Certifying a Death in Vermont
Scenario 3
A 34 year old woman is brought to the Emergency Room by friends, who say the found her unresponsive in the bathroom. Examination reveals no external injuries but the CT scan shows a large intracerebral hemorrhage. She remains comatose for the next several days, is prononced dead by neurolgic criteria and support is withdrawn. You are covering night float and have been asked to certify her death.
Discussion
Even though you don't know this patient, you are obligated to learn some things about her in order to find out if she is a reportable case. The diagnosis of intracerebral hemorrhage is terribly non-specific and will require you to read the imaging reports or contact the primary care team.
For example: if the hemorrhage is subarachnoid and the working diagnosis is rupture of a berry aneyursm, you may certify the case as:
| Part I |
| A. Subarachnoid Hemorrhage |
| Due to, or as a consequence of: B. Rupture of Berry Aneurysm |
| Due to, or as a consequence of: C. |
Part II. OTHER SIGNIFICANT CONDITIONS: Conditions contributing to death but not resulting in the underlying cause of death in Part I.
However, if initial urine toxicology showed the presence of cocaine, then you must contact a medical examiner. Similiarly, if trauma is suspected as in a subdural or epidural hemorrhage, or if there are skull fractures these must be reported.
Some common regions for hemorrhages and probable underlying causes include:
- Basal ganglia distribution due to hypertension
- Middle cerebral artery distribution due to Atherosclerotic cardiovascular disease or thromboembolism (Does the patient have a history of atrial fibrillation?)
- Frontal lobe distribution due to cerebral amyloid angiopathy (any history of dementia?)
- Metastatic carcinoma (Any lesions or history?)