Diagnosing death
Authors: S. Mardel, C. Thomas, G. Campbell-Hewson, C. V Egleston, S. M Robinson, T. English, R. Charlton
Journal: BMJ (1997)

# Start resuscitation first {#article-title-2} Editor–The subtitle of Rodger Charlton's editorial on diagnosing death–Getting it right if vital opportunities for resuscitation are not to be missed–misleads readers.1 It does not emphasise the common need to start resuscitation when the diagnosis is in doubt, which in practice is often while information is still being gathered from attendants. Only when the clinician has decided not to try resuscitation does the thorough examination proposed by Charlton become relevant. Before making this decision respiration should not be checked until the airway is opened, and a pulse should not be sought until effective ventilation has been provided. Although we acknowledge the difficulties posed by diagnosing death in the community, the logical sequence of current resuscitation guidelines2 3 must be followed unless (or until) a positive decision not to resuscitate has been made. Furthermore, in the case of drowning these guidelines (including those referenced by Charlton) do not propose the Heimlich manoeuvre to expel water from the lungs but amply describe the reasons for not doing so. 1. 1.↵1. Charlton R . Diagnosing death BMJ 1986;313:956–7. (19 October.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Handley AJ, 2. Swain A eds. Advanced life support manual. Resuscitation Council (UK). 2nd ed. London: Resuscitation Council (UK), 1994. 3. 3.↵1. Advanced Life Support Working Party of the European Resuscitation Council . Guidelines for advanced life support. Resuscitation 1992;24:111–21. [OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] # Death after electric shock and lightning strike is more clear cut than suggested {#article-title-5} Editor–Some of Rodger Charlton's assertions about death from environmental causes are faulty.1 He says that death should not be confirmed after immersion until water has been expelled from the lungs by a Heimlich manoeuvre and that death should be confirmed with extreme caution after lightning strike, electric shock, and airway obstruction. There is … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DCharlton%26rft.auinit1%253DR.%26rft.volume%253D313%26rft.issue%253D7063%26rft.spage%253D956%26rft.epage%253D957%26rft.atitle%253DDiagnosing%2Bdeath%26rft_id%253Dinfo%253Apmid%252F8892404%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=313/7063/956&atom=%2Fbmj%2F314%2F7078%2F442.2.atom [3]: {openurl}?query=rft.jtitle%253DResuscitation%26rft.stitle%253DResuscitation%26rft.volume%253D24%26rft.issue%253D2%26rft.spage%253D111%26rft.epage%253D121%26rft.atitle%253DGuidelines%2Bfor%2Badvanced%2Blife%2Bsupport.%2BA%2Bstatement%2Bby%2Bthe%2BAdvanced%2BLife%2BSupport%2BWorking%2BParty%2Bof%2Bthe%2BEuropean%2BResuscitation%2BCouncil%252C%2B1992.%26rft_id%253Dinfo%253Adoi%252F10.1016%252F0300-9572%252892%252990016-6%26rft_id%253Dinfo%253Apmid%252F1335602%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1016/0300-9572(92)90016-6&link_type=DOI [5]: /lookup/external-ref?access_num=1335602&link_type=MED&atom=%2Fbmj%2F314%2F7078%2F442.2.atom [6]: /lookup/external-ref?access_num=A1992KA99900002&link_type=ISI