shock is one of the main cause of death very common encountered in day to day practice,in this presentation we look at how it happen,what are the causes and how we diagnose it in brief and its forensic importance
Thanatology
Types of transplants
Cause, Mechanism of Death
Manner of death
Anoxia
Signs of Death
Immediate Changes (Somatic Death)
Early Changes (Molecular Death)
Algor Mortis ......
Reference
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Thanatology
Types of transplants
Cause, Mechanism of Death
Manner of death
Anoxia
Signs of Death
Immediate Changes (Somatic Death)
Early Changes (Molecular Death)
Algor Mortis ......
Reference
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Hii, I have uploaded my class presentation
Death & its causes/ Thanatology is very interesting and important topic in Forensic Medicine, might be useful for other readers also
this is a powerpoint presentation on external examination at autopsy, presented during pg program.. useful for both undergraduate and postgraduate students
IDENTIFICATION OF THE LIVING AND THE DEAD.pptBalinainejoseph
This is a part of forensic medicine that describes the indentification of the living and the dead
It explains both scientific and non scientific methods
Hii, I have uploaded my class presentation
Death & its causes/ Thanatology is very interesting and important topic in Forensic Medicine, might be useful for other readers also
this is a powerpoint presentation on external examination at autopsy, presented during pg program.. useful for both undergraduate and postgraduate students
IDENTIFICATION OF THE LIVING AND THE DEAD.pptBalinainejoseph
This is a part of forensic medicine that describes the indentification of the living and the dead
It explains both scientific and non scientific methods
Deals with the post-mortem examination (autopsy) particularly the internal examinations of the various organs based on Virchow's technique of organ removal.
This PowerPoint talks about shocks and their types, also how it is treated and what their causes and symptoms. this PowerPoint is for college students.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Study of electrocution death in Manipur ,to prevent more mortality from electrocution in the future,and to find out the main reason behind the high number of death from it
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. Shock is any condition in which the
circulatory system is unable to provide
adequate circulation to the vital body
organs such as the brain, heart and lungs.
As a result of a decrease in the blood
pressure.
Shock is usually accompanied by renal
failure, as a normal compensatory
mechanism, because the blood flow to the
kidney is decreased to keep enough blood
for the vital organs.
3. Shock is classified according to the
causes to four classes:
Hypovolemic shock
Distributive shock
Cardiogenic shock
Neurogenic shock
4. 1.Hypovolemic shock is caused by low
blood volume.
Normal blood volume is 5 L and by losing 1-
2 L it can lead to shock.
The Decrease in blood volume is caused
by:
External blood loss: ex. Hemorrhage
Internal blood loss: ex. Ruptured spleen
caused by blunt trauma.
Severe dehydration as a result of:
Vomiting
Diarrhea
This is a typical condition in cholera.
Burns
5. 2. Distributive shock is caused by excess
vasodilatation (ex. Anaphylactic shock and
septicaemia)
Vasodilatation Arteriole resistance
increase blood exchange from the vessels to
the peripheral tissues decrease blood
return to the heart BP shock.
Anaphylaxis, drug, toxin reactions
Trauma: crush injuries, major fractures, major
burns.
Infection/sepsis: G(-/+ ) septicemia,
pneumonia, peritonitis, meningitis, cholangitis,
pyelonephritis, necrotic tissue, pancreatitis, wet
gangrene, toxic shock syndrome, etc.
6. 3.Cardiogenic shock ( heart does not pump
enough blood) is caused by:
A) Myocardial infarction leads to
weak cardiac
As a result
Muscle contraction Ischemia
of
B) Arrhythmia ( such as ventricular
fibrillation, which will stop the heart pump
and that will decrease BP)
Note: Supraventricular (Atria) fibrillation will
not cause shock because 75% of the blood
transfer from the atrium to the ventricles by
passive transport.
7. C) Valve problems, ex. Valvular stenosis
which is narrowing of the valves, or leakage
of blood through the valves (
Regurgitation).
D) Problems in the A-V shunt.
4.Neurogenic shock
Mechanism: Loss of autonomic innervation
of the cardiovascular system (arterioles,
venules, small veins, including the heart)
Causes:
Spinal cord injury
Regional anesthesia
Drugs
Neurological disorders
9. CARDIOGENIC SHOCK Cardiac output
Deficiency of emptying
Deficiency of filling Blood flow
Outflow obstruction
Supply of oxygen
OTHER TYPES
Traumatic shock Anoxia
Neurogenic shock
Hypoadrenal shock Inflammatory mediators
SHOCK
10. Common mediators of septic shock
include TNF-α, IL-1, NO, and Ceramide.
All of these cytokines released during
sepsis cause extreme diffuse vasodilation
and vascular leakage, leading to
distributive shock. Reduced SVR is a
hallmark of septic shock.
11. Hypoxic Cell injury
Activation of innate immunity
Stimulation of macrophages
Release of inflammatory mediators
TNF-α IL-1 Others
Synthesis of Vasodilatation Other cytokines
Nitric oxide (IL-6, 12, 8, PAF)
Generation of Hypotension Free radicals
Free radicals C3a, C5a
Figure: Response of inflammatory mediators in shock.
12. Kidneys
Shock causes “pre-renal” acute renal
failure. Ischemia of tubule epithelium leads
to vasoconstriction, reduced GFR, oliguria,
and azotemia
Ischemia leads to Acute Tubular Necrosis
(ATN)
Brain
Altered mental status occurs early in shock,
due both to hypoxemia and metabolic
problems
GI tract
The GI tract is at very high risk of infarction.
Shock causes infarction of the GI epithelium
13. Liver
Centrilobular necrosis is common.
There is diminished reticuloendothelial
clearance
Blood -- DIC
WBC count may go up or down.
Platelets go way down as they are all
used up in DIC.
Diffuse fibrin thrombosis consumes
feedback inhibitors, leading to more
and more clotting
14. Shock leads to multi-organ dysfunction
syndrome (MODS).
The lungs are usually the first organ to fail,
followed by kidneys, liver, GI tract, and
then brain.
Heart
Grossly, subendocardial hemorrhages
are common.
Microscopically, contraction bands are
seen in myocardial cells.
Fatty change – 18 to 24 hrs well marked
in 3 to 4 days
15. Lung
Shock causes release of inflammatory
mediators such as TNF-α. This injures
endothelial cells.
Endothelial injury allows leakage of
proteinaceous fluid and neutrophils into the
interstitium.
interstitial edema and inflammation
common in shock.
Edema is well discernible after 2 to 3 days
Since it’s interstitial, not alveolar, the septae
between alveoli are greatly widened.
Lungs become heavy, stiff, and
hemorrhagic.
16.
17. Brain
Watershed infarcts are a common
consequence of shock. These are long,
wedge-shaped infarcts at the very distal tips of
a major arterial supply.
Laminar necrosis is another common
consequence of shock.
GI tract
Shock often causes mucosal hemorrhage and
necrosis
Grossly, the GI tract may appear swollen and
bloody.
Adrenal
The may be evidence of focal lipid depletion in
the cortical area within 1 to2 days
18.
19. Liver
Fatty change become evident within 18 to
24 hrs
Shock generally causes centrilobular
necrosis, because the hepatocytes closest
to the central vein are the furthest from the
blood supply.
Kidneys
The most susceptible kidney cells are those
in the proximal tubules and thick ascending
Loop of Henle.
Microscopically, you will see acute tubular
necrosis (ATN). There will be dilation of
proximal tubules due to flattening of the
epithelium. Brownish casts may be seen
20.
21.
22.
23.
24. In a person with haemorrhagic diathesis or
haemophilia, minor injury produce death from
hge.
A trivial bruise causes loss of 20-30ml of blood
loss. So an extensive bruise without any other
injury might also cause dead .
Examination of crime scene is important to
calculate the amount of blood loss.
Men withstand hge better than women.
Sudden rise of BP in neurogenic shock can
precipitate serious complications like –
(a) Intracerebral hge from rupture of
arteriosclerotic cerebral vessels or of berry
aneurysm.
25. (b) Rupture of a dissecting aneurysm of
aorta.
Under such conditions even when the
deceased received minor trauma
before death, the essential cause of
death will be underlying disease process.
Minor stimuli or injury over receptic spots
may cause sudden death from
neurogenic shock.
In persons of neurotic or emotional
temperament, in deeply intoxicated,
severely ill or feeble old and young
children, death from primary shock
occurs readily.
26. Shock is a complex, dynamic disorder
of tissue and cellular hypoperfusion,
produced by multiple interacting
mechanisms that may lead to MODS
& death. Successful treatment of
patients with shock requires prompt
recognition of the shock state and a
thorough understanding of the
pathophysiology of various types of
shock
27. In case of any sudden death meticulous
history taken to rule out any precipitating
factor of shock is a must.
There may not be any evidence of injury in
some cases of death from violence.
E.g sudden death due to vagal inhibition
In such case after full and meticulously
done autopsy, even absence of violence or
morbid cause to account for sudden death
of the subject who was ordinarily healthy
previous to infliction of violence there might
not to be any hesitation to ascribe the
death to be due to functional effect of the
injuries.
28. Autopsy finding in case of death due to
neurogenic shock are mainly inferential
and the diagnosis is arrived at from
history of sudden death following blow or
injury over the area and negative
finding. E.g absence of fatal injuries,
poisoning or natural disease etc
So careful history taking is a must besides
other investigations in establishing the
cause of death.