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The classifications are natural, accident, suicide, homicide, undetermined, and pending. Only medical examiner's and coroners may use all of the manners of death. Other certifiers must use natural or refer the death to the medical examiner. The manner of death is determined by the medical examiner.

In a hospital setting, if appropriate equipment is available, this can be supplemented with one or more of the following: Asystole on continuous ECG monitoring. Absence of pulsatile flow using direct intra-arterial pressure monitoring. Absence of contractile activity using echocardiography.

The absence of a blinking response would be expected in the context of death. Wash hands and don PPE if appropriate. Confirm the patient's identify. Confrim the absence of a central pulse (carotid pulse) Confirm the absence of heart sounds on auscultation. Confirm the absence of respiratory sounds on auscultation.

Nurses can only verify a death if the patient is expected to die and has a do not attempt cardiopulmonary resuscitation (DNACPR) order in place. A DNACPR order is essential because it allows the nurse to verify the death without being concerned with the need to resuscitate the patient.

Death certificates from the nineteenth and early twentieth centuries often include obsolete medical terms which may be unfamiliar or unexpected, such as milk sickness (poisoning by drinking milk from cows that have eaten the white snakeroot plant), Bright's disease (kidney disease) or consumption (tuberculosis).

Talk VERY slowly, honestly and realistically. Avoid euphemisms (do not say passed away) and technical jargon. After you have told the person that the patient has died, STOP for a few seconds to allow the person to take in what you have said. Listen for reactions to gauge when they are ready for more information.

Some appropriate underlying causes are chronic medical conditions. Without them, death would not have occurred at the same time or in the same manner (e.g., cerebrovascular disease, essential hypertension, diabetes mellitus, dementia).