How to Recognize a Dying Patient? | Signs of Approaching Death

Summary

In this video, Belgian nuclear medicine resident Paulien Moyaert discusses the signs of impending death to help families understand and prepare. Key indicators include decreased appetite, changes in breathing, incontinence, agitation, and physical changes like cold extremities. She emphasizes that these signs are not rules but guideposts and that forced nutrition or hydration can worsen the patient's condition.

Takeaways

• 🍽️ Decreased appetite is a common sign of impending death, and forced nutrition may worsen the condition.
• 🏃‍♂️ The body reallocates energy to essential systems, leaving less for digestion, similar to how it reacts after intense exercise.
• 🔥 Ketones, produced when the body breaks down fat for energy, can suppress hunger, thirst, and pain, and may induce a sense of well-being.
• 💧 Artificial hydration can lead to discomfort as the body struggles to regulate fluids, causing edema and lung swelling.
• 🔴 Blood is redirected from non-vital areas to preserve oxygen for the brain and heart, resulting in cold and mottled extremities.
• 💨 Breathing becomes irregular and involuntary as the brain stem takes over, and oxygen administration does not help.
• 🌊 The 'death rattle' is a common but not distressing sound as the patient is typically non-responsive and deeply asleep.
• 🚫 Incontinence occurs as brain signals cease, causing muscles, including the sphincter, to relax.
• 😖 Agitation may occur due to reduced oxygen, dehydration, or pain medications, but is not considered painful for the patient.
• 🔮 These signs are not universal and should be contextualized, as they are guideposts rather than definitive indicators of death.

Q & A

What is the first sign of impending death mentioned by Paulien Moyaert?

The first sign mentioned is a decreased appetite.

Why might forcing nutrition in terminally ill patients worsen their condition?

Forcing nutrition can worsen the patient's condition because it requires energy the dying person may not have, and can make the presence of food painful or intolerable.

How does the body's energy allocation during intense workouts relate to the process of dying?

During intense workouts, the body reallocates resources to the most critical muscle groups and organs, leaving the digestive system with limited energy, similar to how a dying person's body reallocates energy to essential systems, leading to a lack of energy for digestion.

What role do ketones play at the end of someone's life?

Ketones, which build up as the body breaks down fat for energy when carbohydrates are scarce, can suppress hunger, thirst, and pain, and may even produce a state of well-being or mild euphoria.

Why might artificial hydration cause discomfort at the end of life?

Artificial hydration can cause discomfort because as the body shuts down, the kidneys are unable to regulate fluid well, leading to edema or swelling, which can cause shortness of breath and coughing.

What is the significance of blood being shunted away from non-vital areas in the dying process?

The shunting of blood away from non-vital areas to preserve oxygen delivery to the brain and heart can lead to cold and mottled extremities, which is a late sign in the dying process indicating death will occur within hours to days.

How does the breathing pattern change as death approaches?

Breathing becomes irregular, with periods where a person may be unable to breathe for up to 10 to 20 seconds at a time. Administering oxygen does not help, and a gurgling sound may be heard due to pooling of secretions at the back of the throat.

Why does the death rattle occur and is it distressing for the patient?

The death rattle occurs due to difficulty swallowing and pooling of secretions at the back of the throat, but it is not distressing for the patient as they are non-responsive and deeply asleep at this point.

What is the fourth sign of impending death described by Paulien Moyaert?

The fourth sign is incontinence, which occurs as the brain signals to the muscles, including the sphincter, stop, leading to relaxation and loss of control.

What might cause agitation near the end of life and is it painful?

Agitation near the end of life may be caused by reduced oxygen to the brain, dehydration, or pain medications. Although it looks distressing, it is not considered painful for the patient.

How should the signs of impending death be interpreted according to the script?

The signs are guideposts, not rules, and should be contextualized. They are not universal, and showing one of these signs does not necessarily mean the person is actively dying.