D E A T H

Complete, permanent and irreversible

cessation of the vital functions.

Somatic or Clinical death

Molecular death
Somatic or Clinical Death

Permanent and irreversible damage to;

= Brain
= Heart
= Lungs
Difficulties to Diagnosis Somatic
death

Warmness of body

Suspended Animation

Coma due to sedatives or hypnotics-
Barbiturates

Hypothermia

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.
What is the importance of death?

Disposal of the dead body

Death certificate

Post-mortem
Transplantation of organs like:

Liver within 15 minutes

Kidney 30-40 minutes

Heart 1 hour
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
Brain Stem

Mid brain

Pons

Medulla

Permanent and irreversible stoppage of
functions of above areas
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
No spontaneous respiration
No epileptic movements
All brain stem reflexes
Should be absent


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
Brain- stem reflexes
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 :
Absence of coma
Child below 5 yrs of age
Coma due to drugs, hypothermia,
metabolic disorders and shock

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.
Causes of Sudden death
Unnatural
Violence
Poisoning
Combination of both
Natural
Cardiovascular
- Coronary disease
- Congenital heart diseases
- Valvular heart diseases
- Hypertensive heart diseases
- Infection
- Cardiac tamponade
- Aortic aneurysm
Respiratory
- Pulmonary embolism
- Haemoptysis
- Infections
- Chronic asthmatics
- Anaphylaxis
- Obstruction to air passage

C.N.S.
- Intra cerebral haemorrhage
- Sub arachnoid haemorrhage
- Cerebral thrombosis
- Embolism
- Infections
- Tumor of brain
Abdominal
- Haemorrhage in the G.I. tract
- Rupture of abdominal aneurysm
- Liver diseases
- Acute pancreatic bleeding
- Endocrinal
- Adrenal haemorrhage
- Diabetic coma
- Myxoedemic and parathyroid crisis
- Iatrogenic
- Abuse of drugs
- Sudden withdrawal of steroids
- Anesthesia
- Mismatched blood transfusion.

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

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
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.