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Fronsic Medicine > Death & PM changes > Flashcards

Death & PM changes Flashcards

1
Q

Stages of death

A

1- somatic (Clinical) death

2- Molecular (cellular) death.

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2
Q

Somatic (clinical) death

A

COMPLETE And IRREVERSIBLE cessation of vital functions of the (Brain, Heart, Lungs).

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3
Q

Molecular (cellular) death

A

Death of individual ORPHANS and TISSUES due to cessation of circulation.

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4
Q

What is molecular life

A

It is the period BETWEEN (somatic and molecular death), although life ceases in the body as a whole, it persists in its components (tissue and cells respond to physical, chemical, or thermal stimuli).

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5
Q

Duration of the molecular life

A

Depends upon O2 requirement.
Most sensitive: nerve cells (die within few minutes).
Least sensitive: connective tissue cells (die within hours).

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6
Q

Characteristics of molecular life

A
  • muscle contraction on electric excitation.
  • ciliary muscle reaction to atropine by pupil dilatation and physostigmine by its contraction.
  • motile sperms maybe found at GU system for few hours after death.
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7
Q

Diagnosis of death

A

1- immediate signs (6).
(Arrest of circulation- arrest of respiration- arrest of brain function) very imp
( 1ry flaccidity and contact flattening- ocular signs- skin changes).
2- early signs (3). Very imp [first 24 hours].
-cooling -Hypostasis -rigor mortis.
3- delayed signs (4) [ >24 hours]
-putrefaction - mummification -adipocere formation -maceration.

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8
Q

MLI of molecular life

A

Organ transplantation: carried out only during period of molecular life.

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9
Q

Arrest of circulation diagnosed by

A
  • no peripheral Pulse (not reliable).
  • no beat in auscultation on the 5th intercostal space for 5 minutes. (More reliable than pulse but could be difficult in some cases).
  • flat ECG for 5 minutes.(imp)
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10
Q

Arrest of respiration diagnosed by

A

(Must be COMPLETE and CONTINUOUS)
By
-Inspection (chest wall).
-Auscultation for 5 minutes better in the LARYNX.

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11
Q

Define Brain death

A

PERMANENT absence of all brain function including of the brain stem.

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12
Q

Types of brain death

A
  • Cortical death (with intact brain stem so, spontaneous respiration and intact cardiac function).
  • Brain stem death (with intact cortex is RARE).
  • Whole brain death (cessation of all brain function).
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13
Q

Characteristics of Cortical death

A
  • Victim exist in vegetative state.

- Not considered dead.

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13
Q

What is (PVS) persistence vegetative state

A

-is A clinical condition due to cortical death characterized by
complete unawareness of self and environment results from
traumatic and non-traumatic injuries (hypoxia).

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14
Q

MLI of brain death

A
  • To take decision of termination of Life support systems.

- Organ transplantation (only when permanent brain death surely established.

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15
Q

Before diagnosing Brain death

A

Before u have to exclude 3 possibility:

  • Intoxication (sedative, hypnotics, neuromuscular agents
  • metabolic and endocrine disturbances as a cause of coma.
  • Hypothermia as a cause of coma (central body temp should be >35).
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16
Q

Brain death diagnosed by

A 
1- By Ex:
Sx of cortical death:
No wakefulness and awareness 
No gag ,corneal, light reflexes.
Sx of brain stem death:
Loss spontaneous breathing (APNEA TEST)
2- By EEG (not reliable) depends on cortical electricity.
3- By cerebral blood flow (CBF):
Doppler, scintigraphy, angiography.
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17
Q

What is 1ry flaccidity

A

Complete relaxation and loss of both TONE and REFLEXES of VOLUNTARY and INVOLUNTARY muscles.
The duration is: about (3 hours) after clinical death
In this stage muscles: still react to external stimuli (molecular life).

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18
Q

What is contact flattening

A

Flattening of the convex parts of the muscles compressed against flat surfaces

19
Q

Ocular Sx

A

-Sclera “taches noires de la sclérotique”
(Due to exposed to debris, dusts and evaporation).
-Cornea (cloudy opaque dry).
-IOP decrease rapidly
Drops its half at the time of death
And become nil by 2 hours.(imp)
-Retina 1- TRUCKING inside b.v within 15 minutes. 2- pale optic disc

20
Q

What are the PM Skin changes

A
  • Pale skin.
  • Loss its elasticity > no gaping of the wound.
  • loss its translucency due to no circulation
21
Q

Early Sx

1- what is Cooling

A

No heat production
+ continue loosing heat
1-1.5 C*/hour Till reach atmospheric temp in about 18 hours
(heat loss occurs by Conduction, Convection and Radiation).

22
Q

Site of measuring temp in Cooling

A

Sites of measure:

  • Rectal using (Chemical thermometer)
  • Cut Under surface of liver (visceral temp) using (digital probe)
23
Q

MLI of Cooling

A 
1-Time 
2-Cause 
*severe hemorrhage > rapid cooling.
*(P.M. Caloricity): body heat retained or even increase [4S] 
-sunstroke. -Strychnine and tetanus.
-Sepsis. -Severe asphyxia.
3-Differ between 1ry and 2ry flaccidity.
24
Q

2- Hypostasis

A

Bluish purple discoloration of most defendant parts of body (EXTERNALLY and INTERNALLY)
due to gravity of blood inside b.v.

Time of onset: [ 1 - 3 - 8 ]
1- small separate patches
3- coalesce together
8- complete and fixed

25
Q

MLI of Hypostasis

A 
1-SURE Sx of death 
2-Time 
3-Position 
4-Cause: (by site and color of Hypostasis)
Pale > severe anemia and hemorrhage 
Dark > reduce Hb
Red asphyxia > CO, cold and cyanide 
Brown > met Hb (nitrate poison).
26
Q

3- Rigor Mortis def ?

A

Progressive rigidity of VOLUNTARY and INVOLUNTARY muscles.

Decrease ATP > actin-myosin fuses and form (dehydrated stiff gel).

27
Q

Timing of rigor mortis

A

Time: 2 - 12 - 18 - 36

2: starts in small muscles of face
12: whole body
18: disappear from small muscles
36: disappear from whole body and become 2ry flaccidity.

29
Q

MLI of Rigor Mortis

A

1- SURE Sx of death.
2- Time (PMI).
3- Position:
depend about excessive ATP use e.g. Footballer
4- Cause:
Rapid and transient in case of Convulsions, electrocution, violence, septicemia or Strychnine.

30
Q

What is 2ry Flaccidity

A

Muscles become flaccid again but do not respond to stimuli.

This stage synchronous with the onset of putrefaction

31
Q

Differences between 1ry and 2ry Flaccidity

A

1ry:

  • At moment of death.
  • Loss of tone.
  • Respond to stimuli.
  • Warm body temp.

2ry:
- after Rigor mortis.
- due to AUTOLYSIS
- No response.
- Much lowered body temp.

32
Q

Delayed signs of Death

A 
1-Putrefaction.
2-post mortem conditions replacing putrefaction:
A-Mummification.
B-Adipocere.
C-Maceration.
33
Q

Def of Putrefaction

A

Process of decomposition of tissue > resolution of body from organic to inorganic state.

34
Q

Mechanisms of putrefaction

A

1-AUTOLYSIS by tissue enzymes.

2-BACTERIAL action by enzymes and produce gases.

35
Q

MLI of putrefaction

A

1-SURE Sx of death.
2-TIME of death.
3-CAUSE of death.

36
Q

Time of Putrefaction

2days winter , 1day summer

A
  • greenish Rt iliac region (cecum full of bacteria and fluids).
  • ARBORISATION (marbling) means distended green veins.
37
Q

Time of Putrefaction

1week winter ,3-4days summer

A
  • spread of GREENISH over whole body.
  • Distended abdomen and ext genitalia.
  • FROTH from mouth and nostrils.
  • swelling face protruding eye and tongue.
38
Q

Time of Putrefaction

(2weeks winter , 1week summer){ ٣ب}

A
  • Pealing of skin falling of hair and nail.
  • Bursting of abdomen.
  • Body orifices filled with larva (worms).
39
Q

Time of Putrefaction

6 months

A

All soft tissue liquified, only bones ATTACHED by ligaments.

40
Q

Time of Putrefaction

12 months

A

Separate bones which become (lighter, whiter, brittle and less smelly)

41
Q

Rapid putrefaction due to

A
  • SEPTICEMIA.

- EDEMA and ASCITES (CHF, hepatic failure).

42
Q

Slow putrefaction due to

A
  • HEMORRHAGE.

- METALLIC POISON as arsenic > (dehydration and bactericidal).

43
Q

Deferences between putrefaction froth and froth from foam

A

Putrefaction froth :

•Coarse. •Bloody. •Foul smell. •

44
Q

Difference between blisters of putrefaction and burns

A

Putrefactive blisters:

Mainly gas little reddish with no vital reaction.

45
Q

جدول ال

Mummification, adipocere and maceration

A

Mummification: EVAPORATED fluid.
Adipocere: unsaturated F.A > hydrogenated > SATURATED F.A.
Maceration: ASEPTIC AUTOLYSIS.

Fronsic Medicine (4 decks)

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