D E A T H
Complete, permanent and irreversible
cessation of the vital functions.
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Somatic or Clinical death
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Molecular death
Somatic or Clinical Death
Permanent and irreversible damage to;
= Brain
= Heart
= Lungs
Difficulties to Diagnosis Somatic
death
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Warmness of body
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Suspended Animation
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Coma due to sedatives or hypnoticsBarbiturates
Hypothermia
Molecular Death
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Death of individuals tissues and cells
Process competes by two to three hours
after somatic death
Changes in the eye, skin muscles etc.
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What is the importance of death?
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Disposal of the dead body
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Death certificate
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Post-mortem
Transplantation of organs like:
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Liver – within 15 minutes
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Kidney 30-40 minutes
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Heart 1 hour
Brain – Stem death
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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”
Brain Stem
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Mid brain
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Pons
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Medulla
Permanent and irreversible stoppage of
functions of above areas
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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
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No spontaneous respiration
No epileptic movements
All brain stem reflexes
Should be absent
Diagnosis of brain-stem death
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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
Brain- stem reflexes
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Pupillary reflext  Optic
<- Occulomotor
Vestibulo-reflex occular -> Auditory
<- Abducent
Corneal reflex -> Trigeminal
<- Facial
Gag reflex -> Glossopharyngeal
<- Vagus
Dolls eye reflex - > Auditory
<- Abducent
Brain –stem death shall not be
considered in :
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Absence of coma
Child below 5 yrs of age
Coma due to drugs, hypothermia,
metabolic disorders and shock
Sudden Death
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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.
Causes of Sudden death
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Unnatural
Violence
Poisoning
Combination of both
Natural
Cardiovascular
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Coronary disease
Congenital heart diseases
Valvular heart diseases
Hypertensive heart diseases
Infection
Cardiac tamponade
Aortic aneurysm
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Respiratory
Pulmonary embolism
Haemoptysis
Infections
Chronic asthmatics
Anaphylaxis
Obstruction to air passage
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C.N.S.
Intra cerebral haemorrhage
Sub arachnoid haemorrhage
Cerebral thrombosis
Embolism
Infections
Tumor of brain
Abdominal
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Haemorrhage in the G.I. tract
Rupture of abdominal aneurysm
Liver diseases
Acute pancreatic bleeding
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Endocrinal
Adrenal haemorrhage
Diabetic coma
Myxoedemic and parathyroid crisis
Iatrogenic
Abuse of drugs
Sudden withdrawal of steroids
Anesthesia
Mismatched blood transfusion.
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Miscellaneous
Bacteriaemic shock
Shock due to fear or emotion
Malaria
Special causes in children
Cot death or SIDS
Congenital mental abnormalities
Concealed puncture wound.
“ Suspended Animation
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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.
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Modes of death
Manners of death
Mechanism of death
Cause of death
Modes of death
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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.
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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
“ Death due to syncope”
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Failure of the function of the heart
Anaemia of the brain
Due to heart disease
Exhausting diseases
Poisons- Digitalis, tobacco, aconite etc.
“ death due to Asphyxia”
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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
According to Gordon
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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
“ Anoxia”
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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.
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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.
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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.
The Manner of Death”
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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.
“ The Mechanism of Death”
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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.