Determining DEATH How do you know if someone is dead?

Prior to the 17 th century There was no real means of determining if a person was dead

In the olden days……  Wakes originated to delay burial a body started to decompose and smell, to determine if a person was dead.  Vital Dublae Asylums (waiting mortuaries) were used…bodies were placed on cots and allowed to decay before burying them  In the Victorian era (late 1800’s) caskets had bells attached because people were scared of being buried alive

An important discovery  The stethoscope the stethoscope was the most reliable and informative tool available for diagnosing cardiovascular disease and death.  Although other, more sophisticated diagnostic methods have come into use since then, the stethoscope has never been discarded.

The ECG…..Electrocardiogram  The ECG was invented in 1887 by Dr. Augustus D. Waller but not widely used until after the 1920’s  In 1911 Waller said, "I do not imagine that electrocardiography is likely to find any very extensive use in the hospital. It can at most be of rare and occasional use to afford a record of some rare anomaly of cardiac action."  However, just 13 years later, the Nobel Prize in Medicine was awarded to Dutch physiologist Willem Einthoven, who transformed this curious physiologic phenomenon into an indispensable clinical recording device that is still used today.

What is an ECG……  The electrocardiogram, or ECG / EKG is a surface measurement of the electrical potential generated by electrical activity in cardiac tissue. Current flow, in the form of ions, signals contraction of cardiac muscle fibers leading to the heart's pumping action.

Interesting Trivia  An ECG and an EKG are the same thing but since it was invented by a German it was originnally spelled……. …elektrokardiogramm  EKG is often used so as not to confuse ECG with EEG………  what is is an EEG….confused yet??????????

EEG  An electroencephalogram (EEG) is a test that measures and records the electrical activity of your brain.  Special sensors(electrodes) are attached to your head and hooked by wires to a computer.electrodes)  The computer records your brain's electrical activity on the screen or on paper as wavy lines.

REALITY??????

Why It Is Done?  Diagnose epilepsy and see what type of seizures are occurring.epilepsy  Check for problems with loss of consciousness or dementia.dementia  Study sleep disorders, such as narcolepsy.narcolepsy  Watch brain activity while a person is receiving general anesthesia during brain surgery.  Help find out if a person has a physical problem (problems in the brain, spinal cord, or nervous system) or a mental health problem.

But for our purposes….  Help find out a person's chance of recovery from unconsciousness.  To find out if a person who is in a coma is brain-dead.  Really to answer the question… is this person DEAD????????

Generally speaking..  A person is determined dead at a scene only when it is really obvious.  So there is a dead body at the scene…..now what????

Cause and Manner of Death must be established

Mechanism of Death  AKA “Cause of Death”  The specific physiological alteration to the body that made death occur

Mechanisms of Death  Exsanguination… bleeding to death also called hypovolemic shock  Sepsis.. Infection  Cerebral Contusion….trauma to skull/brain  Intracerebral Bleeding…in brain  Subdural or epidural hematoma… bleeding around brain  Asphyxia…breathing stops

Manner of Death  The incident that caused the occurance of a person’s death  Natural  Accidental  Suicide  Homicides …which can be criminal (auto, manslaughter, murder) or non-criminal (self-defense)  Undetermined, unclassified,unknown