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I think you should be good to share. Know Mark. Yeah, should be on. Yeah, looks good. Yeah. All right. So I, I'm Mark. Um one of the fy ones. Uh I'm currently working in the QE and just going to talk through um death certification um with you guys today. So um going to start off with a bit on confirmation of death. So, um I'm not sure if you guys have experience um confirming a death or doing a death certificate, I'm sure you guys have done like mccloskey's or skis on this. So just okay. Uh So um it's important through what was that? So, um for confirming someone death, um usually we get calls from um nurses overnight. That's what usually happens um that they found someone with a low G C S not really responsive and then they'll call you to confirm a death. So usually what you'll do is you'll go to the scene you'll see um if their family members are around, um make sure you're a bit more sensitive. And what I usually do is um if it's an expected um death and that the nurses has confirmed like the nurses went and see and that uh they've passed away and called you to come to the scene. Um I would usually let the family, uh let the family spend some time with the patient and not really interrupt them, um, offer some condolences and um, yeah, and then I'll go in and see the patient afterwards. Um So because it's not really something particularly urgent if that's the case. So in those cases, I'll go in, I'll speak to the patient as if um, there's your life because that's what you're in to do urine to confirm a patient's death. So confirm the identity of the patient first. Usually they have a wrist band on your wrist. Um, otherwise, um it's not uncommon to not find a respect attached to them. So I'll usually go to the nurses that's looking after them or look at their news chart outside your room to confirm if that's the right patient. Um And then I'll assess the patient. So you guys should be quite familiar with this. So you'll speak to the patient. So the CDR get responding to voice and then assess if they're responding to pain. So what you can do is do a Trapezius keys or sternal realm. Um You also should check for their pupillary light reflects, trying to torch in their eye to see if there's any changes in the size of the pupil, check the pulses, carotid pulse, peripheral pulses, and then have a listen on your chest for breath sounds and heart sounds. And yeah, usually I'll listen to the heart sounds and breath sounds for around 2 to 3 minutes. And the most important part is documentation afterwards. So after you've examined the patient, make sure like the patient is dignify, you put, put the blanket back, make sure everything is nice and tidy and then leave the room and then you can document it in the notes. So what I usually start with is writing confirmation of death and writing down the patient's name and kind number very important. And also the time when the nurse found the patient did. So and then you can write down what time that you confirmed the death. But usually on the death certificate, what they're looking for is the time when the patient was first founded. So after that, you can write down all the findings that you did during your examinations. Um like no responsible is no response to pain, no respiratory effort, no heart sounds and etcetera. Okay. So um this documentation part is very important is because if you get called to do this overnight, most likely the one that is going to fill up the death cert wouldn't be you because it's not the night teams job to uh certify someone's death. So you just go to confirm the death and then the death certificate is usually done by the day team. You cross check with your consultant regarding the causes of death and so on. But if it's, if the patient pass away during the day, then you'll just do both of them. Okay. So this is what the death cert looks like. So first page and the second page, um, and usually it comes in a book. So the front of the book there's uh, there's like columns. So you see the serial number at the top, I've crossed it out, but you have to match the serial number of East pages to the ones in front so that they can keep a record of that. Okay. So the first thing that you need to see is the part A which is the details of disease. So you will fill up the name, the date of death, the time of death, the place of death, hell board kind numbers, etcetera. Okay. So a few key things to um remember here is to always right in capital letters and um do not use any abbreviations. Um So like the health bought an area of death occurred. So that's N H S G C but you should write NHS Greater Glasgow and Clyde. Um place of death. You should put the specific ward that the patient died. And also Queen Elizabeth University Hospital followed by the address, 1345 Governor Ruin and stuff like that. Um and part B which is the details of certifying doctor, your name, your G M C number. So this part of the certifying doctor doesn't have to be the doctor that was in attendance. So it's the one the person who's filling up this for basically your G M C number, business address, which is um whatever hospital that you're working in the contact phone, put the ward phone, never put your personal phone number and name of consultant. Okay. So party and part b these are the important things that you should keep in mind. Um Funny thing is I got recently called um not that I'm in trouble anything but I was called by the Death Confirmation Services um because they were called random junior doctors just to make sure that all the informations and stuff are correct. And I think they do surveys and stuff and also they'll give feedback on like if you fill up the form correctly or not. So which is why I get a few tips from them as well. So moving on to the second part, which is part C D and E. So part C is the most important part, which is the cause of death. So you see one, a one A is the, the column that you feel for the cause of death. That that's like that the cause of the condition that leads directly to the death basically. And then B C or D like stuff that's associated to death. And two are like second tools for stuff that are related to the patient situation, but not necessarily leading to the death. Okay. Um I'll give you some example. I give you uh an example on that later at the end of the slide. Okay. So usually the it's quite stressful when you are thinking about like filling up the right information and stuff like that. But usually you're able to confirm with your consultant um regarding what information to put there. So remember the previous slide, let me go back. So if you can see the first column disease or condition directly leading to death, then you can see years, months and days, that's very important as well. Um Just check clinical portal, usually everything will be on there, especially on the sky gateway referral thing. Usually they will have all the dates of when the patient was diagnosed with conditions. So you can fill that inappropriately and if causes of death are not confirmed, um you can put words like probable or presume in front of them. And if there are two causes of death, you can put a joint cause of death. So you put both the conditions in the first column, followed by a bracket writing joint course of that. It's quite rare. I've not done this before and old age can also be used to if an explained gradual decline of patient over 80 years old. And for um this, I don't think you necessarily need to put any interval for that and congenital conditions causing death, you don't need to put that as well. If something that cerebral propose e you can just put since birth beside the condition and quite commonly VC COVID 19 disease. This is the proper term to use if that's the cause for the death and if it's patient having symptoms after 12 weeks and that, that leads directly to death, you should put down his post COVID 19 syndrome. And another tip must be more specific of like image a include the specific type of dementia and also for stroke. Quite a lot of people just write stroke but try to be more specific in terms of like the location of the stroke and the type of stroke. Okay. Stayed. So back to this one, you can see uh part D has it does the body of the disease post a public risk um contaminated and stuff like that. So um you have to take yes or no for these. Is there a cardiac pacemaker or potentially explosive devices? Um You also have to check portal because um a lot of times you are asked during like a night shift to go and confirm uh someone's death. Uh So you should, if you find something, you should document that so that the day team would be aware of this and also never assume that someone doesn't have a cardiac pacemaker double check because it's quite important is that this will bounce back if that's wrong. Um Is there radioactive material, hazardous implant check again on clinical portal if there's any anything? Okay. So part D so part additional information. So this part is quite commonly missed. Um, got a couple of goals with like bounce back of um death certificates from um others that filled in that mist this part because it's all the way at the bottom of the page postmortem if it's needed or not. Um So if the cause of death is not really identified and if they want to further explore what the cause of death is, then we should take this. But most commonly it's a, it's a no on this section and like I said before, um attendance of deceased. So you don't have to be the one that is there during the death to certify it. So you can just take the bottom most column. No doctor was in that. Uh sorry, I was not in attendance upon disease. Okay. And we'll go onto a case. So a 54 year old man with a history of a f was admitted with a stroke and had an unsafe swallow and develop aspiration pneumonia. He became more hypoxic and sustainer cardiac arrest. Um and resuscitation was unsuccessful. So anyone has any idea what to fill for in terms of one a the disease or condition leading to the death? And you want to talk about in the chant. Is there a chat? Oh yeah, I can see it. But yeah, aspiration. Sorry, I'm just going back on the question. So please time of death on the certificate time. So usually I'll put down as the time when the patient was found to be dead. Um, because often times we don't get too go there in time. So it may be like half an hour later or so. So I'll just put the time when the nurses found the patient did. Um, so, yeah, aspiration pneumonia will be appropriate to put as, um, one E and according to the information here, anyone wants to put any, um, anything under one B. So what could have caused the aspiration pneumonia when just type in the chat? Yeah, stroke. But like I said, obviously, it's quite limited information here. He just had a stroke. So I would clarify and see what type of stroke this person is having. Um, usually it will be in the medical notes definitely with the type of stroke. So including that and also remember to put in the interval for that and anyone has anything to put in one c or anyone wants to put anything into. Yeah, the swallow issue is probably due to the stroke causing the aspiration pneumonia. So putting aspiration pneumonia is one A and then under one be putting whatever type of stroke would be appropriate and then probably into I would put a f because that could be a risk factor for this person getting a stroke if okay. Um Yeah, any other questions anyone have, I think that's certification, um, is quite something that you do quite often and, um, it's quite important to know how to do it properly and there is a link I can give you a link and I got, um, on how to fill up, uh, that certification. There's like quite good examples on there as well. Um, and yeah, is there any questions or anything anyone's to ask? I think it's quite straightforward and you're never kind of left alone in terms of, um, putting down the diagnosis. You can always cross track with the senior if you're not sure. Okay. Oh, yeah, sure. Put the link in the chat. Um and obviously like seeing death for the first time. It's quite difficult for a lot of people. So don't be afraid to go and go to your senior to ask for like a deep breath. Um And they are most likely gonna be quite happy with that. Okay. Let me look for the link and then I'll pop in, in the chest. Yeah, just while marks doing that. I'll put a feed by link in the chat. If you guys wouldn't mind filling out, try using this link. I think it will bring you to that fix. Thanks for listening guys and thanks for participating as well.