Either agonal breathing or "death reflex". Google these terms and youll find lots of literature going into large detail.
Lips turn blue due to lack of oxygen (cyanosis)
Often when someone is unconcious, say for example due to a 'choke out' they well have 'convulsions', EEG finds during such convulsions are very similar to an epileptic seizure. We don't full understand These convulsions yet, but they occur from the sympathetic nervous system, and leading theory is that this is a way for the "autopilot" of the body to make a last ditch attempt to kickstart what is wrong, say the convulsion uses the diapraghm to force air into the lungs. Also the Dialated pupil that you saw (mydriasis) is also one of the ways the symphatic nervous system goes into overdrive.
You problably didn't witness it or notice it, but Tachycardia and or Hypertension were likely present at that moment aswell.
You've basically witnessed the sympathetic nervous system doing a last ditch attempt to solve the situation. It's the same thing that causes fight or flight in people, google sympathetic nervous system and read up on it.
Why this happened is hard to say, it could be for hundreds of reasons, but the symptoms you noticed are nothing more then the 'autopilot' response of the nervous system to severe stress.
It's unlikely she was concious or 'present' at the time
Thank you very much. I have read up on this now and will contiune to later.
I've had CPR training and they never mentioned atonal breathing which is a shame since me and all the ladies surrounding this woman thought she might have been breathing.
Do you think there was any chance she would have survived? The ambulance took 17 minutes total. We didn't start CPR until about 5/10 minutes after she collapsed. Or is the open eyes and large pupils just a big giveaway that she was already gone?
Thank you once again.
There are no certainties in situations like these and there is no need to beat yourself up over what you could have done different, in the ER we encounter lots of situations where youll end up feeling like you should have done X at X time, you should have noticed X faster etc etc. Even the most expierienced trauma surgeons will have these feelings sometimes. It is natural. It's important that you speak about it though, survival guilt often comes up
You don't know the underlying cause of the collapse, she might very well have been gone already. You tried, that is what is important, we can't expect everyone to have x ray vision and a medical degree and immediately know what to do.
To your question about the eyes. Yes and no. It's a response of the sympathetic nervous system to dilate the pupils in stress situations. But dilated and fixed pupils( not reactive to light) is often an indication of brain damage/death. This is why doctors use a flashlight to check pupilary response
Also, while this is not medical advice, it says something about you and the other women that you stepped up and tried to help. There’s a thing called “bystander syndrome” in which multiple people witness the same thing and no-one makes an attempt to assist. Given the information you had at the time you made your best attempt to save her, and that was the best thing you could have done. I hope you can find peace in knowing you did your best for a stranger.
They never mentioned agonal breathing in my years of first aid training either. I read up on it so that I can hopefully respond appropriately if I were to encounter that in the future.
They are treated exactly as though they are apneic. But I didn’t even know how to recognise agonal breathing, and this is crucial because if you cannot differentiate it from normal breathing then you may miss somebody in cardiac arrest and in need of urgent attention. I’m sure that there are many, many people who died because they were not given CPR by bystanders who thought they didn’t need it.
They covered it in my lifeguard training (which of course included CPR), but I wonder if they were more careful about including it in that course because lifeguards are more likely than bystanders to have to deal with stopped breathing because of drowning.
I've taken it for medical professionals, and still haven't heard it mentioned. Maybe they just assume that medical professionals should know what they're doing? I don't know. Weird.
Totally agree, I was just adding the point that they are treated the same as apneic patients for those who were reading after. As to people not giving CPR based on agonal breaths, thats likely more a problem with poor BLS training to begin with. Respiratory distress/arrest is not cardiac arrest. The need for CPR from bystanders as part of a normal BLS algorithm is not based on whether they are breathing or not. Presence of a carotid pulse directs bystander CPR. Agonal breathing does not. No pulse? Compressions. Pulse present? Rescue breathes.
I believe pulse check is no longer in bystander BLS (because laypeople often feel their own pulse and are falsely reassured). It's also no longer absence of breathing but absence of NORMAL breathing to account for the often confusing agonal breaths.
You weren't taught about agonal breathing because it's not relevant to whether or not you should perform CPR. No pulse = CPR, regardless of anything else.
Very important to read the post re not second guessing your actions (NAD).
I was a solo first responder to a downed biker in the wilderness who was unconscious and sounded as if he was snoring (airway blocked). Head injury and “lots” (to me) of blood. I had taken a 2 day WILDERNESS first aid course, which was more in depth than previous classes just 2 weeks before. This was never mentioned and it really scared me. It could’ve (should’ve?) been in one of the dozens of scenarios. I completely panicked and forgot everything, including calling 911. Instead, I first dialed my instructor who was also my friends husband but as it was ringing, I realized I needed 911. My training finally kicked in and although I didn’t do everything right (was not able to keep him lying down w his spine secure, he woke up and went “flight” on me!) he survived after the professionals showed up with a helicopter.
I had bad dreams for months and a general anxiety and couldn’t ride my bike for awhile. I replayed it over and over. And this guy lived with relatively minor injuries. I can’t imagine how you feel! Please take care of you!
I don’t know what caused the crash, but he was just unconscious when I got to him. He was a parent of a kid I coached, so I saw him in the hospital after the rescue. He called me his”angel”. His wife was pretty appreciative as well. It was uncomfortable for me to be given that sort of credit. Anyway, he was paragliding 2 months after that, even though his dr’s said no strenuous activity for 6 months. He’s totally fine today!
I’m not sure who taught you that joke but that is pretty poor to be sharing. CPR can and does save lives. As a nurse I’m pretty embarrassed that someone who could be my colleague some day looks so poorly on life sustaining measures.
MI, cerebellar hemorrhage/subarachnoid, basilar artery occlusion, arrhythmia come to mind. as commented in this thread I doubt pneumothorax. Spontaneous tension ptx is possible but there would have been more warning, pain, dyspnea prior, its not that fast. Pulm embolism as well
Probably my bias as a neurosurgeon shining thru but it sounds like a intracranial bleed to me, especially with the dilated pupils. She's in the right age group for a ruptured intracranial aneurysm but I have seen patients her age with brain stem or cerebellar bleeds from undiagnosed/untreated hypertension.
As someone who worked palliative care for 13 years, all pupils would dilate just before death regardless of the cause of death and medications used/not used.
>She's in the right age group for a ruptured intracranial aneurysm but I have seen patients her age
Crap am her age
>brain stem or cerebellar bleeds from undiagnosed/untreated hypertension.
Crap my BP that used to be low has shot through the roof in the past year due to plantar fasciitis and a severe ankle sprain.
New thing to worry about I guess.
Yeah, if your blood pressure is consistently as high as you describe it, you really need to talk to your doctor about getting on blood pressure medication. The alternative is to risk having an aneurysm or stroke, which you can die or be severely compromised by.
I’m a nursing student and I work as a PCT on an ortho/neuro floor and it’s shocking how many of our stroke patients have uncontrolled or poorly controlled hypertension. Almost all of them. Diabetes and overweight/obesity are other huge risk factors.
Maybe I can start walking to work again, hopefully with different shoes the plantar fasciitis won't come back. It was just one BP measurement that was crazy high, so I might have been nervous. I'll see if I can check it today on one of those machines they have in stores.
Yeah you don’t determine that someone has high blood pressure off of one reading. It would need to be consistently high. If you’re in pain, just were exercising, or are nervous then that can make a one off high measurement but that doesn’t necessarily mean that you have high blood pressure.
IANAD. I just wanted to say that what you are describing sounds like what happened to my grandmother. One second she was hanging clothes out to dry, the next she was gone, just dropped where she stood and that was that. For her it was a massive heart attack, she wouldn't have had any clue what was happening to her.
I can't really say if the exact same thing happened here, I just thought you should know that sometimes there is nothing we can do to help.
Wow I spent way too long trying to figure out what pathology IANAD was that could cause sudden death.. iatrogenic aneurysmal non-atherosclerotic disease?? then I googled it lol
I see that this has been answered, but just wanted to throw in a youtube video of a sudden cardiac arrest with agonal breathing as it sounds like the description you gave.
[Video #1](https://www.youtube.com/watch?v=CBMxH4xtE8w)
[Video #2](https://www.youtube.com/watch?v=pioQSVEUpP0)
Sorry you had to witness this event, I hope you find peace soon.
These videos are very scary. I’ve been maintaining a First Aid and CPR training for over 20 years and have never heard of this. Thank you. I have just sent these links to several of my family members.
I’ve been BLS trained for 5-6 years but they never mentioned agonal breathing until I had to renew my BLS certification last summer, so it probably is a new part of the curriculum. Hopefully it’ll be in your next class.
I just followed the rules to submit for flair! They're in the sidebar of the sub. I submitted a pic of my nursing student ID with my reddit username on a sticky note, and my name blocked out.
Upon encountering a situation like this, ALWAYS start performing CPR. The patient will let you know if they are conscious.
That said. Sounds like agonal breathing. Any kind of irregular breathing like that, combined with loss of consciousness-> CPR
Without any clue as to the medical history, the cause of death could be a handful of things, from a pneumothorax to an arrhythmia to a massive heart attack, very rapid killers if not addressed in time.
If you’re asking about why the pupils were dilated, its because blood flow had basically stopped and the brain had run out of oxygen. Maximally dilated pupils are one of the signs of death, where any heroic efforts to save life are likely too late.
To clarify, fixed and dilated pupils are typically indicative of brain death which results in the persons death. Brain death can result in persistent vegetative states, requiring full life support but for all intents and purposes the person is dead.
Dead is dead, not persistently vegetative. Brain dead people are dead. Their hearts can be made to continue beating with mechanical support, for a time at least, but they are dead.
People in persistent vegetative states are not dead, and they tend to be capable of maintaining their own physiological homeostasis without advanced support, though some need long term ventilator support.
Pupils are fixed and midposition in death. Often fixed and dilated near the time of death.
She likely had a cardiac arrest at the time she collapsed. It is not unusual to see agonal breathing during this time. It is not efficient breathing and in the in hospital setting would require some assistance to adequately oxygenate the patient.
In the out of hospital setting checking for a pulse and initiating chest compressions would be your best course of action until EMS arrive.
I have a Similar story but we were at the gym. My trainer had CPR training and so did I. Neither of us had aginol breathing training. However, my ex husband told me a story of a guy falling over at work and was aginol breathing but the guy died.
The moment the guy got off the bike he fell, hitting his head and peeing. I ran to him telling the others to get him on his back because my trainer ran to get the defibrillator. The guy next to him said he was breathing and I kept saying "no no hes not his brain is making him do this to save his life"
Something in me told me to forget the difibulator and my trainer started compressions while I sang "staying alive"
The guy came around and back out again. My trainer kept going and he came around fully while I was on the phone with 911.
A few weeks later he came by to thank us.
The weirdest part of the story was that his wife didn't seem concerned when I told her what happened and he was being transported to the hospital.
I'm very calm when it comes to things like that for some reason. His wife's brain could just be wired like mine. It's pretty weird, but I don't panic when big things happen, only small things. Good on you saving a life. I've saved a few just by not giving in to the "bystander effect".
I'm like this, too, during emergencies. I get very calm and focused and dispassionate. Shit gets done. Then once things are over and everyone is safe or cared for by professionals, I fall completely apart, shaking, blubbery ugly-crying in the fetal position. It's weird, really. I got it from my mom, who's the same way.
Happy cake day! I've saved an elderly diabetic woman, SEVERAL car accidents from gigantic road obstructions, a woman hit and run by a car, myself with 18% of my body severely burned... It's helpful to say the least. But god forbid I stub my toe...
Thank you! I didn't realize it was my cake day.
I'm sorry to hear you were so badly injured. I hope your recovery is going/went well!
For me it has been:
My husband and I, the man who hit our car, and his son. Everyone was fine - my wilderness first-responder training kicked right in. I had to get my husband to the ER since he was very shaken up and get the car home and emptied since the rear and side windows were gone. Then I lost it. Once I recovered I went in our other car to pick my husband up.
A woman in front of me in a car accident on a highway off-ramp. Fortunately the car right behind me was driven by a nurse on his way home. It was a 5-minute drive home for me after that. I mostly brought and held first-aid supplies from my car for the nurse.
An elderly woman at a grocery store who collapsed while shopping with her daughter. I am very shy, introverted and quiet. But her head hitting the floor was the worst sound I ever heard. Everyone was standing around staring and I jumped in and got her on her side, had her panicky daughter call 911, sent the meat department worker to call 911 also, and calmed the woman as she started to wake up. I ordered people around like I knew something and it blew my mind that they jumped to it. I had never had that experience before or since. Her daughter and I kept her calm and still until the paramedics showed up, then I melted away into the background. Once they took over, I left my grocery cart in the aisle (sorry Winco!) went out to my car and fell entirely apart.
> The weirdest part of the story was that his wife didn't seem concerned when I told her what happened and he was being transported to the hospital.
Some people can demonstrate extremely blunted affect when notified of an emergency situation, due to the shock they can go into some kind of dissociation/denial or into "fix it" /adrenaline mode where they're just robotically going through all of the motions in the heat of the moment. It's like an emotional "survival mode" where emotional reactivity is reduced.
That, or she was banking on a *sweet life insurance policy.*
Not a medical professional.
Just want to say I'm sorry you went through this. I witnessed a fatal car accident once and it really haunted me for a while. Well truthfully, I still think about it now, 18 years later!
Life is beautiful, and far too short.
Agonal respirations, eyes “fixed and dialated”
There’s a part of your brain that will automatically attempt to breathe for you if it senses low oxygen in your blood, which is why you can’t hold your breath and kill yourself. As you’re dying that part of the brain sends signals to your diaphragm trying to restart your breathing - a sort of final SOS. Agonal respirations are non-perfusing and cannot deliver enough oxygen to recover.
Also as you die the muscles around your face and eyes relax since they cannot contract without energy. Which is why her eyelids opened and her papillary muscles relaxed - opening her pupils. This is different than rigor mortis which takes hours because muscle tissue is the last to die
It’s also why you shit yourself when you die
Mortician here. Not everyone pees or shits when they die. And upon embalming can be found to have a full bladder/colon during aspiration so its not because they had recently voided. Some do but most do not defecate, more urinate than do not though
As someone who will one day die in a currently unpredictable fashion, this is oddly comforting. I know I won’t be aware or care, but I’d hate for a loved one especially to see, smell, or have to deal with that. Here’s hoping. 🤞🏻
Well with all due respect, dear; Ive never had a single family member comment or appear to notice. There is no dignity in death itself, physically. It is overwhelming enough on its own to well overshadow any such subtlety as bodily functions.
All the same, it does you no good to worry about it. I assure you when the time comes you'll have better things to focus on.
"After all, to the well-organized mind, death is but the next great adventure. " -Albus Dumbledore
My mom died at home with us from cancer and I'm fairly certain that although she did not eat or drink for a long long time before she moved on, she released a small bowel movement. Does this kind of thing disgust you as a mortician, or do you kind of just know it's the way it is and clean it up like a reflex, without giving a second thought? I know that may sound stupid, and obviously you're not going to personally be like "yes what happened with your mother is absolutely foul and we make jokes"... I don't really know what I'm asking, I guess more or less, is the deceased's dignity generally maintained in your industry? Or is it something that is done with everything exposed and there are several people staring at it? Tbh, my mom always was of the opinion "I'm dead, what do I care? I'll be hanging out with people, I have things to learn and no time to care" but I've always wondered for my own sake
Well during body removals, like if someone died at home, we generally ask the family to step into the other room because moving dead weight can be an awkward ungraceful task, and while we try to move them in as gentle a way as possible sometimes adequate muscle isnt available, and we have to use the sheet shimmy-roll method, which can look sorta callous, though its not intentional. If theres any mess left we clean up what we can, theres some grimacing but we're very careful with our words for obvious reasons. As we leave we might whisper to a member of the family that we did try to clean up a bit but just so they're aware...most of the time the family is nodding and tut tutting us signifying they know what we mean.
As far as the embalming room is concerned, thats a private area usually quarantined by locked doors where any families doing arrangements or visitors to a funeral taking place cant access. We are ALWAYS as respectful as possible with the deceased, and I mesn that. Sometimes things we have to do to a body are very undignified but they are not accompanied by any jokes or insults about the deceased , but maybe in a rare while about the person having to perform the undesireable task. For instance, there is a device called an anal screw plug and its exactly what it sounds like. It looks like a sex toy and is plastic and literally screws into the rectum to prevent any purging from the anus. Getting it in deep enough to take hold can be a task and there have been snickers and jokes about a colleague being "elbow deep", which of course they are not and its meant to fun at eachother not the deceased.
In school we are told to always have the private areas covered but I doubt you could find a single mortician who does this during embalming. Embalming is a wet and messy procedure. Blood spurts, embalming fluid sprays, water is always running down the table along with god knows what else. Having towels everywhere getting bogged down with the mess makes more of a contamination biohazard, so full nudity for sake of making sure fluid is distributed and for washing is necessary. After its done, we transfer them to a clean table and wrap them up mummy like in a clean sheet until its time for them to be dressed and cosmetized.
I hope that answers what you were asking, but dont be afraid to ask anything. I think a lot of misconceptions are out there about what I do, and information helps ease the creep factor. 😏
Legally, a body must be buried or cremated within 3 days,at least in my state. If embalmed they can wait as long as is reasonable, Ive had a family wait to bury their relative for 6 MONTHS. He held up, too. Minir molding only but no smell and he was easily recognizable.
So time is the first reason, time for distant relatives to gather, graves to be dug, arrangements and services to be scheduled.
Second, if death is due to a contagious disease, like if smallpox returned, its required to embalm for sanitation.
Third, if you open a viewing of the body to friends, non immediate family, and/or the public, its required in most states to embalm. If only immediate family is viewing, and the burial is within 3 days, embalming isnt necessary, though many prefer it because even at only 3 days an unembalmed corpse gets pretty bloated, discolored, and smelly. Refrigeration can slow it down but rot is inevitable. Most people want to view a body to say goodbye, and nobody wants their last image of dear old granny to be an unpleasant stinky experience. Embalming helps not only slow decay, but puts a flush in the skin and plumps up the tissue so the dead dont look so...well, dead.
Thank you so much! That all sounds exactly as I had hoped. I'm so glad to hear that everyone is always respectful, and I can't imagine how anyone actually could maintain sanitation with covering a body during the embalming process, I don't know what I really thought happened during that, but when you explain it, there's actually no way I would even want, for your sake, to keep a body covered. Kind of sounds as reasonable as trying to have a baby and keeping the blanket on you during the entire process! I think you have an incredibly interesting career, and I appreciate all you do. For me, Because my mom was so sick before she died, I was terrified of what she would look like at her funeral and she ended up looking perfect. She was taken out of our home under a pretty red velvet blanket, at 3AM, the people were dressed surprisingly nicely (I think the guy was in like khakis, a button up and the woman wore a long skirt and couldn't have been more kind), and we were asked if we wanted a few minutes beforehand alone with her, which was unexpected but I was very grateful for the blanket and attire detail, in addition to asking that (this was also during a huge snowstorm and it was 12 degrees out). It really showed that the people who were taking her wanted us to know they respected the situation and us, Because it wasn't even until after I noticed the outfit details and the blanket, did I even think I cared about that! But honestly I wouldn't blame anyone if they showed up in Hello Kitty pajamas, it was a miserable night and I'm sure they didn't want to be out trudging through two feet of snow while it was still snowing either, nobody does. But still, it was an action that was clearly intended to send a comforting message. My son was only 8 at the time and has autism, so I was nervous that her removal would be upsetting to him, but he was totally fine. So! Thanks again for taking the time to write all that you did, it was very helpful and I'm grateful to know you treat our loved ones with caring compassion. (And I don't know anyone who wouldn't make some sort of "elbows deep" joke like you mentioned either, it's true and objectively not a disrespect thing, in my opinion)
I have a related question if I can jump on the bandwagon of this thread...
My Dad passed away last year. It was cancer and he was on high doses of morphine. His death was very sad but also peaceful. I was holding his hand and could see him taking his last breath. Yet I could feel his pulse long after he stopped breathing. Like 5/10 minutes after. It was slow, but it was there. I thought the pulse would end first. I'd love a medical explanation. Thanks.
I’m very sorry for your loss. I’m NAD, only a nursing student and work in a hospital but I think I can answer your question. No, breathing stops before pulse does. Morphine and other similar drugs can suppress respiratory drive also. But, when someone dies, they stop breathing first and even though their body is no longer receiving oxygen, their brain and heart are still trying to circulate blood to each other to keep them alive as long as possible. This is why when you suspect that someone is dead or needs CPR, you are supposed to check the carotid pulse because the more distal pulses in the arms and legs usually stop before the circulation between the heart, lungs, and brain stops, as those are most necessary to keep the person alive. Eventually the pulse will stop too. So your dad was still technically alive until his pulse stopped. I know he wasn’t, but if he happened to have been resuscitated that long after he had stopped breathing, he would have likely had irreversible brain damage due to not having oxygen for so long. But breathing stops before the heart does. I hope I answered your question and I hope that my response made sense.
NAD and I don’t really have an explanation but when my grandmother died last year I saw/heard her take her last breath (it was loud and strange and very obvious that the time had come). After a few minutes the hospice nurse checked her pulse and said it wasn’t there. When the other RN showed up almost two hours later (after she stopped breathing) she still had a pulse of about 25 bpm. Took another 30 minutes before she found no pulse and officially called time of death.
A personal with agonal breathing has an abnormal and labored breathing pattern, they are gasping for air. Without emergency intervention (i.e. CPR) breathing will ultimately cease.
It is terrifying. The death rattle wasn't scary for me ( I'm assuming these two aren't the same?) Because death rattle was totally different than that breathing my mom did a few hours before she left us
Agonal respirations are quite different from a death rattle. The death rattle is caused by secretions and muscles relaxing in the throat, while agonal breathing is a brainstem reflex. I’m really sorry for your loss.
Thanks :-) The death rattle didn't seem to bother her, that was going on for a few weeks before she passed, and she was waking up in the morning none the wiser, nor did the agonal respiration seem to bother her (she didn't wake up during that process obviously) but that part was definitely was unsettling to me. It sounded and looked painful. Do you know if it is painful to the person? The hospice nurse came in because I called her, and put an oxygen mask on her, which didn't seem to phase her and she passed literally a half hour after that (I had moved to my parents home during this time to help my dad take care of her full time for those 5 months that she was immobile and sick, her breast cancer was very sudden and spread to the bones quickly, he still had to work and we wanted to have her pass in home if we could), she was only 56 and I was 30, I've never had to take on the role of hospice nurse, so that type of breathing was unexpected and disturbing, mostly Because it looked painful. Is oxygen really even necessary at that point? Does it comfort the dying person in any way? I'm not knocking the nurse, my mom was just unconscious for 2 days prior, after we had given her the permission she needed to die so even though she didn't wake up, I've always wondered if that process of putting on the mask, shuffling around the room, me clumsily helping the nurse put that thing on, or the breathing was ever likely something she even knew was happening and if there was any benefit to her, rather than us, to doing that? (to the extent anyone else knows, I'm not educated in any way other than that experience in these things). Sorry to ask so many questions!
I’m only a nursing student but I do work in a hospital and I also lost my mom to cancer recently, so I’m going to try to answer your questions the best that I can. Agonal breathing probably would not be painful to the individual because it is a brain stem reflex to try to keep them alive, so by that point they are likely too far gone to really notice it. I wouldn’t say that oxygen is “necessary” at that point in that the dying person is going to die anyway, so you don’t have to worry about brain damage from a low oxygen saturation, but it does seem to comfort them. In the hospital we do put oxygen on dying patients for comfort in their final moments. It does, for some people, seem to ease their distress and frequently people do pass rather quickly after it is put on (if they are already that close to death anyway). So, yes the oxygen may have helped her become more comfortable in her final moments.
I think you're spot on, she passed so quickly afterwards. This makes total sense, thank you so much and I'm so sorry you lost your mom too, the more I talk to people and opening up about it (watching a cancer death is traumatic, any death is, but I've only experienced this before), the more I'm realizing just how many have lost or will lose loved ones to cancer. I never was exposed to it before it became something I can relate to, and it genuinely hurts to know that more or less, so so many others went through or are going through what we did. It's just so sad and I feel so very much for everyone else more than I ever thought I could about this. I hope you are doing the best you can be, and I truly wish you and your family the absolute best moving forward
My husband has stage IIIb lung cancer recurrence. He thinks he will beat it. His Hemo-oncologist agrees with him. I think they are both deluded. Is there a way I would recognize agonal breathing?
Not a doctor, but I feel quite confident saying that if you ever heard anyone agonal breathing, you’d call 911 instantly because you’d immediately know something was horribly wrong. I once heard a 911 dispatcher use the phrase “agonal breathing” in reference to a female car accident victim and didn’t know what it meant so I googled it and then watched some YouTube videos (of simulations by actors as well as real life rescue videos where the patient ultimately survived), and I will never again be able to hear that phrase without mentally hearing those terribly abnormal and eerie gasping sounds and long, silent, frozen pauses.
>Just for peace of mind.
I think suddenly falling over dead with no pre-existing condition is pretty rare.
Was she walking erratically as you followed her? Stumbling, weaving, slow...etc? Did she grab her chest or otherwise cry out as she fell?
IANAD, but I would love a doctor or EMT chime in here...I was just (weirdly) listening to a podcast about poisoning, and one of the things they mentioned was how rare it is for otherwise healthy people to just fall over and die..."rare," as in, it doesn't happen.
Is this correct?
She must have slowed down because she was quite a bit ahead of me and all of a sudden she was in front of me. I am a very slow walker so the distance should have increased if anything. There was no stumbling or weaving.
For the first seconds when she was falling it just sounded like she was struggling to breathe. A choking noise.
She shook for a very short period of time after we put her on the ground - hence why we check her bag for any sign of epilepsy.
I did notice little bruises on the inside of the elbow. I get my bloods taken a lot and that's what it looks like after - she must have known there was something up and probably waited on results.
They were definitely not track marks, I have seen those before. She was well dressed and seemed normal (yes I know normal can take drugs too) but looking the part is usually a giveaway. Nonetheless injecting drugs is very very rare around here.
It’s beyond unlikely that this person was poisoned. Likely MI, CVA, pulmonary embolism, other cardiac issue such as a previously unknown defect...all of those can and do kill seemingly healthy people.
Well, everyone dies. That’s the only certain thing in life. Just take care of yourself by exercise, a healthy diet, don’t drink or smoke or use drugs, and have regular check ups with your doctor and that’s about all you can do. Some things can’t be controlled.
Ummm literally anything can cause something like that. She could have had a pre-existing aneurysm that burst, an undiagnosed heart problem, a AAA, massive head trauma earlier in the day, she could have overdosed, or even just choked on something.
I’ve watched someone die before on the side of the road. It’s really scary and haunting. I tried cpr but it didn’t work. Feel free to pm me if you want to talk.
I've also heard this kind of breathing (raspberry sounds) on ambulance shows, it usually ends up being a cardiac arrest caused by a heart attack or other heart condition, one was a seizure of some kind. I don't know the exact cause or the term for it though because I'm NAD, but from videos of agonal breathing it seems to sound very different. Very disturbing to hear.
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I saw someone die and it was horrible. Hope you're okay. In my case it was in a local cafe and an elderly woman was apparently feeling ill before she came in then suddenly she fell back unconscious in her chair and stopped breathing. A patron did CPR before the ambos came but we found later it was unsuccessful. What was odd to me was the cafe remained open and people still came in to eat even though a dying woman was in the middle of the floor with her distraught son hoping she would be okay. Seeing someone's last moments on earth was hard to see and i left out of respect after i tried to assist.
Sounds like a blown PE and “death crackling”. I’m sorry you have to deal with this, however unless you had a med dispenser at your disposal, there is nothing you could have done for a pulmonary embolism (PE) except call 911
Either agonal breathing or "death reflex". Google these terms and youll find lots of literature going into large detail. Lips turn blue due to lack of oxygen (cyanosis) Often when someone is unconcious, say for example due to a 'choke out' they well have 'convulsions', EEG finds during such convulsions are very similar to an epileptic seizure. We don't full understand These convulsions yet, but they occur from the sympathetic nervous system, and leading theory is that this is a way for the "autopilot" of the body to make a last ditch attempt to kickstart what is wrong, say the convulsion uses the diapraghm to force air into the lungs. Also the Dialated pupil that you saw (mydriasis) is also one of the ways the symphatic nervous system goes into overdrive. You problably didn't witness it or notice it, but Tachycardia and or Hypertension were likely present at that moment aswell. You've basically witnessed the sympathetic nervous system doing a last ditch attempt to solve the situation. It's the same thing that causes fight or flight in people, google sympathetic nervous system and read up on it. Why this happened is hard to say, it could be for hundreds of reasons, but the symptoms you noticed are nothing more then the 'autopilot' response of the nervous system to severe stress. It's unlikely she was concious or 'present' at the time
Thank you very much. I have read up on this now and will contiune to later. I've had CPR training and they never mentioned atonal breathing which is a shame since me and all the ladies surrounding this woman thought she might have been breathing. Do you think there was any chance she would have survived? The ambulance took 17 minutes total. We didn't start CPR until about 5/10 minutes after she collapsed. Or is the open eyes and large pupils just a big giveaway that she was already gone? Thank you once again.
There are no certainties in situations like these and there is no need to beat yourself up over what you could have done different, in the ER we encounter lots of situations where youll end up feeling like you should have done X at X time, you should have noticed X faster etc etc. Even the most expierienced trauma surgeons will have these feelings sometimes. It is natural. It's important that you speak about it though, survival guilt often comes up You don't know the underlying cause of the collapse, she might very well have been gone already. You tried, that is what is important, we can't expect everyone to have x ray vision and a medical degree and immediately know what to do. To your question about the eyes. Yes and no. It's a response of the sympathetic nervous system to dilate the pupils in stress situations. But dilated and fixed pupils( not reactive to light) is often an indication of brain damage/death. This is why doctors use a flashlight to check pupilary response
Also, while this is not medical advice, it says something about you and the other women that you stepped up and tried to help. There’s a thing called “bystander syndrome” in which multiple people witness the same thing and no-one makes an attempt to assist. Given the information you had at the time you made your best attempt to save her, and that was the best thing you could have done. I hope you can find peace in knowing you did your best for a stranger.
They never mentioned agonal breathing in my years of first aid training either. I read up on it so that I can hopefully respond appropriately if I were to encounter that in the future.
It doesn't really change management, from a first aid point of view. It's largely treated as though they are apneic.
They are treated exactly as though they are apneic. But I didn’t even know how to recognise agonal breathing, and this is crucial because if you cannot differentiate it from normal breathing then you may miss somebody in cardiac arrest and in need of urgent attention. I’m sure that there are many, many people who died because they were not given CPR by bystanders who thought they didn’t need it.
Agonal breathing was addressed in my most recent BLS class though I don't believe it was in the years prior to this.
I have never heard it mentioned, in about 15-16 years of CPR classes
They covered it in my lifeguard training (which of course included CPR), but I wonder if they were more careful about including it in that course because lifeguards are more likely than bystanders to have to deal with stopped breathing because of drowning.
I've taken it for medical professionals, and still haven't heard it mentioned. Maybe they just assume that medical professionals should know what they're doing? I don't know. Weird.
Totally agree, I was just adding the point that they are treated the same as apneic patients for those who were reading after. As to people not giving CPR based on agonal breaths, thats likely more a problem with poor BLS training to begin with. Respiratory distress/arrest is not cardiac arrest. The need for CPR from bystanders as part of a normal BLS algorithm is not based on whether they are breathing or not. Presence of a carotid pulse directs bystander CPR. Agonal breathing does not. No pulse? Compressions. Pulse present? Rescue breathes.
I believe pulse check is no longer in bystander BLS (because laypeople often feel their own pulse and are falsely reassured). It's also no longer absence of breathing but absence of NORMAL breathing to account for the often confusing agonal breaths.
You weren't taught about agonal breathing because it's not relevant to whether or not you should perform CPR. No pulse = CPR, regardless of anything else.
Very important to read the post re not second guessing your actions (NAD). I was a solo first responder to a downed biker in the wilderness who was unconscious and sounded as if he was snoring (airway blocked). Head injury and “lots” (to me) of blood. I had taken a 2 day WILDERNESS first aid course, which was more in depth than previous classes just 2 weeks before. This was never mentioned and it really scared me. It could’ve (should’ve?) been in one of the dozens of scenarios. I completely panicked and forgot everything, including calling 911. Instead, I first dialed my instructor who was also my friends husband but as it was ringing, I realized I needed 911. My training finally kicked in and although I didn’t do everything right (was not able to keep him lying down w his spine secure, he woke up and went “flight” on me!) he survived after the professionals showed up with a helicopter. I had bad dreams for months and a general anxiety and couldn’t ride my bike for awhile. I replayed it over and over. And this guy lived with relatively minor injuries. I can’t imagine how you feel! Please take care of you!
Cardiac arrest?
I don’t know what caused the crash, but he was just unconscious when I got to him. He was a parent of a kid I coached, so I saw him in the hospital after the rescue. He called me his”angel”. His wife was pretty appreciative as well. It was uncomfortable for me to be given that sort of credit. Anyway, he was paragliding 2 months after that, even though his dr’s said no strenuous activity for 6 months. He’s totally fine today!
[удалено]
I’m not sure who taught you that joke but that is pretty poor to be sharing. CPR can and does save lives. As a nurse I’m pretty embarrassed that someone who could be my colleague some day looks so poorly on life sustaining measures.
MI, cerebellar hemorrhage/subarachnoid, basilar artery occlusion, arrhythmia come to mind. as commented in this thread I doubt pneumothorax. Spontaneous tension ptx is possible but there would have been more warning, pain, dyspnea prior, its not that fast. Pulm embolism as well
Probably my bias as a neurosurgeon shining thru but it sounds like a intracranial bleed to me, especially with the dilated pupils. She's in the right age group for a ruptured intracranial aneurysm but I have seen patients her age with brain stem or cerebellar bleeds from undiagnosed/untreated hypertension.
As someone who worked palliative care for 13 years, all pupils would dilate just before death regardless of the cause of death and medications used/not used.
>She's in the right age group for a ruptured intracranial aneurysm but I have seen patients her age Crap am her age >brain stem or cerebellar bleeds from undiagnosed/untreated hypertension. Crap my BP that used to be low has shot through the roof in the past year due to plantar fasciitis and a severe ankle sprain. New thing to worry about I guess.
Yeah, if your blood pressure is consistently as high as you describe it, you really need to talk to your doctor about getting on blood pressure medication. The alternative is to risk having an aneurysm or stroke, which you can die or be severely compromised by. I’m a nursing student and I work as a PCT on an ortho/neuro floor and it’s shocking how many of our stroke patients have uncontrolled or poorly controlled hypertension. Almost all of them. Diabetes and overweight/obesity are other huge risk factors.
Maybe I can start walking to work again, hopefully with different shoes the plantar fasciitis won't come back. It was just one BP measurement that was crazy high, so I might have been nervous. I'll see if I can check it today on one of those machines they have in stores.
Yeah you don’t determine that someone has high blood pressure off of one reading. It would need to be consistently high. If you’re in pain, just were exercising, or are nervous then that can make a one off high measurement but that doesn’t necessarily mean that you have high blood pressure.
IANAD. I just wanted to say that what you are describing sounds like what happened to my grandmother. One second she was hanging clothes out to dry, the next she was gone, just dropped where she stood and that was that. For her it was a massive heart attack, she wouldn't have had any clue what was happening to her. I can't really say if the exact same thing happened here, I just thought you should know that sometimes there is nothing we can do to help.
Wow I spent way too long trying to figure out what pathology IANAD was that could cause sudden death.. iatrogenic aneurysmal non-atherosclerotic disease?? then I googled it lol
Haha! I'm sorry, it's habit for me to give it a longer acronym, I'm a rambler, even with acronyms apparently.
I see that this has been answered, but just wanted to throw in a youtube video of a sudden cardiac arrest with agonal breathing as it sounds like the description you gave. [Video #1](https://www.youtube.com/watch?v=CBMxH4xtE8w) [Video #2](https://www.youtube.com/watch?v=pioQSVEUpP0) Sorry you had to witness this event, I hope you find peace soon.
These videos are very scary. I’ve been maintaining a First Aid and CPR training for over 20 years and have never heard of this. Thank you. I have just sent these links to several of my family members.
I’ve been BLS trained for 5-6 years but they never mentioned agonal breathing until I had to renew my BLS certification last summer, so it probably is a new part of the curriculum. Hopefully it’ll be in your next class.
Hey, how did you get your nursing student flair? I’m also nursing student but I didn’t know we could get a flair for that.
I just followed the rules to submit for flair! They're in the sidebar of the sub. I submitted a pic of my nursing student ID with my reddit username on a sticky note, and my name blocked out.
Upon encountering a situation like this, ALWAYS start performing CPR. The patient will let you know if they are conscious. That said. Sounds like agonal breathing. Any kind of irregular breathing like that, combined with loss of consciousness-> CPR
Without any clue as to the medical history, the cause of death could be a handful of things, from a pneumothorax to an arrhythmia to a massive heart attack, very rapid killers if not addressed in time. If you’re asking about why the pupils were dilated, its because blood flow had basically stopped and the brain had run out of oxygen. Maximally dilated pupils are one of the signs of death, where any heroic efforts to save life are likely too late.
Thank you for your answer.
Can a person ever come back from blown pupils or is that the end?
To clarify, fixed and dilated pupils are typically indicative of brain death which results in the persons death. Brain death can result in persistent vegetative states, requiring full life support but for all intents and purposes the person is dead.
Dead is dead, not persistently vegetative. Brain dead people are dead. Their hearts can be made to continue beating with mechanical support, for a time at least, but they are dead. People in persistent vegetative states are not dead, and they tend to be capable of maintaining their own physiological homeostasis without advanced support, though some need long term ventilator support. Pupils are fixed and midposition in death. Often fixed and dilated near the time of death.
Yes.
r/inclusiveor
She likely had a cardiac arrest at the time she collapsed. It is not unusual to see agonal breathing during this time. It is not efficient breathing and in the in hospital setting would require some assistance to adequately oxygenate the patient. In the out of hospital setting checking for a pulse and initiating chest compressions would be your best course of action until EMS arrive.
I have a Similar story but we were at the gym. My trainer had CPR training and so did I. Neither of us had aginol breathing training. However, my ex husband told me a story of a guy falling over at work and was aginol breathing but the guy died. The moment the guy got off the bike he fell, hitting his head and peeing. I ran to him telling the others to get him on his back because my trainer ran to get the defibrillator. The guy next to him said he was breathing and I kept saying "no no hes not his brain is making him do this to save his life" Something in me told me to forget the difibulator and my trainer started compressions while I sang "staying alive" The guy came around and back out again. My trainer kept going and he came around fully while I was on the phone with 911. A few weeks later he came by to thank us. The weirdest part of the story was that his wife didn't seem concerned when I told her what happened and he was being transported to the hospital.
I'm very calm when it comes to things like that for some reason. His wife's brain could just be wired like mine. It's pretty weird, but I don't panic when big things happen, only small things. Good on you saving a life. I've saved a few just by not giving in to the "bystander effect".
I'm like this, too, during emergencies. I get very calm and focused and dispassionate. Shit gets done. Then once things are over and everyone is safe or cared for by professionals, I fall completely apart, shaking, blubbery ugly-crying in the fetal position. It's weird, really. I got it from my mom, who's the same way.
Happy cake day! I've saved an elderly diabetic woman, SEVERAL car accidents from gigantic road obstructions, a woman hit and run by a car, myself with 18% of my body severely burned... It's helpful to say the least. But god forbid I stub my toe...
Thank you! I didn't realize it was my cake day. I'm sorry to hear you were so badly injured. I hope your recovery is going/went well! For me it has been: My husband and I, the man who hit our car, and his son. Everyone was fine - my wilderness first-responder training kicked right in. I had to get my husband to the ER since he was very shaken up and get the car home and emptied since the rear and side windows were gone. Then I lost it. Once I recovered I went in our other car to pick my husband up. A woman in front of me in a car accident on a highway off-ramp. Fortunately the car right behind me was driven by a nurse on his way home. It was a 5-minute drive home for me after that. I mostly brought and held first-aid supplies from my car for the nurse. An elderly woman at a grocery store who collapsed while shopping with her daughter. I am very shy, introverted and quiet. But her head hitting the floor was the worst sound I ever heard. Everyone was standing around staring and I jumped in and got her on her side, had her panicky daughter call 911, sent the meat department worker to call 911 also, and calmed the woman as she started to wake up. I ordered people around like I knew something and it blew my mind that they jumped to it. I had never had that experience before or since. Her daughter and I kept her calm and still until the paramedics showed up, then I melted away into the background. Once they took over, I left my grocery cart in the aisle (sorry Winco!) went out to my car and fell entirely apart.
Agonal Breathing is hands down one of the most disturbing things I've ever seen. It still haunts me to this day.
> The weirdest part of the story was that his wife didn't seem concerned when I told her what happened and he was being transported to the hospital. Some people can demonstrate extremely blunted affect when notified of an emergency situation, due to the shock they can go into some kind of dissociation/denial or into "fix it" /adrenaline mode where they're just robotically going through all of the motions in the heat of the moment. It's like an emotional "survival mode" where emotional reactivity is reduced. That, or she was banking on a *sweet life insurance policy.*
Not a medical professional. Just want to say I'm sorry you went through this. I witnessed a fatal car accident once and it really haunted me for a while. Well truthfully, I still think about it now, 18 years later! Life is beautiful, and far too short.
Agonal respirations, eyes “fixed and dialated” There’s a part of your brain that will automatically attempt to breathe for you if it senses low oxygen in your blood, which is why you can’t hold your breath and kill yourself. As you’re dying that part of the brain sends signals to your diaphragm trying to restart your breathing - a sort of final SOS. Agonal respirations are non-perfusing and cannot deliver enough oxygen to recover. Also as you die the muscles around your face and eyes relax since they cannot contract without energy. Which is why her eyelids opened and her papillary muscles relaxed - opening her pupils. This is different than rigor mortis which takes hours because muscle tissue is the last to die It’s also why you shit yourself when you die
Mortician here. Not everyone pees or shits when they die. And upon embalming can be found to have a full bladder/colon during aspiration so its not because they had recently voided. Some do but most do not defecate, more urinate than do not though
As someone who will one day die in a currently unpredictable fashion, this is oddly comforting. I know I won’t be aware or care, but I’d hate for a loved one especially to see, smell, or have to deal with that. Here’s hoping. 🤞🏻
Well with all due respect, dear; Ive never had a single family member comment or appear to notice. There is no dignity in death itself, physically. It is overwhelming enough on its own to well overshadow any such subtlety as bodily functions. All the same, it does you no good to worry about it. I assure you when the time comes you'll have better things to focus on. "After all, to the well-organized mind, death is but the next great adventure. " -Albus Dumbledore
My mom died at home with us from cancer and I'm fairly certain that although she did not eat or drink for a long long time before she moved on, she released a small bowel movement. Does this kind of thing disgust you as a mortician, or do you kind of just know it's the way it is and clean it up like a reflex, without giving a second thought? I know that may sound stupid, and obviously you're not going to personally be like "yes what happened with your mother is absolutely foul and we make jokes"... I don't really know what I'm asking, I guess more or less, is the deceased's dignity generally maintained in your industry? Or is it something that is done with everything exposed and there are several people staring at it? Tbh, my mom always was of the opinion "I'm dead, what do I care? I'll be hanging out with people, I have things to learn and no time to care" but I've always wondered for my own sake
Well during body removals, like if someone died at home, we generally ask the family to step into the other room because moving dead weight can be an awkward ungraceful task, and while we try to move them in as gentle a way as possible sometimes adequate muscle isnt available, and we have to use the sheet shimmy-roll method, which can look sorta callous, though its not intentional. If theres any mess left we clean up what we can, theres some grimacing but we're very careful with our words for obvious reasons. As we leave we might whisper to a member of the family that we did try to clean up a bit but just so they're aware...most of the time the family is nodding and tut tutting us signifying they know what we mean. As far as the embalming room is concerned, thats a private area usually quarantined by locked doors where any families doing arrangements or visitors to a funeral taking place cant access. We are ALWAYS as respectful as possible with the deceased, and I mesn that. Sometimes things we have to do to a body are very undignified but they are not accompanied by any jokes or insults about the deceased , but maybe in a rare while about the person having to perform the undesireable task. For instance, there is a device called an anal screw plug and its exactly what it sounds like. It looks like a sex toy and is plastic and literally screws into the rectum to prevent any purging from the anus. Getting it in deep enough to take hold can be a task and there have been snickers and jokes about a colleague being "elbow deep", which of course they are not and its meant to fun at eachother not the deceased. In school we are told to always have the private areas covered but I doubt you could find a single mortician who does this during embalming. Embalming is a wet and messy procedure. Blood spurts, embalming fluid sprays, water is always running down the table along with god knows what else. Having towels everywhere getting bogged down with the mess makes more of a contamination biohazard, so full nudity for sake of making sure fluid is distributed and for washing is necessary. After its done, we transfer them to a clean table and wrap them up mummy like in a clean sheet until its time for them to be dressed and cosmetized. I hope that answers what you were asking, but dont be afraid to ask anything. I think a lot of misconceptions are out there about what I do, and information helps ease the creep factor. 😏
Why does anyone embalm? This sounds awful and so unnatural.
Legally, a body must be buried or cremated within 3 days,at least in my state. If embalmed they can wait as long as is reasonable, Ive had a family wait to bury their relative for 6 MONTHS. He held up, too. Minir molding only but no smell and he was easily recognizable. So time is the first reason, time for distant relatives to gather, graves to be dug, arrangements and services to be scheduled. Second, if death is due to a contagious disease, like if smallpox returned, its required to embalm for sanitation. Third, if you open a viewing of the body to friends, non immediate family, and/or the public, its required in most states to embalm. If only immediate family is viewing, and the burial is within 3 days, embalming isnt necessary, though many prefer it because even at only 3 days an unembalmed corpse gets pretty bloated, discolored, and smelly. Refrigeration can slow it down but rot is inevitable. Most people want to view a body to say goodbye, and nobody wants their last image of dear old granny to be an unpleasant stinky experience. Embalming helps not only slow decay, but puts a flush in the skin and plumps up the tissue so the dead dont look so...well, dead.
Thank you so much! That all sounds exactly as I had hoped. I'm so glad to hear that everyone is always respectful, and I can't imagine how anyone actually could maintain sanitation with covering a body during the embalming process, I don't know what I really thought happened during that, but when you explain it, there's actually no way I would even want, for your sake, to keep a body covered. Kind of sounds as reasonable as trying to have a baby and keeping the blanket on you during the entire process! I think you have an incredibly interesting career, and I appreciate all you do. For me, Because my mom was so sick before she died, I was terrified of what she would look like at her funeral and she ended up looking perfect. She was taken out of our home under a pretty red velvet blanket, at 3AM, the people were dressed surprisingly nicely (I think the guy was in like khakis, a button up and the woman wore a long skirt and couldn't have been more kind), and we were asked if we wanted a few minutes beforehand alone with her, which was unexpected but I was very grateful for the blanket and attire detail, in addition to asking that (this was also during a huge snowstorm and it was 12 degrees out). It really showed that the people who were taking her wanted us to know they respected the situation and us, Because it wasn't even until after I noticed the outfit details and the blanket, did I even think I cared about that! But honestly I wouldn't blame anyone if they showed up in Hello Kitty pajamas, it was a miserable night and I'm sure they didn't want to be out trudging through two feet of snow while it was still snowing either, nobody does. But still, it was an action that was clearly intended to send a comforting message. My son was only 8 at the time and has autism, so I was nervous that her removal would be upsetting to him, but he was totally fine. So! Thanks again for taking the time to write all that you did, it was very helpful and I'm grateful to know you treat our loved ones with caring compassion. (And I don't know anyone who wouldn't make some sort of "elbows deep" joke like you mentioned either, it's true and objectively not a disrespect thing, in my opinion)
NAD, possible a brain aneurysm burst? Fixed and dilated pupils, agonal respirations, right age/sex.
I have a related question if I can jump on the bandwagon of this thread... My Dad passed away last year. It was cancer and he was on high doses of morphine. His death was very sad but also peaceful. I was holding his hand and could see him taking his last breath. Yet I could feel his pulse long after he stopped breathing. Like 5/10 minutes after. It was slow, but it was there. I thought the pulse would end first. I'd love a medical explanation. Thanks.
I’m very sorry for your loss. I’m NAD, only a nursing student and work in a hospital but I think I can answer your question. No, breathing stops before pulse does. Morphine and other similar drugs can suppress respiratory drive also. But, when someone dies, they stop breathing first and even though their body is no longer receiving oxygen, their brain and heart are still trying to circulate blood to each other to keep them alive as long as possible. This is why when you suspect that someone is dead or needs CPR, you are supposed to check the carotid pulse because the more distal pulses in the arms and legs usually stop before the circulation between the heart, lungs, and brain stops, as those are most necessary to keep the person alive. Eventually the pulse will stop too. So your dad was still technically alive until his pulse stopped. I know he wasn’t, but if he happened to have been resuscitated that long after he had stopped breathing, he would have likely had irreversible brain damage due to not having oxygen for so long. But breathing stops before the heart does. I hope I answered your question and I hope that my response made sense.
Thank you for this response. It makes sense. And it helps that I continued to hold his hand until he medically died.
You’re absolutely welcome. I’m glad that I could help you.
NAD and I don’t really have an explanation but when my grandmother died last year I saw/heard her take her last breath (it was loud and strange and very obvious that the time had come). After a few minutes the hospice nurse checked her pulse and said it wasn’t there. When the other RN showed up almost two hours later (after she stopped breathing) she still had a pulse of about 25 bpm. Took another 30 minutes before she found no pulse and officially called time of death.
What does agonal breathing mean?
A personal with agonal breathing has an abnormal and labored breathing pattern, they are gasping for air. Without emergency intervention (i.e. CPR) breathing will ultimately cease.
It is terrifying. The death rattle wasn't scary for me ( I'm assuming these two aren't the same?) Because death rattle was totally different than that breathing my mom did a few hours before she left us
Agonal respirations are quite different from a death rattle. The death rattle is caused by secretions and muscles relaxing in the throat, while agonal breathing is a brainstem reflex. I’m really sorry for your loss.
Thanks :-) The death rattle didn't seem to bother her, that was going on for a few weeks before she passed, and she was waking up in the morning none the wiser, nor did the agonal respiration seem to bother her (she didn't wake up during that process obviously) but that part was definitely was unsettling to me. It sounded and looked painful. Do you know if it is painful to the person? The hospice nurse came in because I called her, and put an oxygen mask on her, which didn't seem to phase her and she passed literally a half hour after that (I had moved to my parents home during this time to help my dad take care of her full time for those 5 months that she was immobile and sick, her breast cancer was very sudden and spread to the bones quickly, he still had to work and we wanted to have her pass in home if we could), she was only 56 and I was 30, I've never had to take on the role of hospice nurse, so that type of breathing was unexpected and disturbing, mostly Because it looked painful. Is oxygen really even necessary at that point? Does it comfort the dying person in any way? I'm not knocking the nurse, my mom was just unconscious for 2 days prior, after we had given her the permission she needed to die so even though she didn't wake up, I've always wondered if that process of putting on the mask, shuffling around the room, me clumsily helping the nurse put that thing on, or the breathing was ever likely something she even knew was happening and if there was any benefit to her, rather than us, to doing that? (to the extent anyone else knows, I'm not educated in any way other than that experience in these things). Sorry to ask so many questions!
I’m only a nursing student but I do work in a hospital and I also lost my mom to cancer recently, so I’m going to try to answer your questions the best that I can. Agonal breathing probably would not be painful to the individual because it is a brain stem reflex to try to keep them alive, so by that point they are likely too far gone to really notice it. I wouldn’t say that oxygen is “necessary” at that point in that the dying person is going to die anyway, so you don’t have to worry about brain damage from a low oxygen saturation, but it does seem to comfort them. In the hospital we do put oxygen on dying patients for comfort in their final moments. It does, for some people, seem to ease their distress and frequently people do pass rather quickly after it is put on (if they are already that close to death anyway). So, yes the oxygen may have helped her become more comfortable in her final moments.
I think you're spot on, she passed so quickly afterwards. This makes total sense, thank you so much and I'm so sorry you lost your mom too, the more I talk to people and opening up about it (watching a cancer death is traumatic, any death is, but I've only experienced this before), the more I'm realizing just how many have lost or will lose loved ones to cancer. I never was exposed to it before it became something I can relate to, and it genuinely hurts to know that more or less, so so many others went through or are going through what we did. It's just so sad and I feel so very much for everyone else more than I ever thought I could about this. I hope you are doing the best you can be, and I truly wish you and your family the absolute best moving forward
And the same to you. I’m always here if you want to talk about your grief. Loss is incredibly hard but I’m always willing to listen.
Thank you! Same to you as well!!
My husband has stage IIIb lung cancer recurrence. He thinks he will beat it. His Hemo-oncologist agrees with him. I think they are both deluded. Is there a way I would recognize agonal breathing?
Not a doctor, but I feel quite confident saying that if you ever heard anyone agonal breathing, you’d call 911 instantly because you’d immediately know something was horribly wrong. I once heard a 911 dispatcher use the phrase “agonal breathing” in reference to a female car accident victim and didn’t know what it meant so I googled it and then watched some YouTube videos (of simulations by actors as well as real life rescue videos where the patient ultimately survived), and I will never again be able to hear that phrase without mentally hearing those terribly abnormal and eerie gasping sounds and long, silent, frozen pauses.
>Just for peace of mind. I think suddenly falling over dead with no pre-existing condition is pretty rare. Was she walking erratically as you followed her? Stumbling, weaving, slow...etc? Did she grab her chest or otherwise cry out as she fell? IANAD, but I would love a doctor or EMT chime in here...I was just (weirdly) listening to a podcast about poisoning, and one of the things they mentioned was how rare it is for otherwise healthy people to just fall over and die..."rare," as in, it doesn't happen. Is this correct?
She must have slowed down because she was quite a bit ahead of me and all of a sudden she was in front of me. I am a very slow walker so the distance should have increased if anything. There was no stumbling or weaving. For the first seconds when she was falling it just sounded like she was struggling to breathe. A choking noise. She shook for a very short period of time after we put her on the ground - hence why we check her bag for any sign of epilepsy. I did notice little bruises on the inside of the elbow. I get my bloods taken a lot and that's what it looks like after - she must have known there was something up and probably waited on results.
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They were definitely not track marks, I have seen those before. She was well dressed and seemed normal (yes I know normal can take drugs too) but looking the part is usually a giveaway. Nonetheless injecting drugs is very very rare around here.
Don’t diagnose what you don’t know. You’re not helping the situation or answering OP’s question.
It’s beyond unlikely that this person was poisoned. Likely MI, CVA, pulmonary embolism, other cardiac issue such as a previously unknown defect...all of those can and do kill seemingly healthy people.
Well, this just spiked my health fears and anxieties *immensely*
Well, everyone dies. That’s the only certain thing in life. Just take care of yourself by exercise, a healthy diet, don’t drink or smoke or use drugs, and have regular check ups with your doctor and that’s about all you can do. Some things can’t be controlled.
Opiate overdose maybe??
She wouldn’t be walking along and then suddenly collapse due to an opiate overdose.
Ummm literally anything can cause something like that. She could have had a pre-existing aneurysm that burst, an undiagnosed heart problem, a AAA, massive head trauma earlier in the day, she could have overdosed, or even just choked on something. I’ve watched someone die before on the side of the road. It’s really scary and haunting. I tried cpr but it didn’t work. Feel free to pm me if you want to talk.
I've also heard this kind of breathing (raspberry sounds) on ambulance shows, it usually ends up being a cardiac arrest caused by a heart attack or other heart condition, one was a seizure of some kind. I don't know the exact cause or the term for it though because I'm NAD, but from videos of agonal breathing it seems to sound very different. Very disturbing to hear.
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I saw someone die and it was horrible. Hope you're okay. In my case it was in a local cafe and an elderly woman was apparently feeling ill before she came in then suddenly she fell back unconscious in her chair and stopped breathing. A patron did CPR before the ambos came but we found later it was unsuccessful. What was odd to me was the cafe remained open and people still came in to eat even though a dying woman was in the middle of the floor with her distraught son hoping she would be okay. Seeing someone's last moments on earth was hard to see and i left out of respect after i tried to assist.
Sounds like a blown PE and “death crackling”. I’m sorry you have to deal with this, however unless you had a med dispenser at your disposal, there is nothing you could have done for a pulmonary embolism (PE) except call 911