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Discipline

: Emergency

Sub Discipline

: Emergency

Document Title

: ETD Brought in Dead (BID) Note

Type Of Case

TraumaNon Trauma

Pre Hospital Phase

Brought By

Mode Of Transportation

PRE HOSPITAL PHASE TREATMENT (OTHER THAN PHC)

Pre Hospital Phase Treatment

Bag mask ventilation

Airway Adjunct

Laryngeal Mask Airway insertion

Other Extraglottic Device insertion

Endotracheal intubation

Cardiopulmonary Resuscitation

Defibrillation

IV fluid Infusion

Adrenaline

Atropine

Dextrose

Others, specify

Procedure

Needle Thoracocentesis

YesNo

Immobilization

Cervical Collar

Head Immobilizer

Spinal Board

Upper limb splint

Lower limb splint

Traction splint

Pelvic immobilizer

Hammock

Others, specify

Bleeding Control

Compression bandage

Hemostatic suture

Torniquet

Combat gauze

Others, specify

HOSPITAL PHASE

Chief Complaints

History

Co-Morbidities

Diabetes Mellitus

Hypertension

Ischaemic Heart Disease

Chronic Kidney Disease

Cancer

Psychiatric Illness

Others, specify

PHYSICAL EXAMINATION

Physical Examination

Signs Of Death

Rigor Mortis

Dependent Lividity

Fixed and dilated pupils

Absence of breathing

Absence of pulse

Absence of blood pressure

Absence of electrical activity on cardiac monitor

Others, specify

Presence Of

Vomitus

Urine

Blood

Fecal

Others, specify

Clothing

Presence Of Dnar (Do Not Active Resuscitate)

YesNo

Organ Donor

YesNo

MANAGEMENT

Plan

Orders

Others

Referral

Death Confirmed By

Date Of Pronounced Death

Time Of Pronounced Death

Location Of Death

Burial Permit Issued

YesNo

Cause Of Death

Police Informed

YesNo

Police Officer's Name

Police Report Done

YesNo

Police Report No

SIGNATURES

Notes Component

PRE HOSPITAL PHASE TREATMENT (OTHER THAN PHC)
HOSPITAL PHASE
PHYSICAL EXAMINATION
MANAGEMENT
SIGNATURES

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