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 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

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.