Letters

Diagnosing death

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7078.442a (Published 08 February 1997) Cite this as: BMJ 1997;314:442

Start resuscitation first

  1. Simon Mardel, MSc student in public health and health services researcha,
  2. Colin Thomas, Practitioner in resuscitation medicineb
  1. a Aberdeen AB24 3HX
  2. b Resuscitation Department, Hereford Hospitals NHS Trust, County Hospital, Hereford HR1 2ER
  3. c Addenbrooke's NHS Trust, Cambridge CB2 2QQ
  4. d St Catharine's College, Cambridge CB2 1RL
  5. e School of Postgraduate Medicine, Keele University, Stoke on Trent ST4 7QB

    Editor–The subtitle of Rodger Charlton's editorial on diagnosing death–Getting it right if vital opportunities for resuscitation are not to be missed–misleads readers.1 It does not emphasise the common need to start resuscitation when the diagnosis is in doubt, which in practice is often while information is still being gathered from attendants. Only when the clinician has decided not to try resuscitation does the thorough examination proposed by Charlton become relevant. Before making this decision respiration should not be checked until the airway is opened, and a pulse should not be sought until effective ventilation has been provided. Although we acknowledge the difficulties posed by diagnosing death in the community, the logical sequence of current resuscitation guidelines2 3 must be followed unless (or until) a positive decision not to resuscitate has been made. Furthermore, in the case of drowning these guidelines (including those referenced by Charlton) do not propose the Heimlich manoeuvre to expel water from the lungs but amply describe the reasons for not doing so.

    References

    1. 1.
    2. 2.
    3. 3.

    Death after electric shock and lightning strike is more clear cut than suggested

    1. Gregor Campbell-Hewson, Specialist registrar, accident and emergency medicinec,
    2. Conor V Egleston, Senior registrar, accident and emergency medicinec,
    3. Susan M Robinson, Consultant, accident and emergency medicinec
    1. a Aberdeen AB24 3HX
    2. b Resuscitation Department, Hereford Hospitals NHS Trust, County Hospital, Hereford HR1 2ER
    3. c Addenbrooke's NHS Trust, Cambridge CB2 2QQ
    4. d St Catharine's College, Cambridge CB2 1RL
    5. e School of Postgraduate Medicine, Keele University, Stoke on Trent ST4 7QB

      Editor–Some of Rodger Charlton's assertions about death from environmental causes are faulty.1 He says that death should not be confirmed after immersion until water has been expelled from the lungs by a Heimlich manoeuvre and that death should be confirmed with extreme caution after lightning strike, electric shock, and airway obstruction. There is …

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