घर पर मरीज को देखने के लिए बुलाए जाने पर मृत्यु की घोषणा कैसे करें? #drabhishekshukla #death#aastha

The Nursing Officer asked, “Sir, I was called to a nearby neighborhood for death declaration. If the person is not breathing, should death be declared immediately?” Dr. Abhishek Shukla, Geriatrician, explained that death declaration is a serious clinical responsibility and should always be done carefully, systematically, and with sensitivity, especially when it is outside the hospital setting and no medical instruments are available. He emphasized that absence of breathing alone is not sufficient to declare death. The first step is to check for absence of pulse, preferably the carotid pulse, for at least one full minute, as weak pulses can sometimes be missed. Next, confirm absence of spontaneous respiration by observing chest movements and feeling airflow from the nose and mouth for a full minute. The third step is eye examination. The nursing officer should check for absence of pupillary light reflex using a torch. In death, pupils are usually fixed and dilated and do not react to light. The fourth step is to assess unresponsiveness by calling the patient loudly and applying gentle painful stimuli such as nail-bed pressure. There should be no response. Dr. Shukla further advised that even if the patient is not breathing, it is strongly recommended to suggest the family take the patient to the nearest hospital, whenever feasible. This allows a qualified medical doctor to evaluate the patient and perform an ECG, which provides objective confirmation of cardiac arrest and death. This is especially important in sudden collapse, unclear history, or medicolegal situations. If there is any doubt, the patient should always be treated as potentially alive. Death declaration must be documented properly and conveyed to family members with dignity, empathy, and compassion.