Death (Thanatology) Flashcards
Define death
- Cessation of life/cessation to exist
- Irreversible state of unconsciousness and capacity to breathe
- Permanent & irreversible cessation of function of vital systems of the body
Explain the conventional method for diagnosis of death
Functional status of the Bichat tripod of life
Heart - syncope
Lungs - Asphyxia
Brain - Coma
What is not considered a brain stem death?
- Persistant vegetative state (living cadaver) where cortex damaged, brain stem intact
- Suspended animation (apparent death) where the vital function is at low pitch (metabolic need is low) but person can be revived by resuscitation
- e.g: voluntary act, newborn infant, drowning, electrocution
MLI of brain stem death criteria
To prevent premature certification of death
Diagnostic criteria for brain stem death
- Should be examined by at least 2 teams of doctors with a 6 hours gap
- Patient in coma (unable to breathe spontaneously, on ventilator)
- Cause - irremediable structural brain damage
- All reflexes are absent
- Patient fails to breathe after apnea test
What are all the brain stem reflexes?
- Pupillary reaction to light (afferent 2nd & efferent 3rd CN)
- Corneal (5th & 7th)
- Grimace (5th & 7th)
- Vestibulo-ocular (3rd, 6th & 8th)
- Cough/gag (9th & 10th)
What is apnea test?
Aim is to prove that the patient is incapable of breathing
1. Patient must be on ventilator & should be pre-oxygenated thoroughly
2. Disconnect for 5-10 mins
3. CO2 build up
4. Trigger off respiration (only if cells are alive in the respiratory centre)
Should be repeated twice with intervals
Board that can certify brain stem death
- RMP in charge of hospital
- Independent RMP (specialist)
- Neurologist/neurosurgeon
- RMP treating the person whose brain stem death occurred
What are the 3 different times of death?
- Physiologic - when the victim’s vitals functions actually ceased
- Legal - time recorded on death certificate
- Estimated - time estimated by medical examiner
What are the phases of death?
- Somatic/clinical death = cessation of vital functions
(Transplantation of human organs can be done) - Cellular/molecular death = death of individual tissue & cells
MLI of death
- Disposal of dead body
- Issuing death certificate
- PM examination (autopsy)
What are the modes of death?
Bichats tripod of life
Heart = syncope
Lungs= asphyxia
Brain = coma
What are the manners of death?
Natural
Unnatural - suicidal, homicidal, accidental
Undetermined
