Death Flashcards
A written or oral statement of a person who is dying as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances
Honored by the court, exception to nonadmissibility of heresay
Dying declaration
Wish of someone about to die usually in the hospital not because of unlawful act
Death bed wish
Person not heard from for seven years
Presumption of death
7 he is probably in heaven
Person not heard from a 75 year old is presumed death after not hearing from him after
5 years
For property, money, inheritance
Deliberate and painless acceleration of death of a person suffering from incurable distressing disease
Terminal or incurable disease
Euthanasia
If a doctor assists in performing euthanasia what is the doctor guilty of?
Criminal liability
Guilt beyond reasonable doubt
Murder
Patient is allowed to die without treatment
Orthonasia
AND form
Allow natural death
DNR form
Despite signing of DNR
the goal is still for the patient to
be free from pain
receive vital basic life essentials
IV fluids and nutrition
52/M
GCS 3
Married
3 children (17, 12, 5)
Who will sign consent form?
Wife
52/M
living with mistress
2 children with mistress
Estranged with wife
Who will sign the consent form?
Wife
Consent
Spouse
Descendant if legal age >18
Ascendant parent, Father (if no legal age children)
Ascendant parent, Mother
There is an attempt to extend the lifespan with extraordinary treatment
Dysthanasia
Quantitative determination of the chloride content of the blood in the right and left ventricle
Gettler’s Test
For determination of time of death by examination of CSF
Schourups formula
Importance of Death Determination
Civil personality of a natural person is extinguished by death
Property of a person is transmitted to her heirs at the time of death
Death of a partner is one of the causes of dissolution of partnership agreement (Marriage agreement)
Death of either a principal or agent is a mode of extinguishment of agency
Criminal liability of a person is extinguished by death
Extrajudicial means of death
solis
The following may sign the death certificate
Attending physician
Municipal health officer if there is no physician
Municipal mayor if there is no health officer or physician
Municipal secretary - in the absence of the mayor
Any councilor
Bases of Estimate for Duration of Interment
Presence or abscence of soft tissues still adherent to the bones
Firmess and weight, brittleness, dryness of the bone
Degree of erosion of bone surface
Changes in clothings, coffin, painting
Interment cannot apply for
cremation
Removing someone from the ground and exhumating them
Disterment
Cessation of the function of 3 systems:
CVS
Respiratory system
CNS
Death
Organ Donation Act of 1991
Cells no longer functioning or have metabolic activities or aerobic respiration
Different tissues die at a different rate
Cellular death
Molecular death
Organ/tissue decomposition
Solis
Complete, persistent and continuous cessation of vital functions
The person is irreversibly unconscious not aware of surrounding environment and he is unable to appreciate sensory stimuli or initiate any voluntary movement
BP 0
HR 0
No spontaneous respiration
Isoelectric ECG flat line
Somatic death
Clinical death
3 Phase Criteria in establishing brain death
No reflex, spontaneous breathing, muscular activity
No clinical EEG response to noise or pinching (isoelectric EEG)
Repetition of 1 and 2 after 24-48 hours
No brainstem reflex (pupils dilated, non reactive, no doll’s eye, no corneal reflex)
No spontaneous respiration
Presumption of Death
Person not heard from for seven years
Absentee shall not be presumed for purpose of opening of succession till after 10 years
Disappeared after 75 years old - death after 5 years
If body is exposed to more than 75 C
Heat stiffening
Stiffening of the body when the body is frozen
Cold stiffening
Instantaneous rigidity at the moment of death due to extreme nervous tension, exhaustion and injury to the nervous system or chest
Cadaveric spasm
Instantenous rigor
The most useful indicator of time of death during the first 24 hours post-mortem
Cessation of circulation
Body Cooling
Algor Mortis
Cooling of the body
Rapid during 1st 2 hours
Fall of temperature 15-20 degrees F (-9 C)
Certain sign of death
Algor Mortis
Rise of temperature of the body after death due to rapid and early putrefactive changes during the first 2 hours after death
Post-mortem Caloricity
Post-mortem Caloricity may be observed in
STRYCHNINE POISONING Cholera Yellow fever Liver abscess Peritonitis Cerebrospinal fever Meningitis Rheumatic fever Tetanus Smallpox
Factors affecting algor mortis
Delayed cooling
Acute pyrexial diseases Sudden death in good health Obesity Death by asphyxia Death of Middle Age
Hastened cooling
Leanness of the body
Extreme age
Long-Standing or lingering illness
Chronic pyrexial disease with wasting
3-6 hours after death Last 24-36 hrs Whole body is stiff = 12 hours Lactic acid Phosphoric acid
Cadaveric Rigidity
Death struggle of muscles
Rigor mortis
Occurs 1-2 hrs after death
Algor mortis
Substances responsible for rigor mortis
Lactic acid
Phosphoric acid
Rigor mortis is due to
Loss of ATP
Rigor mortis starts to develop about
2-3 hours after death
Rigor mortis is first detected in
smaller muscle groups
eyes, mouth, jaw and fingers
Demontrates the last activity one did prior to death and is therefore significant in forensic investigations
eg clinging on a knife tightly
Cadaveric spasm
A crude indicator of the mode of death
Color of Hypostasis
Cherry pink
CO poisoning
Dark blue-pink
Cyanide poisoning
Brown
Methemoglobinemia
Bronze
Septic abortion caused by C perfringes
Pallor
Anemia, hemorrhage or in normal extremes of age
Organism associated with abortion
Clostridium perfringes
Clostridium sordelli
Organism associated with putrefaction/decomposition
Clostridium welchii
Site of hypostasis when the position of the body before death is supine
Shoulders
Buttocks
Heels pressing against surface give white color (pale)
Site of hypostasis when vertical (hanging)
Distally in legs and feet
Sites of hypostasis in drowing
Chest
Upper chest
Upper limbs
Sites of hypostasis in face-down death
As in epilepsy, drunked vitcims
Whitening around nose and lips
Earliest sign of putrefaction occurs in
right iliac area
Near cecum, more bacteria therefore earlier putrefaction
Hypostasis is also
Livor mortis
Greenish discoloration of skin of anterior abdominal wall most commonly in right iliac fossa (over cecum) due to
sulphmethemoglobin formation
The first visible sign of putrefaction occurs in
12-18 hours
greenish discoloration on R iliac fossa
Peculiar odour (smell) emitted on opening of the abdomen at autopsy
Rotten eggs hydrogen sulphide
Bitter almond odor
cyanide
Rotten eggs odor
Hydrogen sulphide
Where the sclera remains exposed, two triangles of discoloration appear at each side of the cornea, either brown or black
Tache noire
Dark, red-brown stripe that develops horizontallt across eyelids when not closed after death
Tache noir
Lungs are distended like balloons
Overlapping the heart
With rib markings on the surface
Emphysema aquosum
Emphysema hydroaerique
Death by drowning
Due to entrance of water into the air sacs which makes the lungs doughy readily pits on pressure
Edema aquosum
Death by drowning
Whitish foam which accumulates in the mouth and nostrils
Champignion de
Bronze coloration of the head and neck of a dead person observed in drowning
Tete de negri
Hemorrhage Usually in lower lobes of lungs in drowning
Paltauf’s hemorrhages
Goose skin has no value as a diagnostic sign of death from drowning
Cutis anserina
Death due to burning
Heat stiffening
Pugilistic attitude
Immediate cause of death in burning
CO poisoning
Post Mortem Decomposition
Putrefaction
Mummification
Adipocrere
Skeletelization
Pugilistic attitude
UE Flexed + Hands clenched
Flexors are stronger
Starts immediately after death at the cellular level
Becomes visible in 48-72 h
Its onset may be sped up or delayed by several factors mainly:
temperature
humidity
Putrefaction
Two phenomenon for putrefaction
Autolysis
Bacterial action - Clostridium welchii predominates
Are the first to be affected by putrefaction
Brain and epithelial tissues
Survives for longer periods once putrefaction commences
Heart
Uterus
Prostate
The organs that show putrefactive changes in the following order:
Larynx and trachea Stomach, intestines, spleen Liver and lungs Brain Heart Uterus, prostate, kidney Skin muscle, tendon Bone
Grave wax
Fat decomposition which results from hydrolysis and hydrogenation of the lipids (fatty cells) that compose subcutaneous fat tissues
Adipocere
Fat decomposition results from
Hydrolysis
Hydrogenation
Saponification
Fatty tissues of the body are transformed to soft brownish-white
Waxy material, rancid or moldy odor, floats in water
Saponification
Adipocere formation
Prominence of superficial veins with reddish discoloration during decomposition
Marbolization
Autolytic postmortem process that occurs in intrauterine deaths
It is caused by endogenous enzymes
Maceration
the shriveling up of a tissue, as in dry gangrene, or of a dead, retained fetus
Dry, shriveled up
Mummification
Types of Death
Somatic death
Molecular death
State of Suspended Animation/Apparent death
