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DEATH AND ITS

CAUSE
BY : Dr Anoop Kumar
 Thanatology :- deals with death in all its aspects.
 According to (Sec. 46 , IPC) – The Word “Death”
denotes to death of human being .
 Thanatology is the scientific study of death in all
its aspects including its cause and phenomena.
 It also includes bodily changes and their medico-
legal significance.
Types of Death

 Death is of two types :


1 . Somatic ,Systemic or Clinical.
2. Molecular or cellular.
Somatic Death
 It is the complete and irreversible stoppage of the
 Circulation
 Respiration
 And Brain Functions
( Bishop’s Tripod of Life).
As long as circulation of oxygenated blood is maintained
to brain stem , life exist. Whether a person is alive or
dead can only be tested by withdrawal of artificial
maintenance.
Signs of Somatic Death (immediate)

• Loss of EEG Rhythm



• Loss of ECG Rhythm

• Cessation of Respiration
Cellular / Molecular Death
After somatic death tissue & cells survive for varying period
depending on the oxygen requirement.
 When these individual tissue & cell die , it is termed as
cellular/ molecular death.
 It is generally completed in 3-4 hours of somatic death.
 Note : Nervous tissues dies rapidly ,the vital centre of brain in about
5 min., but the muscles lives up to 1-2 hours.
Signs of Molecular Death
Differentiation : Somatic and Molecular Death
Feature Somatic Death Molecular Death

Definition Irreversible cessation of function of Death of individual tissues and cells


brain and stoppage of the
circulation and respiration
Onset Precedes Molecular death Succeeds Somatic death ( 1-2 hours )
after stoppage of the vital functions
Response to Muscle responds thermal , Does not respond
external stimuli electrical or chemical stimulus
Confirmation Flat ECG and EEG and absent Rigor mortis , algor mortis, Post
breath sound. mortem lividity, putrefaction
Resemblance Suspended animation, coma, Does not resemble any condition
hypothermia
 The success of homograft mainly depends on type of tissue
involved and rapidity of its removal after circulation has
stopped in the donor.
 Cornea can be removed from dead body within 6 hours
 Skin in 24 hours
 Bones in 48 hours and blood vessels within 72 hours for
transplantation.
 Kidney , Heart , Lungs, Pancreas and Liver must be obtained
soon after circulation has stopped as they deteriorate rapidly.
Modes of Death
 Acc. to Bichat , there are 3 modes of the death , depending
on whether death begins in one or other of the three system ,
irrespective the remote cause may be.
 Coma
 Syncope
 Asphyxia
ASPHYXIA
 Asphyxia is a condition caused by interference with respiration ,
due to lack of oxygen in respired air , due to which the organs and
tissues are deprived of oxygen( together with failure to eliminate
Co2, causing unconsciousness and death.
 Nervous tissues are affected first by
deficiency of oxygen and their functions
are disturbed even by mild oxygen lack.
 The neurons of cerebral cortex
will die in 3-7 min. of complete
oxygen deprivation and other
nerve cells remain alive for little
longer time.
TYPES AND CAUSE OF ASPHYXIA
 1. Mechanical :
a) closure of external respiratory orifices , as by closing of
the nose and mouth with the hand.
b) Closure of the external air passage by external pressure
on the neck as in hanging and strangulation.
c) closure of passage by impaction of the foreign body as in
case of chocking.
d) prevention of entry of air due to air passage being filled
with fluid as in drowning.
 2 . Pathological :
In this entry of oxygen to the lungs is prevented by diseases
of upper respiratory tract or lungs e.g. bronchitis , laryngeal
spam , tumour and abscess. Paralysis of the respiratory
muscles may result from acute poliomyelitis.
 3. Toxic : Poisonous substances prevent the use of the
oxygen e.g. a) poisoning by CO b) respiratory centre may
be paralysed in poisoning by opium, barbiturates, strychnine
etc.
 4. Environmental : Insufficiency of oxygen in the inspired
air e.g. in enclosed places.
 5. Traumatic : a)Pulmonary embolism from femoral vein
thrombosis due to an injury to lower limb. b) bilateral
pneumo thorax from injury to chest wall .
Post- mortem examination
 Triad of asphyxial stigmata may be seen :
a) Cyanosis : Bluish discoloration of the skin , face (
particularly lips and ear ) , nailbeds, mucous membranes of
the internal organs.
b) Petechial hemorrhage : on the face conjunctiva,subpleura
or sub epicardium ( Tardieu spots).
c) Congestion and oedema of the face and visceral
congestion due to raised venous pressure .
Coma
 It is a state of profound unconsciousness from which a person
can not be roused , with minimal or no detectable
responsiveness to stimuli. This is death from failure of the
function of the brain .
 Causes :
 1. injury or disease of brain .
 2. Systemic disorder such as diabetic ketoacidosis ,
uremia , heat stroke.
 3. Intoxication with alcohol , opium,
cocaine, chloral hydrate,
anesthetics atropine etc.
Post-mortem findings
 It may reveal the cause , such as inflammation of meninges ,
compression from haemorrhage , tumor or vascular lesion.
 In case of poisoning and metabolic disorder , a hyperemic
condition of the brain and its covering membrane may be
found.
SYNCOPE
 SYNCOPE is sudden stoppage of action of the heart, which
may prove fatal resulting in hypoxia and hypoperfusion of the
brain.
 CAUSES:
-Heart diseases ,
Pathological state of blood
Haemorrhage
Vagal inhibition and poisoning.
Post-mortem Examination :
Non specific findings. Heart is contracted and chambers are
empty when death occur from anemia .
Anoxia
 “ Lack of Oxygen”
 According to Gordon (1944) the stoppage of the vital function
depends upon tissue anoxia.
 1. Anoxic anoxia
 2. Anaemic anoxia
 3. Stagnant anoxia
 4. Histotoxic anoxia
These four types of anoxia ultimately leads to cardiac failure and
death.
Normal level of O2 in arterial blood is 90-100mm of Hg. at 30 yrs
and 65- 80 at 60 yrs and above .
Reduction to 60 mm of Hg results in severe Hypoxia and death may
occur at 20 mm of Hg.
 1. Anoxic anoxia: Oxygen can not reach the blood because of
the lack oxygen in the lungs .This occur
a)from breathing in contaminated atmosphere or exposure to
gas.
b) From mechanical interference with the passage of air into
or down the respiratory tract. e.g. in smothering, drowning,
chocking , hanging, strangulation and traumatic asphyxia.
2. Anaemic Anoxia : Oxygen carrying capacity of blood is
reduced e.g. in massive haemorrhage ,CO poisoning etc.
3. Stagnant Anoxia : impaired circulation results in reduction
in O2 supply e.g. heart failure and embolism.
4. Histotoxic Anoxia : In this type the enzymatic processes by
which the oxygen in the blood is used by the tissues are
blocked . eg. In acute cyanide poisoning.
Brain / Brainstem death
 As the ventilator technology advanced, circulation and
respiration could be maintained by means of mechanical
respirator , despite loss of all brain function and thus have
brought the concept of brain death, i.e. irreversible loss of
cerebral functioning.
 Brain death is complete and irreversible cessation of
functioning of brain. It includes all the centre nervous system
except spinal cord.
 Brain death is now accepted as brainstem death. The
respiratory centre control respiration lies within the
brainstem. If this area is dead , the person is unable to breath.
Mechanism of Brain Death
 Brain injury has number of causes , such as traumatic or
cerebrovascular injury and generalized hypoxia.

Brain edema .
 Edema is acompanied by an increase in intracranial pressure
leading to gradual decrease in cerebral circulation to a level
of almost cessation, causing aseptic necrosis of the brain .
 Within 3-5 days ,there occur widespread brain destruction of
the cerebrum and brain stem, the brain become a liquefied
mass.
Thank you