This document discusses caring for dying patients. It outlines that junior doctors are often required to care for dying patients. Proper care involves early recognition that a patient is dying, continuous assessment of their needs, anticipating and promptly managing symptoms, and ensuring the patient's and family's wishes are addressed. Key goals are keeping the patient free from pain, respiratory secretions, nausea and breathlessness and providing psychological and spiritual support for the patient and family.

1. “Caring for a Dying
Patient”
‘Am I Going To Die?’
Dr Yassir NourEldaim
Consultant of Anaesthesia&ICU

2. Introduction
• Every year, more than half a million people die
in the United Kingdom, and over half of these
deaths occur in hospital.
• Junior doctors are often required to care for
dying patients
• Early recognition of dying facilitates meeting
patients’ and relatives’ preferences for end of
life care
•Communication is the cornerstone of good end
of life care
•The principles of end of life prescribing are: to
stop non-essential drugs; convert essential
drugs to the subcutaneous route; and use
anticipatory prescribing

3. Cont: Introduction
•Terminal care is not just cancer care
but other relevant diseases include:
1. Heart failure.
2. Respiratory failure.
3. Chronic renal failure.
4. Hepatic failure.
5. Certain neurological diseases such as
multiple sclerosis and motor neurone
disease,.
6. AIDS.

4. keys
•The key to managing and supporting
the dying patient involves:
1. Identifying that the patient is dying.
2. Continuous assessment of symptoms
& psychological/spiritual needs.
3. Anticipating likely problems before
they arise so that treatments are
readily available.
4. Appropriate & prompt management
of symptoms

5. Strategic goals for the dying
patient
Both the patient’s/family’s awareness &
understanding of diagnosis of dying is
communicated and documented.
Patient is assessed and a care plan is
developed in line with the
patient’s/family’s wishes.

6. Clinical goals for the dying
patient
1. Current medication assessed & non-essential
medicines discontinued.
2. PRN subcut meds/fluids written up as
appropriate.
3. Inappropriate interventions discontinued e.g.
blood tests, BP monitoring.
4. Cardiac defibrillators (ICDs) deactivated in
consultation with cardiologist.
5. DNAR order completed.
6. Organ donation considered

7. Ongoing assessment goals for the
dying patient
1. Patient is free from pain, agitation, excessive
respiratory tract secretions &
nausea/vomiting,severe breathlessness.
2. Pressure care - if death is imminent, reposition
for comfort only – consider pressure relieving
mattress.
3. Bowel care – patient is free from bowel
problems causing distress.
4. Urinary status – patient has appropriate aids.
5. Eyes, mouth & lips clean & moist - consider
family involvement in these tasks, if
appropriate

8. Cont:Ongoing assessment goals for
the dying patient
1. Emotional & psychological care– patient and
family have appropriate support
2. Spiritual, religious and cultural support –
needs are assessed and supported
3. GP and community team informed of the
patient’s condition
4. Goals to support the family as the patient
nears death
5. Next-of-kin / significant others identified &
contact details recorded.
6. Family prepared as far as possible for the
patient’s death

9. 5 physical symptoms
associated with dying
Regular / PRN
subcutaneous
medications
1. Pain. 1. Analgesics (e.g.morphine)
2. Agitation & distress. 2. Sedatives (e.g. midazolam)
3. Respiratory tract
secretions (‘noisy rattle’).
3. Anti-cholinergics (e.g.
hyoscine hydrobromide)
4. Nausea & vomiting 4. Anti-emetics (e.g.
metoclopramide )
5. Breathlessness

10. Pronouncing Death
•It is important to pronounce and
confirm death in a professional yet
compassionate manner, knowing that
the family will remember acutely this
time, your words, and the tone of your
voice.

11. Death Certification
•A death certificate is available from the local
registrar of Births Deaths and Marriages by
providing the following details to register the
death:
1. Full name and surname of the deceased
2. Gender, marital status, occupation and date of
birth or age of the deceased.
3. Date and place of death.
4. If deceased was married, the occupation of their
spouse, or deceased spouse if widowed.
5. If deceased was a child, the occupation of the
father or, if the parents were not married the
occupation of the mother.
6. Death Notification Form of the Cause of Death.