Death Investigation Flashcards
Define Death
Death is a process not an event
Time of death is recorded as an event
No legal definition
- when doctor records it
Define taphophobia
Fear of being berried alive
Many “genuine” published accounts of premature burial
Fear peaked during cholera epidemics of 18th and 19th centenary
Features of safety coffins
Ropes of levers inside - to bell, flags or pyrotechnics Rope to church bells Window in coffin Trumpet tube Hatched with key inside Air/feeding tubes Food and water supply Shovel
Types of safety coffins
Portable death chamber
- chamber with bell and window and placed over empty grave
- watchman checked for signs of life or putrefaction over a few days
- floor opened to grave and chamber reused
Taberger Coffin design
- strings to head, hands and feet of corpse
- attached via tube to bell above ground
- housing prevented accidental ringing
- netting prevented insects entering coffin
Types of death
Apparent death - collapse, no pulse - opportunity for resuscitation - cardiac arrest, LOC Brain death - cerebral cortex - 1st - brain stem - 2nd - whole brain Somatic (clinical) death of person as whole Cellular/molecular death Putrefaction
Define resusciation
To bring someone or something back to life or consciousness
To revive from unconscious
Make active or vigorous again
Types of cardio-pulmonary resuscitation
Mouth to mouth resuscitation External cardiac massage Defibrillation Drugs - adrenaline and atropine Intubation and ventilation
Features of apparent death (suspended animation)
No or minimal signs of life Responsive to prolonged resuscitation Recognised in certain situations - electrocution - drowning - drug overdose - hypothermia - cardiac arrest in children
Clinical assessment of death
History and circumstances Signs - collapse with LOC and muscle flaccidity - cessation of heartbeat - cessation of breathing - dilated fixed pupils Physical examination Resuscitate if in doubt
Clinical triad of death
Triad of Bichat Failure of body as integrated system associated with irreversible loss of - circulation - respiration - innervation - consciousness
Stages of natural cardiac death
Disease or injury - MI Primary cardiac arrest Cerebral hypoxia - cortex in 2-3 mins - brainstem in > 4 mins - whole brain Secondary respiratory arrest - brainstem controls breathing Somatic death Cellular death
Stages of natural respiratory arrest
Disease of injury - COPD, asthma, PE Primary respiratory arrest Cerebral hypoxia - cortex in 2-3 mins - brainstem in > 4 mins - whole brain Secondary cardiac arrest Somatic death Cellular death
Causes of brain death
Cardiac arrest Other hypoxia Haemorrhage Stroke Poisoning Hypoglycaemia
Function of brain sections
Cortical - higher functions - emotions - sensation - movement Brainstem - consciousness (RAS) - respiratory centre - vasomotor centre - pulse and BP
Define whole brain death
No legal definition Brain death is nearest equivalent Necessary component is brainstem death - innervation - spontaneous respiration - heartbeat Bedside clinical diagnosis
Define persistent vegetative state
Cortical damage
- cardiac arrest, hypoxia, trauma, poisoning, hypoglycaemia
Brainstem intact
- spontaneous breathing and heartbeat
- eyes open/close cyclically, swallow, grimace intact
Awake but unaware of self or environment
No speech or purposeful movement
May live many years with nutritional support
Diagnosis of PVS
Brain damage
No awareness of self or environment
No reversible causes
Duration > 6 months
Assessment includes
- no spontaneous meaningful motor response including voice
- no language comprehension or expression
- no sustained, reproducible, purposeful or voluntary behavioural response to normal or noxious visual, auditory or tactile stimulus
Cortical death seen post-mortem
PVS vs BS Death
PVS - cortex dead - awake but unaware - spontaneous breathing - spontaneous heartbeat - moral dilemma - should they be allowed to die as no way back for higher functions BS Death - BS destroyed - unconscious - artificial ventilation - spontaneous heartbeat - no moral dilemma - stop ventilating corpse
Brainstem functions
Maintains consciousness - reticular activating system Initiates every breath - respiratory centre Controls heart rate and BP - vasomotor centre All sensory input from whole body to cortex passes through brainstem - apart from smell and vision All motor output from cortex passes through BS Medicates cranial nerve reflexes
Cranial nerves
Olfactory - smell Optic - sight Oculomotor - eye movement Trochlear - eye movement Trigeminal - face sensory Abducens- eye movement Facial - muscular control of face Vestibulo-cochlear - balance and hearing Glossopharyngeal - swallow, breathing Vagus - swallow, breathing, heart rate, intestines Accessory - muscles of shoulders Hypoglossal - muscles of tongue 2-10 can be tested at the bedside - 1, 11 and 12 cannot
Brainstem death UK code
Tests performed by 2 senior Drs (>5yrs)
Appropriate specialist
Tests repeated
