whoRyou Posted January 9, 2014 Share Posted January 9, 2014 I was wondering can a Physician Assistant pronounce death or cause of death? Also can they sign any form related to pronouncing death? Does it vary from state to state? If so, I am curious as to what are the circumstances? Link to comment Share on other sites More sharing options...
cinntsp Posted January 9, 2014 Share Posted January 9, 2014 It is state-specific. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 9, 2014 Administrator Share Posted January 9, 2014 I can in Washington. Haven't needed to yet, but am registered with the state DOH online service to do just that. Link to comment Share on other sites More sharing options...
LKPAC Posted January 9, 2014 Share Posted January 9, 2014 We do this in Nebraska. Link to comment Share on other sites More sharing options...
skyblu Posted January 9, 2014 Share Posted January 9, 2014 Yes in MA. But death certificate needs MD. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 9, 2014 Share Posted January 9, 2014 ^^^. Same in Tx. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 9, 2014 Moderator Share Posted January 9, 2014 Further info on MASS NP can declare and sign death cert but a PA can only declare MAPA is looking into this and hopefully will get it changed soon It is an odd question as it has NOTHING to do with the delivery of care - you can't really "screw up" a death cert as long as you fill it out correctly.... so what is the deal with not allowing a PA or NP to sign it? Link to comment Share on other sites More sharing options...
UGoLong Posted January 10, 2014 Share Posted January 10, 2014 In Ohio, we can pronounce and I have. It still takes an MD to sign as we do not determine the cause of death. Paramedics also can pronounce in the field here. Link to comment Share on other sites More sharing options...
marley85 Posted January 10, 2014 Share Posted January 10, 2014 As a student who hasn't seen this done before, would someone mind going over in detail the process/paperwork involved? Link to comment Share on other sites More sharing options...
greenmood Posted January 11, 2014 Share Posted January 11, 2014 When you're on clinicals just ask someone (floor nurse will probably be able to help you) to let you have a death packet to look through. I was given one when started my job so that the first time a patient died wouldn't be the first time I had seen the paperwork. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
whoRyou Posted January 11, 2014 Author Share Posted January 11, 2014 As a student who hasn't seen this done before, would someone mind going over in detail the process/paperwork involved? As a PA wanna-be I am curious myself ... Link to comment Share on other sites More sharing options...
marley85 Posted January 11, 2014 Share Posted January 11, 2014 Im on my inpatient rotation now so I will definitely do that. What about any specific criteria to follow on declaring death? Mainly dealing with PEA on the monitor, anything like that? Link to comment Share on other sites More sharing options...
whoRyou Posted January 11, 2014 Author Share Posted January 11, 2014 As a PA wanna-be I am curious myself ... When you're on clinicals just ask someone (floor nurse will probably be able to help you) to let you have a death packet to look through. I was given one when started my job so that the first time a patient died wouldn't be the first time I had seen the paperwork. Sent from my iPad using Tapatalk greenmood: What did the packet consist of? Link to comment Share on other sites More sharing options...
skyblu Posted January 11, 2014 Share Posted January 11, 2014 Hm, not sure there is a "process". At least in the ER. We resuscitate (unless DNR), but if it isn't working, no cardiac activity by bedside ultrasound, no ROSC, we just call time of death. We don't make determinations as to brain death and such. If someone has a heartbeat, we admit to ICU. If we tried everything we could and still no heartbeat, we call time of death. Then we call the ME and they decide whether they want the case or not. If they want the case, every line and tube stays in place. If they decline it, we can remove lines and tubes to make the remains more presentable for the family. Then we fill out the death certificate (well, I fill out and MD signs it), and that's it. Body goes to the morgue, end of my involvement. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 11, 2014 Share Posted January 11, 2014 ^^^, except I don't recall seeing anyone in any of our ED's fill out a certificate. Link to comment Share on other sites More sharing options...
skyblu Posted January 12, 2014 Share Posted January 12, 2014 What do you mean? You've never seen a PA fill out a certificate, or you've never seen anyone do it? To clarify, we don't sign it. We just sometimes fill out the form. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 12, 2014 Share Posted January 12, 2014 Never seen anyone fill one out in over ten years of EM. I know that the nurses used to have to fill out a lot of paperwork after a departmental death and maybe they filled it out for the physician to sign while I was off doing my own thing. I just have not knowingly seen one filled out or looked at the form(s). Link to comment Share on other sites More sharing options...
skyblu Posted January 14, 2014 Share Posted January 14, 2014 Huh. Interesting. We have to file a death certificate on every death in our department. We fill it out before the body leaves the ED. Can't send someone to the morgue (or a funeral home) without a signed death certificate! When the dead guy wakes up in the freezer, the morgue tech wants to have an MD's signature so he knows who to blame. ;) Link to comment Share on other sites More sharing options...
Qkwan Posted January 26, 2014 Share Posted January 26, 2014 In the ER, I agree you know when to call a code and there isn't really a process to declaring time of death. In smaller hospitals though I have been called to inpatient units to declare a patient I've never seen before. Then I do a sternal rub, check pupils, check for carotid pulse, visually watch for any respiratory efforts, etc. before pronouncement. But maybe that's just me... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 26, 2014 Share Posted January 26, 2014 In the ER, I agree you know when to call a code and there isn't really a process to declaring time of death. In smaller hospitals though I have been called to inpatient units to declare a patient I've never seen before. Then I do a sternal rub, check pupils, check for carotid pulse, visually watch for any respiratory efforts, etc. before pronouncement. But maybe that's just me... This is where a portable, bedside echo device would come in handy. Just because there isn't a palpable carotid pulse doesn't exclude myocardial activity (I realize that this is a technicality but we've all heard the stories as alluded to by skyblu). My ED days were done by the time we received the legal authority to pronounce in my state. Link to comment Share on other sites More sharing options...
coloradopa Posted January 27, 2014 Share Posted January 27, 2014 This is where a portable, bedside echo device would come in handy. Just because there isn't a palpable carotid pulse doesn't exclude myocardial activity (I realize that this is a technicality but we've all heard the stories as alluded to by skyblu). My ED days were done by the time we received the legal authority to pronounce in my state. The opposite. We've called PEA after multiple rounds of ACLS. If you echo the heart there is still some contractility. Sometimes you see disorganized activity in the heart when there is no electrical activity on the monitor. If you don't have a carotid pulse you aren't perfusing the brain. Everything else is academic. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 27, 2014 Share Posted January 27, 2014 My point is that a lack of a palpable pulse does not for any number of reasons confirm death. Look at hypothermia drownings as an example. You don't pronounce "cold and dead", you wait until they're "warm and dead". With the use of the echo you're using it to confirm absence of "effective" contractility in the absence of effective respiration and a sustainable rhythm. Now, if you don't have access, the individual in question has no appreciable respiration, no pulse, and no discernible heart sounds, then I'd be comfortable. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 27, 2014 Moderator Share Posted January 27, 2014 My point is that a lack of a palpable pulse does not for any number of reasons confirm death. Look at hypothermia drownings as an example. You don't pronounce "cold and dead", you wait until they're "warm and dead". With the use of the echo you're using it to confirm absence of "effective" contractility in the absence of effective respiration and a sustainable rhythm. Now, if you don't have access, the individual in question has no appreciable respiration, no pulse, and no discernible heart sounds, then I'd be comfortable. asystole on the monitor is also fairly convincing.... Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 27, 2014 Share Posted January 27, 2014 ^^^...once you've checked your leads. Link to comment Share on other sites More sharing options...
skyblu Posted January 27, 2014 Share Posted January 27, 2014 I don't think anyone would pronounce a cold death. We all know the maxim "they're not dead until they're warm and dead." We usually have people on two monitors: the wall one and the portable defibrillator one. Separate set of leads. Asystole on both, absent resporations, GCS of 3, absent palpable or dopplerable pulses are all pretty convincing. Having said that, I often do a bedside echo anyway because the machine is right there. We had a very hard pedi code a couple months ago and Mom said it helped her accept the decision to stop resuscitation when the echo showed no cardiac motion. If it had shown even a little fib, we'd probably have continued even longer than the two hours. Not that it would have changed the outcome, but losing a 3 month old is unimaginable enough for his parents that I'd stay there all night doing pointless CPR if it helped them feel we had tried absolutely everything. Link to comment Share on other sites More sharing options...
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