In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
Physical signs
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
Mottling of skin occurs during the last week of life. Sometimes it may occur sooner or within just a few days of death.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
Metabolic failure: The kidneys, the liver, and other organs begin to fail near the end of life, and the physiological issues these events cause can interfere with brain function and result in delirium, restlessness, and agitation.
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
As the moment of death comes nearer, the person's breathing may slow down and become irregular. It might stop and then start again or there might be long pauses or stops between breaths. This is sometimes known as Cheyne-Stokes breathing.
In the final hours of life, your loved one's body will begin to shut down. Their circulatory and pulmonary systems will slowly begin to fail. This may lead to falling body temperatures, but may also cause sudden outbursts. Your loved one will also experience greater difficulty interacting with the outside world.
Touch and hearing are the last senses to go when we die.
Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours.
Fear, anxiety and anger are all commonly seen characteristics of patients with terminal illnesses. As your loved one's health declines, you may notice them develop bitterness or anger. This is called terminal agitation. Along with this, terminal delirium and terminal restlessness may also present themselves.
After someone dies, it's normal to see or hear them. Some people also reporting sensing the smell or warmth of someone close to them, or just feel a very strong sense of their presence. Sometimes these feelings can be very powerful. They may be comforting but also feel disturbing.
Agonal breathing or agonal gasps are the last reflexes of the dying brain. They are generally viewed as a sign of death, and can happen after the heart has stopped beating.
Agonal breathing or agonal respirations are medical terms used to describe insufficient breathing that often sounds like snoring, snorting, gasping, or labored breathing. The person will appear to be choking or having an involuntary gasp reflex.
Cheyne-Stokes respirations are a rare abnormal breathing pattern. View Source that can occur while awake but usually occurs during sleep. The pattern involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all, called apneas.
The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
Terminal agitation means agitation that occurs in the last few days of life. You might also hear terminal agitation being described as terminal restlessness, terminal anguish, confusion at the end of life, or terminal delirium. These terms all have different meanings but they do overlap.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Midazolam is a commonly used benzodiazepine in palliative care and is considered one of the four essential drugs needed for the promotion of quality care in dying patients. Acting on the benzodiazepine receptor, it promotes the action of gamma-aminobutyric acid.
Seriously ill patients encountered by hospice and palliative care clinicians are at risk for thirst due to dehydration, electrolyte disturbances, hypotension, xerostomia, and immobility which can impede access to water.
Rigor mortis appears approximately 2 hours after death in the muscles of the face, progresses to the limbs over the next few hours, completing between 6 to 8 hours after death. [10] Rigor mortis then stays for another 12 hours (till 24 hours after death) and then disappears.