death

1. D E A T HD E A T H

2. Complete, permanent and irreversibleComplete, permanent and irreversible
cessation of the vital functions.cessation of the vital functions.
 Somatic or Clinical deathSomatic or Clinical death
 Molecular deathMolecular death

3. Somatic or Clinical DeathSomatic or Clinical Death
Permanent and irreversible damage to;Permanent and irreversible damage to;
= Brain= Brain
= Heart= Heart
= Lungs= Lungs

4. Difficulties to Diagnosis SomaticDifficulties to Diagnosis Somatic
deathdeath
 Warmness of bodyWarmness of body
 Suspended AnimationSuspended Animation
 Coma due to sedatives or hypnotics-Coma due to sedatives or hypnotics-
BarbituratesBarbiturates
 HypothermiaHypothermia

5. Molecular DeathMolecular Death
 Death of individuals tissues and cellsDeath of individuals tissues and cells
 Process competes by two to three hoursProcess competes by two to three hours
after somatic deathafter somatic death
 Changes in the eye, skin muscles etc.Changes in the eye, skin muscles etc.

6.  What is the importance of death?What is the importance of death?
 Disposal of the dead bodyDisposal of the dead body
 Death certificateDeath certificate
 Post-mortemPost-mortem

7. Transplantation of organs likeTransplantation of organs like::
 Liver – within 15 minutesLiver – within 15 minutes
 Kidney 30-40 minutesKidney 30-40 minutes
 Heart 1 hourHeart 1 hour

8. Brain – Stem deathBrain – Stem death
 What is Brain –stem deathWhat is Brain –stem death
 How to diagnoseHow to diagnose
 What is its importance to knowWhat is its importance to know
 Tests for confirmation of brain-stem deathTests for confirmation of brain-stem death
 Medico-legal importance “suspendedMedico-legal importance “suspended
 animation”animation”
 ““Transplantation of Organs”Transplantation of Organs”

9. Brain StemBrain Stem
 Mid brainMid brain
 PonsPons
 MedullaMedulla
Permanent and irreversiblePermanent and irreversible stoppage ofstoppage of
functions of above areasfunctions of above areas

10.  Tests for confirmation of brain-stem deathTests for confirmation of brain-stem death
 In coma for more than 6hrs or 24 hrs ifIn coma for more than 6hrs or 24 hrs if
cardiac arrest is the causecardiac arrest is the cause
 No abnormal decorticate or decerebrateNo abnormal decorticate or decerebrate
postures should be presentpostures should be present

11.  No spontaneous respirationNo spontaneous respiration
 No epileptic movementsNo epileptic movements
 All brain stem reflexesAll brain stem reflexes
 Should be absentShould be absent

12. Diagnosis of brain-stem deathDiagnosis of brain-stem death
 Establishment of positive diagnosis ofEstablishment of positive diagnosis of
coma and its causescoma and its causes
 ““irremediable, structural damage of brain”irremediable, structural damage of brain”
 Trying to remedy it and failing”Trying to remedy it and failing”
 Correction –low blood pressureCorrection –low blood pressure
 Correction-HypoxiaCorrection-Hypoxia
 Removal of blood clotRemoval of blood clot

13. Brain- stem reflexesBrain- stem reflexes
 Pupillary reflextPupillary reflext  OpticOptic
 <- Occulomotor<- Occulomotor
 Vestibulo-reflex occular -> AuditoryVestibulo-reflex occular -> Auditory
 <- Abducent<- Abducent
 Corneal reflex -> TrigeminalCorneal reflex -> Trigeminal
 <- Facial<- Facial
 Gag reflex -> GlossopharyngealGag reflex -> Glossopharyngeal
 <- Vagus<- Vagus
 Dolls eye reflex - > AuditoryDolls eye reflex - > Auditory
 <- Abducent<- Abducent

14. Brain –stem death shall not beBrain –stem death shall not be
considered in :considered in :
 Absence of comaAbsence of coma
 Child below 5 yrs of ageChild below 5 yrs of age
 Coma due to drugs, hypothermia,Coma due to drugs, hypothermia,
metabolic disorders and shockmetabolic disorders and shock

15. Sudden DeathSudden Death
 Sudden deaths are those which are notSudden deaths are those which are not
preceded or are of only preceded for apreceded or are of only preceded for a
short time of or with morbid symptoms.short time of or with morbid symptoms.
Medico – legallyMedico – legally
They raise a suspicion of foul play.They raise a suspicion of foul play.

16. Causes of Sudden deathCauses of Sudden death
 UnnaturalUnnatural
 ViolenceViolence
 PoisoningPoisoning
 Combination of bothCombination of both
 NaturalNatural

17. CardiovascularCardiovascular
- Coronary diseaseCoronary disease
- Congenital heart diseasesCongenital heart diseases
- Valvular heart diseasesValvular heart diseases
- Hypertensive heart diseasesHypertensive heart diseases
- InfectionInfection
- Cardiac tamponadeCardiac tamponade
- Aortic aneurysmAortic aneurysm

18.  RespiratoryRespiratory
- Pulmonary embolismPulmonary embolism
- HaemoptysisHaemoptysis
- InfectionsInfections
- Chronic asthmaticsChronic asthmatics
- AnaphylaxisAnaphylaxis
- Obstruction to air passageObstruction to air passage

19.  C.N.S.C.N.S.
- Intra cerebral haemorrhageIntra cerebral haemorrhage
- Sub arachnoid haemorrhageSub arachnoid haemorrhage
- Cerebral thrombosisCerebral thrombosis
- EmbolismEmbolism
- InfectionsInfections
- Tumor of brainTumor of brain

20. AbdominalAbdominal
- Haemorrhage in the G.I. tractHaemorrhage in the G.I. tract
- Rupture of abdominal aneurysmRupture of abdominal aneurysm
- Liver diseasesLiver diseases
- Acute pancreatic bleedingAcute pancreatic bleeding

21. - EndocrinalEndocrinal
- Adrenal haemorrhageAdrenal haemorrhage
- Diabetic comaDiabetic coma
- Myxoedemic and parathyroid crisisMyxoedemic and parathyroid crisis
- IatrogenicIatrogenic
- Abuse of drugsAbuse of drugs
- Sudden withdrawal of steroidsSudden withdrawal of steroids
- AnesthesiaAnesthesia
- Mismatched blood transfusion.Mismatched blood transfusion.

22.  MiscellaneousMiscellaneous
 Bacteriaemic shockBacteriaemic shock
 Shock due to fear or emotionShock due to fear or emotion
 MalariaMalaria
 Special causes in childrenSpecial causes in children
 Cot death or SIDSCot death or SIDS
 Congenital mental abnormalitiesCongenital mental abnormalities
 Concealed puncture wound.Concealed puncture wound.

23. ““ Suspended AnimationSuspended Animation
 The condition where the person mayThe condition where the person may
appear to be dead due to the fact that theappear to be dead due to the fact that the
vital functions are at such a low level as tovital functions are at such a low level as to
be minimum compatible with life,be minimum compatible with life,
 The Suspended AnimationThe Suspended Animation
 Apparent deathApparent death
 As a voluntary Act ( Death Trance)As a voluntary Act ( Death Trance)
 Hypothermia, Drowning, new born, electHypothermia, Drowning, new born, elect
shock etc.shock etc.

24.  Modes of deathModes of death
 Manners of deathManners of death
 Mechanism of deathMechanism of death
 Cause of deathCause of death

25. Modes of deathModes of death
 Abnormal physiological state, that existedAbnormal physiological state, that existed
at the time of deathat the time of death
 According to BichatAccording to Bichat
 ComaComa
 SyncopeSyncope
 AsphyxiaAsphyxia
 Depending upon the involvement of theDepending upon the involvement of the
system and irrespective of the remotesystem and irrespective of the remote
cause of death.cause of death.

26.  Coma DeathComa Death
 Failure of functions brainFailure of functions brain
 Due to paralysis of the vital centersDue to paralysis of the vital centers
 Compression of brain due to diseasesCompression of brain due to diseases
 Injuries to brainInjuries to brain
 Poisoning to brain-opium, alcohol etcPoisoning to brain-opium, alcohol etc
 Metabolic disorders- UraemiaMetabolic disorders- Uraemia

27. ““ Death due to syncope”Death due to syncope”
 Failure of the function of the heartFailure of the function of the heart
 Anaemia of the brainAnaemia of the brain
 Due to heart diseaseDue to heart disease
 Exhausting diseasesExhausting diseases
 Poisons- Digitalis, tobacco, aconite etc.Poisons- Digitalis, tobacco, aconite etc.

28. ““ death due to Asphyxia”death due to Asphyxia”
 Failure of the function of lungsFailure of the function of lungs
 Pathological conditions- PneumoniaPathological conditions- Pneumonia
 Poisoning- OpiumPoisoning- Opium
 Irrespirable gases – co, co2 etc.Irrespirable gases – co, co2 etc.
 Traumatic Asphyxia- StampadeTraumatic Asphyxia- Stampade
 Mechanical interference prevention of airMechanical interference prevention of air
entry to respiratory trackentry to respiratory track

29. According to GordonAccording to Gordon
 The functions of vital organs depends onThe functions of vital organs depends on
the availability and utilization of oxygen bythe availability and utilization of oxygen by
the body tissues -> “ Anoxia”the body tissues -> “ Anoxia”
 Anoxic AnoxiaAnoxic Anoxia
 Anaemic AnoxiaAnaemic Anoxia
 Histotoxic AnoxiaHistotoxic Anoxia
 Stagnent AnoxiaStagnent Anoxia

30. ““ Anoxia”Anoxia”
 Anoxic AnoxiaAnoxic Anoxia
 Mechanical Interference to the passage of airMechanical Interference to the passage of air
 Closure of the external respiratory orificesClosure of the external respiratory orifices
 Eg. SmotheringEg. Smothering
 Closure of the air passages by external pressureClosure of the air passages by external pressure
on the neckon the neck
 Eg. Hanging, StrangulationEg. Hanging, Strangulation
 Closure by impaction of foreign body closure byClosure by impaction of foreign body closure by
fluid- Drowning.fluid- Drowning.

31.  Prevention of normal movements of thePrevention of normal movements of the
chest’chest’
 Pressure on the chest- stampade, fall ofPressure on the chest- stampade, fall of
mason etcmason etc
 Injury to chest wall- penetrating injuriesInjury to chest wall- penetrating injuries
 Poisoning- strychninePoisoning- strychnine
 Electric shock due to bulbar palsyElectric shock due to bulbar palsy
 Vitiated atmosphere.Vitiated atmosphere.

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

33. The Manner of Death”The Manner of Death”
 It is a ‘design’ or ‘ fashion’ in which theIt is a ‘design’ or ‘ fashion’ in which the
cause of death came into beingcause of death came into being
 If death occurs from some disease, theIf death occurs from some disease, the
manner of death is ; Natural’manner of death is ; Natural’
 If death occurs due to violence the mannerIf death occurs due to violence the manner
will be ‘ unnatural’ or ‘violent’ death, maywill be ‘ unnatural’ or ‘violent’ death, may
be accidental, suicidal or homicidal, itbe accidental, suicidal or homicidal, it
depends on circumstances of the episode.depends on circumstances of the episode.

34. ““ The Mechanism of Death”The Mechanism of Death”
 It is a physiological or biochemicalIt is a physiological or biochemical
disturbances- metabolic acidosis,disturbances- metabolic acidosis,
alkalosis, sepsis, toxaemia or paralysisalkalosis, sepsis, toxaemia or paralysis
etc.etc.
 ““The Cause of death”The Cause of death”
 Disease or injuryDisease or injury
 Chain of eventsChain of events
 Brief or prolongedBrief or prolonged
 Produces fatal outcome.Produces fatal outcome.