It's good that this question is not an accusatory question, but a question which is the result of curiosity.
And there are some people like Rajinder Bhalla ji whose knowledge about the details of an ICU or a ventilator is questionable, but answers the question as if everything is hopeless and futile in modern medicine, like this answer
.So let's get to know the facts when the patient is put in a ventilator.
So, what is a ventilator, also called a mechanical ventilator?
Respiratory therapist examining a mechanically ventilated patient on an Intensive Care Unit (Source - Link
)Mechanical ventilation or assisted ventilation is the medical term for artificial ventilation where mechanical means is used to assist or replace spontaneous breathing.
Which means that this machine assists/replaces the work of breathing when the patient cannot breathe spontaneously.
The functionality is akin to an air pump inflating a balloon, albeit more sophisticated.
(Source of this picture - Link
)Just like this experiment above, our lungs work under negative pressure ventilation, i.e. the lungs get air through the negative pressure created around the lungs inside the thoracic cavity by the diaphragm. When this fails, then we fill the lungs with air by forcing it through the airway (just like inflating the two balloons inside the jar by putting our mouth over the inlet straw in the diagram) called positive pressure ventilation.
The mechanical ventilator works through positive pressure ventilation.
And here you have to know this - the mechanical ventilator concerns only the respiratory system, and has nothing to do with the other vital systems.
Now you know the concept, it'll be easier to answer your question.
How to know if your patient, who is currently in a ventilator, is alive or not?
- Check the ECG monitor - As the ventilator has nothing to do with the cardiovascular system, so ECG is an important indicator of life. It's very difficult to fake an ECG, and even if you suspect it, check if the electrodes are still now in the body or not. A straight line electrocardiogram for more than 2 minutes is an indication for death.
- Give some pain to the patient - I know it sounds barbaric, but when no stimulus works in arousing a drowsy patient, pain is the only way to wake them up, or atleast elicit a response. Pinching works on a normal sleeping person, but not in heavily sedated patients or drowsy ones. The safest way to elicit a good pain stimulus is to run the knuckles of your hand over the sternum (breastbone). If you see some movement of the arms and legs of the patient, he/she is alive. We usually do this to check the status of the central nervous system during an emergency.
- Check the corneal reflex - It is a very simple and effective way of knowing if a patient is alive or not, and it's one of our standard ways to know the same. This involves touching a wisp of cotton on the eyeball surface over the pupil, which is called the cornea. The expected response would be blinking, or at the least, movement of the eyelids. This is one of the last resorts to check whether the patient is alive or dead, alongwith the pupillary reflex.
(Source - Link
)- Check for signs of death - It's not that family members are not allowed visitation time, so you can check this too. Is the arm unusually stiff and unmoving? (Considering that the patient does not have a previous history of paralysis, in which case the affected arm will be stiffer.) Is the chest, neck area, and abdomen cold to touch? Are certain areas of the abdominal skin a bit greenish? Are the dependant areas of the body (the areas in long-time contact with the bed) coloured purplish red? Do you smell something rotting? If most of these are yes, don't confront the doctor immediately, but go to him/her and ask about those unusual signs. Usually if these signs appear, the patient is already dead for a long time.
Time and again, I have told in my answers that there are some dishonest people in every profession, and doctors are no exception. But please do not generalise all the doctors based upon a few. Confront them diplomatically. Take a legal course of action if you are fully certain of foul play, alongwith evidence. Don't lynch doctors.
Thanks for the A2A Vivek R
Regards,
Footnotes