Chapter 28: End of life care
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Anatomy and physiology
In the days and hours leading up to an expected death, the following are common (Fürst [8], NICE [8]):
- a weaker pulse (but regular unless previously arrhythmic)
- a gradual drop in blood pressure (though at this stage it should not be routinely taken)
- shallower, slower breathing which varies in depth, often in a Cheyne–Stokes pattern
- a decreasing level of consciousness leading eventually to coma, except in those few patients who remain awake until a few minutes before they die
- cooling and clamminess of the skin from the periphery towards the main trunk
- cyanosis of the skin on the extremities and around the mouth
- eventual loss of all signs of cardiorespiratory function and the corneal reflex – death is said to occur at this point.
