Terminal respiratory secretions, commonly known as a “death rattle,” occur when mucous and saliva build up in the patient's throat. As the patient becomes weaker and/or loses consciousness, they can lose the ability to clear their throat or swallow.
Death rattle is a common symptom in the dying phase which is caused by an accumulation of secretions in the upper airway [1]. This accumulation of fluid (mucus) cannot be easily coughed up or swallowed by the patient, often as a result of a diminished consciousness.
Symptoms of Death Rattle
When someone dies, they make a crackling, wet sound that gets louder as they breathe in and out. Sometimes, the sound is soft and moan-like. It can sometimes sound familiar or loud like someone snoring or gargling, but it can also be quiet.
The limbs may become cool and perhaps bluish or mottled. Breathing may become irregular. Confusion and sleepiness may occur in the last hours. Secretions in the throat or the relaxing of the throat muscles can lead to noisy breathing, sometimes called the death rattle.
Death rattle usually becomes audible 24 to 48 hours before death (6,7). Reducing the distress among listeners has been conventionally treated through attempts to reduce or eliminate patient noise.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
Anticholinergic medication is considered the standard treatment for death rattle. Treatment of death rattle is regarded as an essential intervention in the care of dying patients by specialists in palliative care [8].
In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool.
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.
Many people lose consciousness near the end of life. But they may still have some awareness of other people in the room. They may be able to hear what's being said or feel someone holding their hand.
Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
This typically lasts no more than a few hours, but each patient is different and it can continue for as long as 24-48 hours. While the sound is difficult for family members to hear, it does not cause the patient pain or distress.
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.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
The brain and nerve cells require a constant supply of oxygen and will die within a few minutes, once you stop breathing. The next to go will be the heart, followed by the liver, then the kidneys and pancreas, which can last for about an hour. Skin, tendons, heart valves and corneas will still be alive after a day.
The brain is the first organ to begin to break down, and other organs follow suit. Living bacteria in the body, particularly in the bowels, play a major role in this decomposition process, or putrefaction. This decay produces a very potent odor. “Even within a half hour, you can smell death in the room,” he says.
Is sudden cardiac death painful? Some people have chest pain during the initial seconds of sudden cardiac arrest. However, once you lose consciousness, you don't feel pain.
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.
Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.
Give anticholinergic medication, as ordered by your physician. Anticholinergics, such as atropine or scopolamine, help dry up excess secretions, which can help clear up the death rattle.
Hearing may indeed be one of the last senses to lose function as humans die.
“First hunger and then thirst are lost. Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
As the blood pools, patches appear on the skin within 30 minutes of death. About two to four hours postmortem, these patches join up, creating large dark purplish areas towards the bottom of the body and lightening the skin elsewhere. This may be less apparent on darker skin. This process is called livor mortis.