Summary
Persons dying suddenly are very likely to be taken to the nearest Accident and Emergency Department. The task of informing and counselling bereaved relatives therefore frequently falls to the staff of these Departments. Adequate preparation is important in allowing such situations to be dealt with in a sensitive and appropriate manner. Advice on coping with different aspects of sudden death is given and some common reactions discussed. Special problems are also considered (eg, the death of a child, criminal violence, communication difficulties). Aftercare must also not be forgotten and staff should receive training in the care of the bereaved.
The case is presented of a 39-year-old Type 1 diabetic patient of 22 years duration with recurrent hypoglycaemic comas. He was of unusual personality and had bizarre ideas on self-regulation of his diabetes, resulting in wide variations of insulin dosage. In one 12-month period he had 88 separate admissions to an emergency department with severe hypoglycaemic coma requiring intravenous glucose administration. The cycle of admissions was eventually broken by the intervention of a social worker, who provided structured non-medical support. The patient's diabetic misconceptions remained, but he appeared to gain sufficient insight to prevent recurrent hypoglycaemia.
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