Special Situations

Patients with End Stage Heart Disease, End Stage Lung Disease, Amyotrophic Lateral Sclerosis and other similar diseases are at high risk for sudden death. It is important to inform loved ones about this possibility.

Death by exsanguination

Some head and neck tumors can erode into the carotid artery. Such occurrences though uncommon will result in sudden and high volume arterial bleeding which will result in death in a matter of minutes. If the patient is at risk for sudden exsanguinations:

• Educate the family about this risk of bleeding.
• Explain to family members that death due to exsanguination is extremely rapid and thus most patients are dead almost instantaneously and thus their suffering is unlikely to be prolonged.
• Order a parenteral benzodiazepine to alleviate patient anxiety and suffering due to bleed. For example “midazolam 5 mg sub cutaneous stat on bleeding, may repeat once after 5 minutes for evidence of suffering.”
• Remove all white bed linen and replace with a dark color linen (green or brown preferred) as blood stains on dark linen are less dramatic and therefore less distressing.

Discontinuing ventilator support

Fast Facts Link #33: Ventilator Withdrawal Protocol (Part I); #34: Symptom Control for Ventilator Withdrawal in the Dying Patient (Part II); #35: Information for patients and families about ventilator withdrawal (Part III)