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    Chapter 2 Death

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    Sukhdeep Singh
    This document discusses different aspects of death including types of death, diagnosing death, importance of determining time of death, and causes of sudden death. It describes somatic or clinical death as irreversible damage to the brain, heart, or lungs. Molecular death occurs later as tissues and cells die over 2-3 hours after somatic death. Determining brain stem death is important for organ transplantation. Causes of sudden death include cardiovascular, respiratory, central nervous system, abdominal issues as well as endocrine disorders and poisoning. The modes, manners, mechanisms and causes of death are also outlined.

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    Chapter 2 Death

    Uploaded by

    Sukhdeep Singh
    64 views34 pages
    This document discusses different aspects of death including types of death, diagnosing death, importance of determining time of death, and causes of sudden death. It describes somatic or clinical death as irreversible damage to the brain, heart, or lungs. Molecular death occurs later as tissues and cells die over 2-3 hours after somatic death. Determining brain stem death is important for organ transplantation. Causes of sudden death include cardiovascular, respiratory, central nervous system, abdominal issues as well as endocrine disorders and poisoning. The modes, manners, mechanisms and causes of death are also outlined.

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    This document discusses different aspects of death including types of death, diagnosing death, importance of determining time of death, and causes of sudden death. It describes somatic or clinical death as irreversible damage to the brain, heart, or lungs. Molecular death occurs later as tissues and cells die over 2-3 hours after somatic death. Determining brain stem death is important for organ transplantation. Causes of sudden death include cardiovascular, respiratory, central nervous system, abdominal issues as well as endocrine disorders and poisoning. The modes, manners, mechanisms and causes of death are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    64 views34 pages

    Chapter 2 Death

    Uploaded by

    Sukhdeep Singh
    This document discusses different aspects of death including types of death, diagnosing death, importance of determining time of death, and causes of sudden death. It describes somatic or clinical death as irreversible damage to the brain, heart, or lungs. Molecular death occurs later as tissues and cells die over 2-3 hours after somatic death. Determining brain stem death is important for organ transplantation. Causes of sudden death include cardiovascular, respiratory, central nervous system, abdominal issues as well as endocrine disorders and poisoning. The modes, manners, mechanisms and causes of death are also outlined.

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    of 34

    D E A T H

    Complete, permanent and


    irreversible cessation of the vital
    functions.

    Somatic or Clinical death

    Molecular death

    Somatic or Clinical Death


    Permanent and irreversible damage to;
    = Brain
    = Heart
    = Lungs

    Difficulties to Diagnosis
    Somatic death

    Warmness of body

    Suspended Animation

    Coma due to sedatives or hypnoticsBarbiturates

    Hypothermia

    Molecular Death

    Death of individuals tissues and cells

    Process competes by two to three


    hours after somatic death

    Changes in the eye, skin muscles etc.

    What is the importance of death?

    Disposal of the dead body

    Death certificate

    Post-mortem

    Transplantation of organs
    like:

    Liver within 15 minutes

    Kidney 30-40 minutes

    Heart 1 hour

    Brain Stem death

    What is Brain stem death


    How to diagnose
    What is its importance to know
    Tests for confirmation of brain-stem
    death
    Medico-legal importance suspended
    animation
    Transplantation of Organs

    Brain Stem

    Mid brain

    Pons

    Medulla

    Permanent and irreversible stoppage of


    functions of above areas

    Tests for confirmation of brain-stem


    death
    In coma for more than 6hrs or 24 hrs
    if cardiac arrest is the cause
    No abnormal decorticate or
    decerebrate postures should be
    present

    No spontaneous respiration
    No epileptic movements
    All brain stem reflexes
    Should be absent

    Diagnosis of brain-stem
    death

    Establishment of positive diagnosis of


    coma and its causes
    irremediable, structural damage of
    brain
    Trying to remedy it and failing
    Correction low blood pressure
    Correction-Hypoxia
    Removal of blood clot

    Brain- stem reflexes

    Pupillary reflext Optic


    <- Occulomotor
    Vestibulo-reflex occular -> Auditory
    <- Abducent
    Corneal reflex -> Trigeminal
    <- Facial
    Gag reflex -> Glossopharyngeal
    <- Vagus
    Dolls eye reflex - > Auditory
    <- Abducent

    Brain stem death shall not be


    considered in :

    Absence of coma
    Child below 5 yrs of age
    Coma due to drugs, hypothermia,
    metabolic disorders and shock

    Sudden Death

    Sudden deaths are those which are


    not preceded or are of only
    preceded for a short time of or with
    morbid symptoms.

    Medico legally
    They raise a suspicion of foul play.

    Causes of Sudden death

    Unnatural
    Violence
    Poisoning
    Combination of both
    Natural

    Cardiovascular
    -

    Coronary disease
    Congenital heart diseases
    Valvular heart diseases
    Hypertensive heart diseases
    Infection
    Cardiac tamponade
    Aortic aneurysm

    Respiratory
    Pulmonary embolism
    Haemoptysis
    Infections
    Chronic asthmatics
    Anaphylaxis
    Obstruction to air passage

    C.N.S.
    Intra cerebral haemorrhage
    Sub arachnoid haemorrhage
    Cerebral thrombosis
    Embolism
    Infections
    Tumor of brain

    Abdominal
    -

    Haemorrhage in the G.I. tract


    Rupture of abdominal aneurysm
    Liver diseases
    Acute pancreatic bleeding

    Endocrinal
    Adrenal haemorrhage
    Diabetic coma
    Myxoedemic and parathyroid crisis
    Iatrogenic
    Abuse of drugs
    Sudden withdrawal of steroids
    Anesthesia
    Mismatched blood transfusion.

    Miscellaneous
    Bacteriaemic shock
    Shock due to fear or emotion
    Malaria
    Special causes in children
    Cot death or SIDS
    Congenital mental abnormalities
    Concealed puncture wound.

    Suspended Animation

    The condition where the person may


    appear to be dead due to the fact that
    the vital functions are at such a low level
    as to be minimum compatible with life,
    The Suspended Animation
    Apparent death
    As a voluntary Act ( Death Trance)
    Hypothermia, Drowning, new born, elect
    shock etc.

    Modes of death
    Manners of death
    Mechanism of death
    Cause of death

    Modes of death

    Abnormal physiological state, that


    existed at the time of death
    According to Bichat
    Coma
    Syncope
    Asphyxia
    Depending upon the involvement of
    the system and irrespective of the
    remote cause of death.

    Coma Death
    Failure of functions brain
    Due to paralysis of the vital centers
    Compression of brain due to diseases
    Injuries to brain
    Poisoning to brain-opium, alcohol etc
    Metabolic disorders- Uraemia

    Death due to syncope

    Failure of the function of the heart


    Anaemia of the brain
    Due to heart disease
    Exhausting diseases
    Poisons- Digitalis, tobacco, aconite
    etc.

    death due to Asphyxia

    Failure of the function of lungs


    Pathological conditions- Pneumonia
    Poisoning- Opium
    Irrespirable gases co, co2 etc.
    Traumatic Asphyxia- Stampade
    Mechanical interference prevention
    of air entry to respiratory track

    According to Gordon

    The functions of vital organs depends


    on the availability and utilization of
    oxygen by the body tissues -> Anoxia
    Anoxic Anoxia
    Anaemic Anoxia
    Histotoxic Anoxia
    Stagnent Anoxia

    Anoxia

    Anoxic Anoxia
    Mechanical Interference to the passage of air
    Closure of the external respiratory orifices
    Eg. Smothering
    Closure of the air passages by external
    pressure on the neck
    Eg. Hanging, Strangulation
    Closure by impaction of foreign body closure
    by fluid- Drowning.

    Prevention of normal movements of the


    chest
    Pressure on the chest- stampade, fall of
    mason etc
    Injury to chest wall- penetrating injuries
    Poisoning- strychnine
    Electric shock due to bulbar palsy
    Vitiated atmosphere.

    Anaemic Anoxia :
    Reduced oxygen carrying capacity of blood
    Acute haemorrhage, acute poisoning by co.
    and nitrites.
    Histotoxic Anoxia:
    Decreased oxidative process in tissue, tissue
    cells are poisoned eg. Cyanide poisoning.
    Stagnant Anoxia:
    In efficient circulation through the tissuesshock . C.C.F. etc.

    The Manner of Death

    It is a design or fashion in which the


    cause of death came into being
    If death occurs from some disease, the
    manner of death is ; Natural
    If death occurs due to violence the manner
    will be unnatural or violent death, may
    be accidental, suicidal or homicidal, it
    depends on circumstances of the episode.

    The Mechanism of Death

    It is a physiological or biochemical
    disturbances- metabolic acidosis,
    alkalosis, sepsis, toxaemia or paralysis
    etc.
    The Cause of death
    Disease or injury
    Chain of events
    Brief or prolonged
    Produces fatal outcome.

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