Reporting for Duty.

Knowing when to report a death requires clinicians to dutifully exercise some medical forethought. It requires the knowledge that while the phrase sudden death is the common thread that defines many reportable deaths, not all sudden deaths actually need reporting to the Medical Examiner or Coroner (ME/C) and can be certified by a treating clinician of record. It further requires the consideration that causes other than that due to natural disease could have triggered a chain of clinicopathologic events leading to the patient’s demise, be they sudden or delayed in progression.

Ultimately and for many important public health  and legal reasons, the goal is to ensure that deaths potentially occurring under non-natural circumstances are not missed and are otherwise identified, investigated, and certified by the ME/C.

Time out for a PPQ (Practice Pearls Quizlet) exercise. Playing the role of the treating clinician of record, consider the following case scenarios and whether or not the circumstances dictate reporting:

1. Sudden death in the ED in a 23 year-old female presenting with symptoms and signs of hypovolemic shock, electrolyte disturbance, and acute renal failure. Past medical history only of Addison’s disease, non-compliant with her prescribed medication regimen with multiple prior ER visits all nicely documented in the EMR.

This death needs reporting. True or False?

2. Patient pronounced dead after arrival. History of ischemic cardiomyopathy and coronary artery disease with multiple prior admissions for acute exacerbation.

This death needs reporting. True or False?

3. Sudden death in an asthmatic presenting in status asthmaticus with a history of cocaine abuse.

This death needs reporting. True or False?

4. Death from bacterial sepsis following spontaneous perforation of ischemic bowel. Remote history of a gunshot wound to the abdomen with visceral injury complicated by bowel adhesions with incarceration requiring multiple abdominal surgeries.

This death needs reporting. True or False?

5. Sudden death in a patient visiting from another state, pronounced dead after 36 hours of hospitalization following resuscitative efforts for a respiratory arrest. Accordingly, no electronic medical record exists and the past medical history is otherwise unknown. A prescription for albuterol, metoprolol, atorvastatin, and methadone along with a DAWN kit are found among the patient’s personal effects. The UDS is negative.

This death needs reporting. True or False?

 

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