (replaces cremation form B). Confirmation of Death. What is death?

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Confirmation of Death Death Certification Cremation Form 4

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  1. Confirmation of DeathDeath CertificationCremation Form 4 Dr Sarah Jones

  2. Learning Objectives: • Know HOW to confirm death and what to write in the notes • Know how (and how not) to fill in the MCCD • Know how to fill in CR 4 (replaces cremation form B)

  3. Confirmation of Death • What is death? • “The cessation of cardiopulmonary activity, without which life is impossible” • FY1/2s are rarely involved in the more complex ‘brainstem death’

  4. Diagnostic criteria • Fixed, dilated pupils; • No ventilatory effort (>3 minutes); • No pulse; • No heart sounds (>1 min).

  5. Misdiagnoses • Hypothermia (“You ain’t dead til you’re warm and dead”, Kovac, ER) • Diabetic coma • Cheyne-Stokes respiration

  6. Still uncertain • ECG • Retinal inspection

  7. Documentation • You are not a priest • You are not writing a novel • These are medical notes like any other

  8. Medical Certificate of the Cause of Death

  9. The top half • Find somewhere undisturbed • Days and months in words • Don’t leave gaps • You don’t need to have seen the body

  10. Cause of Death: Dos and Don’ts • Do ask your seniors, the pathologist or Coroner’s Officer if you are unsure • Do fill in the counterfoil and notice to informant • Don’t use abbrieviations • Don’t confuse mode of death with cause of death

  11. The lower half: Cause of Death

  12. Terms that must always be backed up • Organ failure • ‘Pneumonia’ • Clinical signs, eg. haemoptysis, haematemesis, etc • Cancer • Infections • Old age

  13. Referral to the Coroner • From the Coroner’s Act 1959: • “Violence, misadventure or unfair means” • “Negligence, misconduct or malpractice” • Homicide • Suicide • Accidents or injuries, direct or indirect • Industrial disease • Unexpected death • Patients not seen in the preceding 14 days by a doctor • Deaths under anaesthetic or immediately post-operative • HAI • SIDS

  14. Cremation forms (CR 4)

  15. Stillbirth • Fetus >24weeks gestation born with NO signs of life = stillbirth certificate only • Fetus <24 weeks gestation born with NO signs of life = no legal requirement for certification • Fetus of any gestation showing any signs of life= registerable birth and death

  16. Useful resources • http://www.dhsspsni.gov.uk/guidance-death-stillbirth-and-cremation-certification-pt-b.pdf • http://www.justice.gov.uk/guidance/docs/cremation-doctors-guidance.pdf

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