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Forensic Medicine > Death > Flashcards

Death Flashcards

1
Q

Give five scenarios where prolonged resuscitation is very worthwhile?

A
  1. Electrocution
  2. Drowning
  3. Overdose
  4. Hypothermia
  5. Children
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2
Q

Commonest example of somatic/clinical death?

A

Atherosclerotic coronary artery disease

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3
Q

After primary cardiac arrest and during cerebral hypoxia, how long does it take to deprive the cortex and then brainstem?

A

Cortex 2-3 minutes

Brainstem >4 minutes

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4
Q

Can brain be destroyed by hypoglycaemia?

A

Yes

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5
Q

What three systems does brainstem control?

A

Consciousness (RAS)-reticular activating system
Respiratory centre
Vasomotor centre (BP)

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6
Q

What is necessary component for whole brain death?

A

Brainstem death:
innervation
spontaneous respiration
heartbeat

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7
Q

Cortical damage but brainstem is intact-spontaneous breathing and heartbeat?

A

Persistent Vegetative State

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8
Q

How long must PVS be going on for before diagnosis?

A

Greater than 6 months or 12 months

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9
Q

What does assessment of PVS include:

A

No spontaneous meaningful motor response inc voice
No language comprehension or expression
No sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus

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10
Q

Is there moral dilema for BS death?

A

No - stop ventilating the corpse

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11
Q

When is someone legally dead?

A

When brainstem is destroyed

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12
Q

All sensory input from whole body travels through brainstem except what?

A

Smell and vision

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13
Q

What three CNs cannot be tested at bedside?

A

1, 11 and 12

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14
Q

Give three signs of brainstem activity?

A

Epileptic fit- cortical activity, motor nerves
Decorticate rigidity
Positive Doll’s eye reflex- eyes remain fixed on moving head

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15
Q

What are the 3 pre conditions for diagnosing BS death?

A
  1. Deeply comatose, requiring artifical ventilation
  2. Cause of coma unknown
  3. Reversible causes excluded: hypoxia, hypotension, SOL
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16
Q

Name some reversible causes that must be excluded for diagnosing brainstem death?

A
  1. Drugs
  2. Alcohol
  3. Hypothermia
  4. Diabetes/hypothyroidism
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17
Q

What cranial nerve tests must be done for diagnosing BS death?

A
  1. Pupils do not react to light (2,3)
  2. No corneal reflex (3,5,7)
  3. No nystagmus upon ear irrigation (3, 4, 6, 8)
  4. No grimace to pain (5, 7)
  5. No gag reflex (9, 10)
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18
Q

Explain the apnoea test.

A

100% oxygen for 10 minutes
5% CO2 for 5 minutes
Disconnect from ventilator for 10 minutes
Rising CO2 fails to stimulate spontaneous breath

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19
Q

Once circulation stops, how long does it take for cellular death in the CNS?

A

4 minutes

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20
Q

Once circulation stops, how long does it take for cellular death in the peripheral NS?

A

5 minutes

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21
Q

Once circulation stops, how long does it take for cellular death in muscle?

A

3 hours

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22
Q

Once circulation stops, how long does it take for cellular death in blood cells?

A

6 hours

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23
Q

Once circulation stops, how long does it take for cellular death in the skin?

A

24 hours

24
Q

Once circulation stops, how long does it take for cellular death in bone/cornea?

A

48 hours

25
Q

What causes cells to die and degenerate?

A

Autolysis- intracellular enzymes

26
Q

What year was most recent human tissue act installed?

A

2004

27
Q

Where does human tissue act 2004 apply to?

A

England and Wales- provisions relating to retention of material for DNA testing apply also to Scotland

28
Q

“material that has come from a human body and consists of, or includes, human cells”

A

Human Tissue

29
Q

Who is the only person who can retain tissue?

A

Coroner to establish cause of death

30
Q

What does the HTA 2004 authorise museums to do?

A

Move human remains

31
Q

What does the HTA 2004 do for transplantation?

A

Makes it lawful to preserve organs for transplant

32
Q

What new offence did the HTA 2004 create?

A

DNA theft

33
Q

What act regulates removal, storage and use of human tissue?

A

HTA 2004

34
Q

What year was the Scottish HTA installed?

A

2006

35
Q

What did the HTA 2006 do for the anatomy act?

A

Amended the AA 1984

36
Q

What does the HTA 2006 have that 2004 english one doesnt?

A

Post mortem examination section: makes provision for authorisation of hospital PMs by adult or mature child while still alive

37
Q

Give three purposes of death certificate?

A
  1. Information
  2. Disposal of body
  3. Proof of death
38
Q

Who can write death certificate in Scotland?

A

Any doctor who knows cause of death- need not attended in last illness or viewed body after death.

39
Q

In Scotland how long is there to register a death?

A

7 days

40
Q

Dr who attended during last illness (<14 d), OR
Dr who attended regularly during last illness & has viewed body
Dr seeing body for the first time may not certify
Slip given to informant
5 days to register death

A

Death certification in England and Wales

41
Q

Who is application for cremation issued by?

A

Funeral director

42
Q

Who is application for cremation completed by?

A

Relative in charge

43
Q

Who is medical certificate completed by?

A 
Doctor who issued DC:
Registered medical practitioner
not related to decead
no pecuniary interset
must view body after death
44
Q

Who completes a confirmatory medical certificate?

A

Doctor registered >5 years

  • not related to deceased
  • not colleague or relative of dr B form
  • must discuss with Dr B form
  • must be satisfied death is normal
  • must view body after death
45
Q

What is form D

A

Issued by PF
After investigation
Replaces forms B and C

46
Q

What is form E

A

Issued by registrar
After PM instructed
Replaces forms B and c

47
Q

If coroner is involved in death what happens?

A

They replae all other processes with form E

48
Q

What is autopsy rate in Scotland?

A

10%

49
Q

Do you refer to PF if relatives refuse permission for hospital autopsy?

A

No

50
Q

Do you refer outdoor deaths to PF?

A

Yes

51
Q

Do you refer death during anaesthesia?

A

Yes

52
Q

When is 2 doctor autopsy done?

A

Homicide
Suspicious
RTA

53
Q

When is 1 doctor autopsy done?

A

Suicide
Accident
Natural

54
Q

What deaths must PF report to crown office?

A

Suspicious, criminal, suicide, danger to public, medical mishap, FAI mandatory, or requested by family, death of police officer, death due to fireo r explosion

55
Q

What is FAI mandatory under?

A

1976 Act- in employment or legal custody

56
Q 
Murder
Manslaughter
Infanticide
Death by dangerous driving
Suicide with abettment

What stops for these?

A

Coroners inquest

Forensic Medicine (13 decks)

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