*Hypothermia
*Drug overdose (drugs like opioids, tricyclic antidepressants, barbiturates, alcohol and anaesthetic agents)
*Near drowning, cold water immersion
*Severe hypoglycemia
*Severe hepatic encephalopathy
*Myxedema coma
*Severe catatonic state
------
*These conditions are important and need to be remembered when you are confirming death of a patient. It is also important for everybody to know the PROTOCOL FOR CONFIRMATION OF DEATH :
1. Feel for a major (carotid or femoral) pulse for atleast 1 minute.
2. Listen for heart sounds over the cardiac apex for at least 1 minute.
3. While you are doing this, watch the chest wall for any movement.
4. Listen to the chest for breath sounds for 3 minutes.
5. Watch for any spontaneous movement during your examination.
6. Check there is no motor response to supra-orbital examination.
7. Simultaneously retract both eyelids, shine a bright light into each eye in turn and check that both pupils are fixed and unreactive.
8. Check the corneal reflexes, which should be absent. (The video below shows how you elicit a CORNEAL REFLEX)
*In certain situations, additional investigations may be available and confirmatory: for example, an ECG monitor trace showing asystole, absence of pulsatile flow from an intra-arterial line or absence of contractile motion on echocardiography.
