Death

Question 1

Somatic (clinical death)

Answer 1

loss of
     ,circulation 
respiration
.
and
CNS

Question 2

Molecular (cellular) death:

Answer 2

The death of individual organs and tissues of the body

Question 3

Cessation of Circulation :

Answer 3

Loss of pulsations in big arteries
(carotid or femoral pulsations).

No Blood pressure
Loss of heart beat

Flat line on all leads of ECG for 5 minutes

Question 4

-

Cessation of Respiration

Answer 4

Apnea

Arterial Blood Gas
Severe hypoxia and hypercapnea not consistent with life (>60mmHg)

اقل من ٦٠ ما بشخصه وفاة

Question 5

Cessation of brain

Answer 5

permanent cessation of cerebral hemispheres and brain stem functions.

Question 6

‏The cerebrum has been referred to as the "higher brain" because it has primary
‏control of Awareness
and
cognition
.

Answer 6

The brainstem has been called the “lower brain,” since it controls spontaneous vegetative functions
(swallowing, yawning and sleep-wake cycles).

Question 7

Exclusions of death

Answer 7

-where the patient may be under the
effects of drugs e.g therapeutic drugs
or overdoses (e.g. sedatives and hypnotics).

-where the core temperature of the body below 35C.

-where the patient is suffering from severe metabolic or endocrine
disturbances which may lead to severe but reversible coma e.g. diabetes.

Question 8

Preconditions of diagnosis

Answer 8

The patient must be deeply comatose.
The patient must be maintained on a ventilator
The cause of the coma must be known

Question 9

Signs of Brainstem death

Answer 9

Apnea test. Positive

Absence of corneal reflex

Absence of pupillary response of bright light.
Absence of gag reflex, spontaneous swallowing , tongue or facial movements.

No oculo vestibular response

Absence of oculo- cephalic response

Question 10

Investigations

Answer 10

🔵Isoelectric EEG for 60 minutes
in adult, clinically brain dead who is not
hypothermic or intoxicated by drugs known to suppress the EEG.
🔵Absence of cerebral blood flow (scintigraphy and
Trans cranial Doppler)
🔵 PET

Question 11

The brain stem death should be confirmed by;

Answer 11

two medical experts, each separately

not including any of the transplant team and perform examination twice
24hours apart.

Question 12

Difficult diagnosis of death

Answer 12

Soon after death.
Hypothermia.
Depressant drugs.
Apparent death.

Question 13

Suspended Animation “Apparent Death”
slowing of life processes
Slide 19

Answer 13

Hhh

Question 14

Persistent vegetative
state
(PVS)

Answer 14

loses the higher cerebral powers of the brain but the

functions of the brainstem remains relatively intact.

This condition occur in
massive cerebral infarcts

hypoxic encephalopathy

head trauma
.

Question 15

Sudden Death

Answer 15

This is unexpected death of apparently healthy individual, or death within 24 hours of terminal disease

Question 16

Sudden death may occur as a result of

Answer 16

▶️Trauma head injury, burns, electric shock.

▶️Poisoning insecticide CO narcotics or hypnotics ▶️Disease (Natural death)
: when a rapid termination of life develops in clinically silent patient

Question 17

The great majority of sudden, unexpected natural deaths seen at a medical examiner’s office are due to________

Answer 17

cardiovascular disease

Less common are due to CNS, pulmonary disease and sepsis

Question 18

Other causes

Congenital heart disease: A.S.D., and V.S.D.
Cardiac tamponade: ruptured infarction or aortic aneurysm.
Rheumatic heart disease. Internal hemorrhage. Fulminating infections.

Answer 18

✅

Question 19

CNS

Answer 19

Epilepsy
Nontraumatic subarachnoid hemorrhage

Intracerebral hemorrhage

Fulminating meningitis
and encephalitis
Brain tumors

Question 20

Respiratory system

Answer 20

Asthma.
Pulmonary embolism.
Laryngeal and pulmonary edema.
Pneumonia and bronchopneumonia

Question 21

GIT

Answer 21

such cases are uncommon, with
possibly the most common entity a massive hematemesis due to esophageal varices complicating cirrhosis of the liver

peritonitis
from a perforated duodenal ulcer or an acute peritonitis

Aspleen massively enlarged due to
undiagnosed leukemia may rupture, causing exsanguinations.

Question 22

Post mortem changes
1- P.M Cooling (
Algor Mortis) : Mechanism

Answer 22

Stoppage of heat production due to stoppage of oxidative processes and metabolism

The body losses 1-1.5 c/hour

Question 23

Factors affecting postmortem cooling

Answer 23

Initial temp.
Posture of the body after death. Sex
Age
Surroundings : weather, water , clothes

Question 24

PM caloricity

heating

Answer 24

the body temperature rises 2-3c then cools as usual

Pontine hemorrhage, asphyxia, infection

Question 25

Primary flaccidity (Contact flattening):

Answer 25

At the moment of death

complete muscle
relaxation and loss of reflexes occur.
Face acquires a peaceful look
Jaw drops, pupil dilate

The muscles contract by electric stimuli(being in the molecular life stage.)

Question 26

Rigor mortis start two hours after death.

Answer 26

Small muscles of the face 
Neck
Trunk
Upper extremity 
Legs
Finger and toes

Question 27

Factors affecting rigor mortis

Answer 27

Temp. Muscle bulk. Activity.

Question 28

Cadaveric spasm :

Answer 28

It
s a condition of muscle contraction involving a group of voluntary muscles related to individuals who are at high levels of emotional or physical stress immediately before death

Question 29

Cadaveric spasm Mechanism

Answer 29

neurogenic

Question 30

Secondary Flaccidity

Answer 30

The muscles became soft and flaccid (after R.M.) once again, but don’t respond to mechanical or electrical stimuli.

This stage is synchronous with
the onset of putrefaction

Question 31

Changes of the Eyes:

Answer 31

Loss of corneal and light reflexes
.
Segmentation of retinal vessels
and pallor of optic disc (starts 15 minutes after death).
Fall of intraocular pressure
results into sinking
and flaccidity of eyeballs (starts 1/2 an hour after death)

cornea becomes cloudy and opaque after 2hours

Question 32

Taches noire

Answer 32

brownish discoloration of

the exposed sclera appear within 3 hours due to accumulation of cellular debris and dust.

Question 33

Changes of the skin:

Answer 33

The skin becomes pale and opaque.
due to absence of circulation
looses its elasticity so wounds do not gap.

Question 34

P.M. Lividity (Hypostasis
or Livormortis
)

Answer 34

Bluish discoloration and staining of the skin and tissue of the most dependent parts of the body

It starts immediately after death due to cessation of circulation. Within one hour It becomes maximum and fixed in about

8 hours
due to blood clotting .

Question 35

Putrefaction

P.M. Decomposition

Answer 35

It’s the final decomposition of soft tissues leaving nothing except bones.

Question 36

Putrefaction Mechanism

Answer 36

⏺Autolysis after death certain enzymes

⏺Bacterial action aerobic and anaerobic bacteria present in human body

Question 37

Rate of putrefaction

Answer 37

Greenish
staining of lower abdomen-rt iliac fossa(1-2 days)

Whole body greenish black staining 1wk.

Burst abdomen and larvae 2wks

Bones attached by ligaments 6months
Separate bones 12months

Question 38

Factors affecting putrefaction

Answer 38

Environment:
Temp.
Moisture.
Medium

Individual: Vascularity Age.
More bacteria,

Question 39

Adippcere

Answer 39

fatty areas of bodies submerged in water or buried in wet ground. It replaces putrefaction

Mechanism

Unsaturated fatty acids change to saturated fatty acid by the action of hydrogen derived from water and become hard

It starts three weeks after
submersion and completed after
6 months

Question 40

Mummification

Answer 40

occurs in death in the desert. It replaces putrefaction. The body becomes dry with brown wrinkled skin. It begins after death and completed after. 3-12 months

Question 41

MLI of adippocere and mummifaction

Answer 41

Preservation of features.
Time of death.
Denotes long submersion in
        adepoccere 
Or
death in desert.

Question 42

The anesthesia :

Answer 42

overdose -depression of respiratory center or myocardial depression

Light anesthesia- vagal stimulation.
during induction due to tracheal intubations

during recovery due to traction on viscera.

Hypoxia
Obstruction of air passages
Fire and explosion

Question 43

Malignant hyperthermia

Answer 43

80%
of patients who developed this problem died

an antidote drug was
–
dantrolene sodium

Question 44

Elevated potassium after succinylcholine

Answer 44

patients suffering from
muscle disease
Burn
Trauma
Spinal cord injury

Question 45

Local anesthetics

Answer 45

injected into vessels in large amounts, the patient may
     experience a
seizure
and
cardiac
 arrest

Question 46

The Investigations of a Case of death under anesthesia:

Answer 46

detailed report
Autopsy of the Victim.

Toxicological analysis of samples taken from the body as early Blood collected under oil.
Ø Alveolar air from lung puncture.
Ø The brain and lungs preserved frozen