Concept of Death Dr Rizwan

8/7/2019 Concept of Death Dr Rizwan

1/57

CONCEPT OF DEATH CONCEPT OF DEATH


2/57

Death is the end of dying.

It is a process rather than an event, except insituations where death occur instantaneously

like bomb blast, crushing of head in Roadside accidents.


3/57


4/57

S ection 2b of the Registration of Births andDeaths Act defines death as

Permanent disappearance of allevidence of life at any time after live birth hastaken place


5/57

U nited S tate (Blacks) Dictionary of Lawdefines death as:

The cassation of life, the ceasing toexist


6/57


7/57

S hapiro (1969) defines death asThe irreversible lose of the properties of

living matter


8/57


9/57

Rantoul and S mith (1973):- C omplete and persistent cessation of

respiration and circulation


10/57

Death is not a moment

buta Continuous Process


11/57

C LASS IFIC ATION OF DEATH

B iologically

Death occurs in bits & pieces

Moment of start of this disintegration,cannot be ascertained

Declaring------Death - has become more difficult

Since 1967-Dec

(First human heart transplant was successfully carried)


12/57


13/57

The living body depends upon the integrity of three principals, interdependent upon eachother, these systems are

1) Respiration2) C irculation3) Enervation

The failure of one of themWill cause failure of other twoThis lead to the death of

an individual.

C irculation

Enervation

Respiration


14/57

There are two phases of death1. Extinction of the personality is the immediate

sign of vital processOR

S omatic Death2. Progressive disintegration of the body tissue

ORMolecular Death / C ellular Death


15/57

BRAIN

HEART

LU NG

TRIPOD of LIFE

(Atria mortis)


16/57

TWO STAGES1) Somatic Death (Soma- B ody)

Irreversible loss of integrating and co-coordinating functions of the organs as awhole is labeled as Somatic Death.

It is the complete and persistent

loss of coordinated functioning of tripod of life i.e stoppage of Functioning - and failure to return

a) B rain

b) Heartc) Lung

BRAIN

HEART

LU NG

TRIPOD of LIFE(Atria mortis)

Deaths protocolof entry


17/57

Same is also called

Systemic

Clinical

Legal

Death


18/57

II. Molecular DeathIt is the death of individual organs and

tissues (which persisted individually after

somatic death)


19/57

In 1967- Single Organ, Shifted from a dead

unit to another living unit.

During interval it was kept alive to avoid

molecular death.

Till it was shifted to already prepared

body Ready to receive Heart of Dead


20/57

Time Interval between Somatic &

Molecular stages

Heart Survives For 60 minutesLiver Survives for 15 minutes

Kidney Survives for 45minutesCornea Survives for 6-24 HoursB lood Survives for 6 HoursB one Marrow Survives for 6 Hours


21/57


22/57

DEATHMeans an irreversible cessation of the entire

function of brain stem.

BRAIN DEATHMeans irreversible loss of brain and brain

stem functions simultaneously,

DONORMeans a person who donates any part of his

body, organ. tissue or cell;


23/57


24/57

Criteria for determining permanent nonCriteria for determining permanent nonfunctioning of the brain.functioning of the brain.I. U nreceptivity and unresponsivetyII. No movements and breathing

III. No reflexes AND

Flat isoelectric encephalogram EEG(confirmatory test)


25/57

Philadelphia Protocol, 1969:1. lack of responsiveness.2. absence of spontaneous breathing3. no muscular movements, flaccidity4. Reflexes and Responses:

(a) pupils, (b) corneal reflex, (c) pressure response, (d)no ocular response to ice water, (e) no superficial or deep tendon reflexes, (f) no planter response.

5. Falling arterial pressure6. E C G for 5mins repeated every 30 mins for 6 hrs


26/57

Harvard Criteria:

U nreceptively and unresponsivelyNo movements

Apnea Absence of reflexes Absence of E C G


27/57

B rain death is declared when there is1. Permanent fixed bilateral dilatation of

pupils.

2. Absent all nerve reflexes3. Cessation of respiration

(without aids.)4. Cessation of cardiac activity

(COMPLETE FLAT ECG)

DIAGNOSIS OF DEATH


28/57

D/D of Death

1. Suspended animation

2. B arbiturate poisoning

3. Electrocution4. Drowning

5. Hypothermia


29/57

Immediate physical changes

Loss of tripod of life Absence of brain functionLoss of muscle tone

Onset of muscular flaccidity / primaryflaccidityLoss of reflexes

Dropping of lower jawLoosness of limbsNo response to external stimuliC ooling of body


30/57

Cause of brain death /Manner of death

Natural

U nnatural


31/57

Natural

Haemorrhage into brain tissue / CV A Apoplexy (rupture of vessel in to an organ) Aneurysm / embolism of cerebral vesselsC ystic tumor / abscess which may rupture intoventriclesC erebral haemorrhage

S ubarachnoid haemorrhageEpilepsy (cont discharge of impulses)


32/57

Natural cont.

C erebral thrombosis and subsequent infarctionC erebral embolism

MeningitisTumor of brain producing pressureTumor of brain with sudden haemorrhageMetabolic disorders e.g. uraemiaC ardiovascular condition e.g MIRespiratory condition e.g Asthma, C OPD


33/57

U nnatural

Accidental head injuries e.g. RTAHomicidal head injuries e.g. stab, lacerated,

incised, firearmS uicidal head injuries e.g. firearm injuryPoisoning e.g. Opium, alcohol

AsphyxiaS yncope


34/57

M ode of DeathM ode of Death

1.1. Coma :Coma :- - failure of function of brainfailure of function of brain2.2. Syncope :Syncope :- - failure of function of heart failure of function of heart

3.3. Asphyxia : Asphyxia :- - failure of function of respiratory failure of function of respiratory

systemsystem


35/57

C oma:- failure of function of brain andirreversible damage to its vital centers

Due toRaised I C P, due to injuries to or diseases of brain e.gmeningitisPoisons such as opioids and alcoholMetabolic disorders like U remia

Post mortem :-oedema and congestion of brain and

membranes


36/57

S yncope :- death due to failure of function of heart due to decrease flow of blood to brainand leading to hypoxia of brain.Due to

Heart diseasesDiseases of bloodHemorrhage

Poisoning due to digitalis, aconite, potassium.Postmortem findings:-V iscera appear pale and capillaries appear congested


37/57


38/57

SIGNS OF DEATH SIGNS OF DEATH ImmediateImmediateEarly Early LateLate


39/57


40/57

a.a.Insensibility and loss of voluntary Insensibility and loss of voluntary power to move. power to move. (Not a sure sign of death)

It is the foremost sign but also occurs in:

- Prolonged fainting- Vagal inhibition- Epilepsy- Electrocution

- Drowning- Suspended Animation


41/57

b.b. Cessation of circulationCessation of circulation

No heart beat for a continuous period of 5 minutes (with

stethoscope - sure sign)

Difficulty in - Feeble sounds- Thick Chest

- Emphysema


42/57

c. Cessation of Respirationc. Cessation of Respiration

i. No abdominal movement (Ant.wall)

ii. No auscultation with stethoscope for 5 minutes

iii. Mirror Test

iv. Feather Test

v. Glass water Test. (Winslows Test )


43/57

B . Early signs (molecular death)B . Early signs (molecular death)

a. Cooling of body

b. Eye changes

c. Skin changesd. Post-mortem lividitye. Muscles changes Rigor Mortis


44/57

B . EARLY SIGNS B . EARLY SIGNS contcont

a)a) Cooling Cooling of of body body :: (Algor (Algor M ortis)M ortis)I. During life: B alance of temperature is

maintained i.e. Heat produced = Heat lossII. After death no heat production, so only heat

loss.

III.The heat loss is gradual.

IV. This remarkable phenomenon was used tocalculate time since death.


45/57

b)b) Eye changesEye changes

i. Permanent fixed bilateral dilatation of pupils.

ii. Cornea becomes hazy & opaque

iii. Corneal & Conjunctival reflexes are lostiv. Luster of cornea is lost.

v. Eyes become sunken.


46/57

C) Skin changesC) Skin changes

i. Skin becomes pale(more on non dependent

parts

ii. Skin elasticity is lostiii. Skin luster is lost


47/57

d)d) Post Post M ortem Lividity M ortem Lividity

It is the staining or discoloration of skin and

organs of a dead body due to accumulation of

blood because of gravitation and arrest of

circulation resulting in distension of toneless

capillaries and veins of dependent parts.


48/57


49/57

DEVELOP M ENT OF LIVIDITY DEVELOP M ENT OF LIVIDITY After somatic or clinical death:-

Circulation stopsB lood remains fluid for some hoursO 2 in blood (which is carried in loose

combination with Hb) is still being suppliedto the tissue(till molecular death).

No more pumping of blood by heartO 2 is gradually decreased & Hb is reduced

(B lue colour)Due to gravity blood settles, directly in

dependent areas of skin or viscerae


50/57

Putrefaction ( U ltimate fate of all living creatures.)It is the final stage of dissolution of the body tissue resulting in

breaking down of complex organic body constituents intosimpler inorganic ones.Arrest of putrefaction.

(Extra ordinary phenomenon)

- Mummification- Adipocere formation

C.C. Late signs Late signs


51/57


52/57

MUMMIFI CAT ION MUMMIFI CAT ION It It isis alsoalso aa modificationmodification of of putrefaction putrefaction

process, process, whichwhich becomesbecomes arrested arrested and and body body

tissuestissues undergoundergo mummificationmummification. .

It It isis characterized characterized by by dehydrationdehydration of of body body

tissuestissues and and visceraeviscerae after after deathdeath


53/57

ADIPO CERE (SA PONIFI CAT ION) ADIPO CERE (SA PONIFI CAT ION)

It is a modification of process of

putrefaction, which may become arrested and

fatty tissue of body may get converted into fatty

acids. It has the properties of fat and wax, so the

name

(Adipo - soft fat) (Cera - Wax)


54/57

Suspended animationSuspended animation(Apparent Death)(Apparent Death)HeartHeart beatbeat && respiratoryrespiratory movementsmovements areare notnotheardheard ordinarilyordinarily (as(as theythey areare atat aa veryvery lowlowpitchpitch..) )


55/57

I. Involuntary S uspended animation

may occur in:Drowning casesNew bornAnesthesia

ConcussionHeat StrokeProlonged illnessElectrocutionDeep Shock

All may revive byresuscitation methods


56/57

II. V oluntary S uspended animationS .A

Y ogis (Holding of B reath)


57/57

Date post:	09-Apr-2018
Category:	Documents
Upload:	rizwan-zafar-ansari
View:	217 times
Download:	0 times

Concept of Death Dr Rizwan

Documents