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    Death

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    Sriram Shirke
    Death is the irreversible cessation of all vital functions of the body. It can occur through somatic death when there is loss of function of the brain, heart, and lungs. Molecular death is the death of tissues and cells. Brain death is the irreversible loss of brain function and can be diagnosed by examining for the absence of brainstem reflexes and apnea during a medical test. The cause, manner, and mode of death are important to determine in medical-legal cases. Vasovagal inhibition can sometimes cause reflex cardiac arrest and death.

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    Death

    Uploaded by

    Sriram Shirke
    18 views49 pages
    Death is the irreversible cessation of all vital functions of the body. It can occur through somatic death when there is loss of function of the brain, heart, and lungs. Molecular death is the death of tissues and cells. Brain death is the irreversible loss of brain function and can be diagnosed by examining for the absence of brainstem reflexes and apnea during a medical test. The cause, manner, and mode of death are important to determine in medical-legal cases. Vasovagal inhibition can sometimes cause reflex cardiac arrest and death.

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    Death is the irreversible cessation of all vital functions of the body. It can occur through somatic death when there is loss of function of the brain, heart, and lungs. Molecular death is the death of tissues and cells. Brain death is the irreversible loss of brain function and can be diagnosed by examining for the absence of brainstem reflexes and apnea during a medical test. The cause, manner, and mode of death are important to determine in medical-legal cases. Vasovagal inhibition can sometimes cause reflex cardiac arrest and death.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    18 views49 pages

    Death

    Uploaded by

    Sriram Shirke
    Death is the irreversible cessation of all vital functions of the body. It can occur through somatic death when there is loss of function of the brain, heart, and lungs. Molecular death is the death of tissues and cells. Brain death is the irreversible loss of brain function and can be diagnosed by examining for the absence of brainstem reflexes and apnea during a medical test. The cause, manner, and mode of death are important to determine in medical-legal cases. Vasovagal inhibition can sometimes cause reflex cardiac arrest and death.

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    DEATH

    DEATH
    Introduction
    ➢Death is the inevitable end of life.
    ➢A living body owes its life because of
    integrity of 3 principal interdependent
    systems namely
    ➢circulation,
    ➢respiration and
    ➢ nervous system.
    ➢Heart, brain and lungs are called as Bishop’s
    tripod of life.
    Death is a process not an event
    Definition

    • Black’s law dictionary: Cessation of life


    • Chamber’s dictionary: Extinction of life
    • Clinical definition: Irreversible cessation of life
    • Registration of births and deaths act:
    permanent disappearance of all evidence of
    life at any time after live birth has taken place.
    Types
    SOMATIC DEATH

    ➢It signifies death of personality or death of


    individual as a whole, when there is complete
    loss of body functions.
    ➢ DEFINITION >
    Irreversible cessation of functioning of the
    brain,heart and lungs resulting in complete
    loss of sensibility and ability to move the body
    ➢DIAGNOSIS >
    a. Cessation of cardiac activity,
    b. Cessation of respiration,
    c. Cessation of Brain activity .
    MOLECULAR DEATH
    ➢ Ultimate death of all cellular elements.
    ➢ It signifies death of the tissues and cells of the
    body individually. It does not occur before 2 to 3
    hours after somatic death.
    ➢ Molecular death can be confirmed by absence of
    any response to an electrical, thermal or chemical
    stimulus in the tissues.
    BRAIN DEATH
    ➢Irreversible loss of cerebral functions.

    TYPES
    1. CEREBRAL or CORTICAL
    2. BRAIN STEM DEATH
    3. WHOLE BRAIN DEATH
    CEREBRAL DEATH
    ➢Brain stem is intact with continuous heart
    sounds and respiration but total loss of
    sensitivity .
    ➢Severe brain damage which does not involve
    brain stem, may result in persistent vegetative
    state .
    ➢These patients breathe spontaneously, open
    and close their eyes, swallow and make facial
    grimaces.
    CAUSES
    1. CEREBRAL HYPOXIA
    2. TOXIC CONDITIONS
    3. WIDE SPREAD BRAIN INJURY.
    WHOLE BRAIN DEATH

    It comprises combination of both cortical and


    brain stem death

    BRAIN STEM DEATH

    Cerebrum is intact but cut off functionally from


    stem lesions.
    Mike- the headless chicken
    Hydrancephaly
    Committees which define Brain death

    1. Harvard Adhoc committee


    2. Philadelphia Protocol
    3. Minnesota criteria
    Harvard Ad hoc Committee.
    (Report of the Ad hoc committee of the medical school to
    examine the definitions of brain death. JAMA,1968;205,337-340)

    1. Unreceptivity and unresponsivity


    2. No spontaneous muscular
    movements
    3. No spontaneous respiration
    4. Absence of all the reflexes
    5. Flat EEG
    BRAINSTEM DEATH
    CAUSES
    1. Cerebral edema

    2. Increased intracranial tension

    3. Intracranial hemorrhage
    DIAGNOSIS
    1. Patient is deeply comatosed and unable to
    breath spontaneously and needs to be
    maintained on ventilator
    2. Cause of irreversible coma must be known
    3. All the Brainstem reflexes are absent and
    the apnoeic test is negative
    Brainstem reflexes
    1. Pupillary reflex
    2. Corneal reflex
    3. Vestibulo ocular reflex
    4. Grimace reflex
    5. Gag reflex
    Apnoeic test
    • No respiratory movements occur when the
    patient is disconnected from the ventillator for
    long enough to ensure that the carbon dioxide
    concentration in the blood rises above the
    threshold for stimulating respiration.
    • After giving the patient 100% oxygen for
    5minutes the ventilator is disconnected for 10
    minutes, if no spontaneous breathing occurs
    within this 10minutes the brainstem is incapable
    of reacting to the presence of carbon dioxide and
    is thus confirmed to be dead.
    Confirmatory tests
    1. Conventional angiography
    2. EEG – No electrical activity over 30
    minutes
    3. Trans cranial Doppler U/S
    4. Technetium -99m HMPA Brain scan
    5. Somato sensory evoked potentials
    CONDITIONS

    1. Intoxication
    2. Depressant drugs
    3. Muscle relaxants
    4. Hypothermia
    5. Hypo volume shock
    6. Metabolic or endocrinal disturbances
    7. Hypnotic Trance / Samadhi / Yogic Trance
    Who can certify brainstem death?
    It needs to be certified by a board of doctors
    consisting of
    1. The registered medical practitioner in charge of
    the hospital
    2. An independent registered medical practitioner
    who is specialist
    3. A neurologist or neurosurgeon
    4. The registered medical practitioner treating the
    person whose brainstem death has occurred

    Certification should be done with a time interval of a


    minimum of 6 hours
    Preconditions to be fulfilled
    • The cause of irreversible brainstem damage
    producing non responsive coma must be
    established.
    1. The patient must be examined by a team of
    doctors at least twice, with a gap of 6 hours
    in between.
    2. The doctors who participate in the diagnosis
    of brainstem death should not have any
    interest in the transplantation of any organ
    being removed from the cadaver.
    Medico legal importance of Death
    1. Death and Indian Penal code Section 46, states
    that the word DEATH denotes death of a human
    being unless the contrary appears from this
    context.
    2. Tissue and organ transplantation
    - Viability of transplantable tissues and organs
    falls sharply after somatic death
    3. Question of presumption of survivorship.
    4. Issuing of death certificate.
    Differential Diagnosis For Death.
    Suspended Animation/Apparent
    Death
    SUSPENDED ANIMATION

    Defined as a condition in which signs of Life are


    Not found as the functions are interrupted for
    sometime or reduced to the minimum.

    The Metabolic rate is reduced to such an extent


    where the requirement for oxygen by individual
    cells is satisfied through the use of oxygen
    dissolved in the body fluids.
    • Examples
    ➢ Drowning
    ➢Electrocution
    ➢New born
    ➢Yogic trance

    Medicolegal importance
    1. Resuscitation should be given in all such
    cases
    2. Confirmation of death should be done.
    • Mode of death
    • Manner death
    • Cause of death
    • Mode of death
    The Mode of Death refers to the abnormal physiological
    state that existed at the time of death.
    According to Bichat, there are three modes of death depending
    upon the system involved, irrespective of what the remote cause
    of death may be. These are:
    • Coma, i.e. failure of functions of brain.
    • Syncope, i.e. failure of functions of heart.
    • Asphyxia, i.e. failure of respiratory system.
    • Coma: Coma refers to unconscious state of a person characterized by
    complete insensibility or unarousability.
    • The unconsciousness is complete without any response to any sort of
    stimuli.
    • When the patient is partially conscious and responds to deep and painful
    stimuli, it is termed as stupor.

    • Syncope: Syncope results from stoppage of functioning of heart with


    consequent cessation of circulation.
    • In syncope there occurs loss of consciousness with postural collapse due to
    an acute decrease in cerebral blood flow.

    • Asphyxia: Asphyxia is a condition caused by interference with


    respiration, or due to lack of oxygen in respired air, due to which the organs
    and tissues are deprived of oxygen, causing unconsciousness or death.
    Vicious cycle of asphyxia
    Triad of asphyxia
    • Cyanosis: More than 5g/100 ml of whole blood should be in the form
    of reduced haemoglobin to produce cyanosis regardless of the total
    haemoglobin concentration. The essential cause of cyanosis is diminished
    oxygen tension in the blood with a rise in proportion of the reduced
    haemoglobin.

    • Petechial haemorrhages- are caused due to raised venous


    pressure from impaired venous return resulting in overdistension and
    rupture of venules, especially in lax tissues

    • Congestion of organs
    • Manner of death
    Manner of death refers to the way (or design/fashion) in which the
    cause of death comes into being.
    • Cause of death
    • It is the injury, disease, or combination of the two that initiates
    a train of physiological disturbances (brief or prolonged),
    resulting in the termination of an individual’s life.
    Vagal Inhibition

    • Also termed as: Vasovagal attack, reflex cardiac


    arrest, nervous apoplexy, or, primary
    neurogenic shock.
    • Condition characterised by- fulminant
    circulatory failure due to reflex cardiac arrest,
    severe hypotension due to reflex vasodilatation
    or combination of both the mechanisms.
    Physiological basis
    • Network of sensory nerve supply to the skin,
    pharynx, larynx, pleura, peritoneum. Afferent
    pathway through lateral tract of spinal cord----
    vagus nucleus---- efferent through cerebrum
    and thlamus
    • Carotid sinus nerve endings of glosso
    pharyngeal nerve--- communicates with
    medullary cardiovascular centre and dorsal
    motor nucleus of vagus---- Reflex fall of B.P and
    heart activity.
    Circumstances of Vasovagal shock
    • Sudden pressure over neck e.g in hanging,
    strangulation.
    • Sudden blow on the abdomen, larynx or genital
    organs.
    • During intubation, or, impaction of food in larynx
    • Penetration of pleura/peritoneum in surgical
    procedures
    • Sudden cerebral concussion
    • Sudden immersion of body in cold water
    • Intense fear, fright, emotions or horrible sight
    Reflex gets accentuated in conditions having low
    voluntary control.
    Autopsy diagnosis ?
    • Absence of any typical autopsy findings
    • ‘diagnosis of exclusion’ : elimination of natural
    disease, poisoning or some other obvious
    cause which has been ruled out by relevant
    investigations.
    • Presence of circumstantial evidence.
    • History of event which can explain
    physiological mechanism.
    Medicolegal Importance

    • Death may occur under circumstances where


    there is ‘no intention to kill’.
    • Due to instant loss of consciousness, victim is
    likely to be found in position in which he was
    at time of death.
    • Scared to death: if death occurs as a result of
    crime, then it is considered as homicide.
    • Obscure autopsy
    • Negative autopsy
    THANK YOU

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