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 hypnotics- Barbiturates • 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 tissues- shock . 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.