D E A T HD E A T H

Complete, permanent and Complete, permanent and irreversible cessation of the vital irreversible cessation of the vital functions.functions.

Somatic or Clinical deathSomatic or Clinical death

Molecular deathMolecular death

Somatic or Clinical DeathSomatic or Clinical Death

Permanent and irreversible damage to;Permanent and irreversible damage to;

= Brain= Brain

= Heart= Heart

= Lungs= Lungs

Difficulties to Diagnosis Difficulties to Diagnosis Somatic deathSomatic death

Warmness of bodyWarmness of body

Suspended AnimationSuspended Animation

Coma due to sedatives or hypnotics- Coma due to sedatives or hypnotics- BarbituratesBarbiturates

HypothermiaHypothermia

Molecular DeathMolecular Death Death of individuals tissues and cellsDeath of individuals tissues and cells

Process competes by two to three Process competes by two to three hours after somatic deathhours after somatic death

Changes in the eye, skin muscles etc.Changes in the eye, skin muscles etc.

What is the importance of death?What is the importance of death?

Disposal of the dead bodyDisposal of the dead body

Death certificateDeath certificate

Post-mortemPost-mortem

Transplantation of organs Transplantation of organs likelike::

Liver – within 15 minutesLiver – within 15 minutes

Kidney 30-40 minutesKidney 30-40 minutes

Heart 1 hourHeart 1 hour

Brain – Stem deathBrain – Stem death What is Brain –stem deathWhat is Brain –stem death How to diagnoseHow to diagnose What is its importance to knowWhat is its importance to know Tests for confirmation of brain-stem Tests for confirmation of brain-stem

deathdeath Medico-legal importance “suspended Medico-legal importance “suspended animation”animation” ““Transplantation of Organs”Transplantation of Organs”

Brain StemBrain Stem

Mid brainMid brain

PonsPons

MedullaMedulla

Permanent and irreversiblePermanent and irreversible stoppage of stoppage of functions of above areasfunctions of above areas

Tests for confirmation of brain-stem Tests for confirmation of brain-stem deathdeath

In coma for more than 6hrs or 24 hrs In coma for more than 6hrs or 24 hrs if cardiac arrest is the causeif cardiac arrest is the cause

No abnormal decorticate or No abnormal decorticate or decerebrate postures should be decerebrate postures should be presentpresent

No spontaneous respirationNo spontaneous respiration No epileptic movementsNo epileptic movements All brain stem reflexesAll brain stem reflexes Should be absentShould be absent

Diagnosis of brain-stem Diagnosis of brain-stem deathdeath

Establishment of positive diagnosis of Establishment of positive diagnosis of coma and its causescoma and its causes

““irremediable, structural damage of irremediable, structural damage of brain”brain”

Trying to remedy it and failing”Trying to remedy it and failing” Correction –low blood pressureCorrection –low blood pressure Correction-HypoxiaCorrection-Hypoxia Removal of blood clotRemoval of blood clot

Brain- stem reflexesBrain- stem reflexes

Pupillary reflext Pupillary reflext Optic Optic <- Occulomotor<- Occulomotor Vestibulo-reflex occular -> AuditoryVestibulo-reflex occular -> Auditory <- Abducent<- Abducent Corneal reflex -> TrigeminalCorneal reflex -> Trigeminal <- Facial<- Facial Gag reflex -> GlossopharyngealGag reflex -> Glossopharyngeal <- Vagus<- Vagus Dolls eye reflex - > AuditoryDolls eye reflex - > Auditory <- Abducent <- Abducent

Brain –stem death shall not be Brain –stem death shall not be considered in :considered in :

Absence of comaAbsence of coma Child below 5 yrs of ageChild below 5 yrs of age Coma due to drugs, hypothermia, Coma due to drugs, hypothermia,

metabolic disorders and shockmetabolic disorders and shock

Sudden DeathSudden Death

Sudden deaths are those which are Sudden deaths are those which are not preceded or are of only not preceded or are of only preceded for a short time of or with preceded for a short time of or with morbid symptoms.morbid symptoms.

Medico – legallyMedico – legally

They raise a suspicion of foul play.They raise a suspicion of foul play.

Causes of Sudden deathCauses of Sudden death

UnnaturalUnnatural ViolenceViolence PoisoningPoisoning Combination of bothCombination of both NaturalNatural

CardiovascularCardiovascular

- Coronary diseaseCoronary disease- Congenital heart diseasesCongenital heart diseases- Valvular heart diseasesValvular heart diseases- Hypertensive heart diseasesHypertensive heart diseases- InfectionInfection- Cardiac tamponadeCardiac tamponade- Aortic aneurysmAortic aneurysm

RespiratoryRespiratory- Pulmonary embolismPulmonary embolism- HaemoptysisHaemoptysis- InfectionsInfections- Chronic asthmaticsChronic asthmatics- AnaphylaxisAnaphylaxis- Obstruction to air passageObstruction to air passage

C.N.S.C.N.S.- Intra cerebral haemorrhageIntra cerebral haemorrhage- Sub arachnoid haemorrhageSub arachnoid haemorrhage- Cerebral thrombosisCerebral thrombosis- EmbolismEmbolism- InfectionsInfections- Tumor of brainTumor of brain

AbdominalAbdominal

- Haemorrhage in the G.I. tractHaemorrhage in the G.I. tract- Rupture of abdominal aneurysmRupture of abdominal aneurysm- Liver diseasesLiver diseases- Acute pancreatic bleedingAcute pancreatic bleeding

- EndocrinalEndocrinal- Adrenal haemorrhageAdrenal haemorrhage- Diabetic comaDiabetic coma- Myxoedemic and parathyroid crisisMyxoedemic and parathyroid crisis- IatrogenicIatrogenic- Abuse of drugsAbuse of drugs- Sudden withdrawal of steroidsSudden withdrawal of steroids- AnesthesiaAnesthesia- Mismatched blood transfusion. Mismatched blood transfusion.

MiscellaneousMiscellaneous Bacteriaemic shockBacteriaemic shock Shock due to fear or emotionShock due to fear or emotion MalariaMalaria Special causes in childrenSpecial causes in children Cot death or SIDSCot death or SIDS Congenital mental abnormalitiesCongenital mental abnormalities Concealed puncture wound.Concealed puncture wound.

“ “ Suspended AnimationSuspended Animation

The condition where the person may The condition where the person may appear to be dead due to the fact that appear to be dead due to the fact that the vital functions are at such a low level the vital functions are at such a low level as to be minimum compatible with life,as to be minimum compatible with life,

The Suspended AnimationThe Suspended Animation Apparent deathApparent death As a voluntary Act ( Death Trance)As a voluntary Act ( Death Trance) Hypothermia, Drowning, new born, elect Hypothermia, Drowning, new born, elect

shock etc.shock etc.

Modes of deathModes of death Manners of deathManners of death Mechanism of deathMechanism of death Cause of deathCause of death

Modes of deathModes of death

Abnormal physiological state, that Abnormal physiological state, that existed at the time of deathexisted at the time of death

According to BichatAccording to Bichat ComaComa SyncopeSyncope AsphyxiaAsphyxia Depending upon the involvement of Depending upon the involvement of

the system and irrespective of the the system and irrespective of the remote cause of death.remote cause of death.

Coma DeathComa Death Failure of functions brainFailure of functions brain Due to paralysis of the vital centersDue to paralysis of the vital centers Compression of brain due to diseasesCompression of brain due to diseases Injuries to brainInjuries to brain Poisoning to brain-opium, alcohol etcPoisoning to brain-opium, alcohol etc Metabolic disorders- UraemiaMetabolic disorders- Uraemia

“ “ Death due to syncope”Death due to syncope”

Failure of the function of the heartFailure of the function of the heart Anaemia of the brainAnaemia of the brain Due to heart diseaseDue to heart disease Exhausting diseasesExhausting diseases Poisons- Digitalis, tobacco, aconite Poisons- Digitalis, tobacco, aconite

etc.etc.

“ “ death due to Asphyxia”death due to Asphyxia”

Failure of the function of lungsFailure of the function of lungs Pathological conditions- PneumoniaPathological conditions- Pneumonia Poisoning- OpiumPoisoning- Opium Irrespirable gases – co, co2 etc.Irrespirable gases – co, co2 etc. Traumatic Asphyxia- StampadeTraumatic Asphyxia- Stampade Mechanical interference prevention Mechanical interference prevention

of air entry to respiratory trackof air entry to respiratory track

According to GordonAccording to Gordon

The functions of vital organs depends The functions of vital organs depends on the availability and utilization of on the availability and utilization of oxygen by the body tissues -> “ oxygen by the body tissues -> “ Anoxia”Anoxia”

Anoxic AnoxiaAnoxic Anoxia Anaemic AnoxiaAnaemic Anoxia Histotoxic AnoxiaHistotoxic Anoxia Stagnent AnoxiaStagnent Anoxia

“ “ Anoxia”Anoxia”

Anoxic AnoxiaAnoxic Anoxia Mechanical Interference to the passage of airMechanical Interference to the passage of air Closure of the external respiratory orificesClosure of the external respiratory orifices Eg. SmotheringEg. Smothering Closure of the air passages by external Closure of the air passages by external

pressure on the neckpressure on the neck Eg. Hanging, StrangulationEg. Hanging, Strangulation Closure by impaction of foreign body closure Closure by impaction of foreign body closure

by fluid- Drowning.by fluid- Drowning.

Prevention of normal movements of the Prevention of normal movements of the chest’chest’

Pressure on the chest- stampade, fall of Pressure on the chest- stampade, fall of mason etcmason etc

Injury to chest wall- penetrating injuriesInjury to chest wall- penetrating injuries Poisoning- strychninePoisoning- strychnine Electric shock due to bulbar palsyElectric shock due to bulbar palsy Vitiated atmosphere.Vitiated atmosphere.

Anaemic Anoxia :Anaemic Anoxia : Reduced oxygen carrying capacity of blood – Reduced oxygen carrying capacity of blood –

Acute haemorrhage, acute poisoning by co. Acute haemorrhage, acute poisoning by co. and nitrites.and nitrites.

Histotoxic Anoxia:Histotoxic Anoxia: Decreased oxidative process in tissue, tissue Decreased oxidative process in tissue, tissue

cells are poisoned – eg. Cyanide poisoning.cells are poisoned – eg. Cyanide poisoning. Stagnant Anoxia:Stagnant Anoxia: In efficient circulation through the tissues- In efficient circulation through the tissues-

shock . C.C.F. etc.shock . C.C.F. etc.

The Manner of Death”The Manner of Death”

It is a ‘design’ or ‘ fashion’ in which the It is a ‘design’ or ‘ fashion’ in which the cause of death came into beingcause of death came into being

If death occurs from some disease, the If death occurs from some disease, the manner of death is ; Natural’manner of death is ; Natural’

If death occurs due to violence the If death occurs due to violence the manner will be ‘ unnatural’ or ‘violent’ manner will be ‘ unnatural’ or ‘violent’ death, may be accidental, suicidal or death, may be accidental, suicidal or homicidal, it depends on circumstances homicidal, it depends on circumstances of the episode. of the episode.

“ “ The Mechanism of Death”The Mechanism of Death” It is a physiological or biochemical It is a physiological or biochemical

disturbances- metabolic acidosis, disturbances- metabolic acidosis, alkalosis, sepsis, toxaemia or paralysis alkalosis, sepsis, toxaemia or paralysis etc.etc.

““The Cause of death”The Cause of death” Disease or injuryDisease or injury Chain of eventsChain of events Brief or prolongedBrief or prolonged Produces fatal outcome.Produces fatal outcome.