1. D E A T H

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

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

4. Difficulties to Diagnosis Somatic death
Warmness of body
Suspended Animation
Coma due to sedatives or hypnotics- Barbiturates
Hypothermia

5. 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.

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

7. Transplantation of organs like:
Liver – within 15 minutes
Kidney minutes
Heart 1 hour

8. 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”

9. Brain Stem Mid brain Pons Medulla
Permanent and irreversible stoppage of functions of above areas

10. 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

11. No spontaneous respiration
No epileptic movements
All brain stem reflexes
Should be absent

12. 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

13. Brain- stem reflexes Pupillary reflext  Optic <- Occulomotor
Vestibulo-reflex occular -> Auditory
<- Abducent
Corneal reflex -> Trigeminal
<- Facial
Gag reflex -> Glossopharyngeal
<- Vagus
Dolls eye reflex - > Auditory

14. 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

15. 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.

16. Causes of Sudden death Unnatural Violence Poisoning
Combination of both
Natural

17. Cardiovascular Coronary disease Congenital heart diseases
Valvular heart diseases
Hypertensive heart diseases
Infection
Cardiac tamponade
Aortic aneurysm

18. Respiratory
Pulmonary embolism
Haemoptysis
Infections
Chronic asthmatics
Anaphylaxis
Obstruction to air passage

19. C.N.S.
Intra cerebral haemorrhage
Sub arachnoid haemorrhage
Cerebral thrombosis
Embolism
Infections
Tumor of brain

20. Abdominal Haemorrhage in the G.I. tract Rupture of abdominal aneurysm
Liver diseases
Acute pancreatic bleeding

21. Endocrinal
Adrenal haemorrhage
Diabetic coma
Myxoedemic and parathyroid crisis
Iatrogenic
Abuse of drugs
Sudden withdrawal of steroids
Anesthesia
Mismatched blood transfusion.

22. Miscellaneous
Bacteriaemic shock
Shock due to fear or emotion
Malaria
Special causes in children
Cot death or SIDS
Congenital mental abnormalities
Concealed puncture wound.

23. “ 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.

24. Modes of death
Manners of death
Mechanism of death
Cause of death

25. 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.

26. 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

27. “ 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.

28. “ 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

29. 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

30. “ 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.

31. 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.

32. 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.

33. 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.

34. “ 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.