L1: Death Flashcards
Def of Death
- Death is irreversible cessation of life, and it is a process not an event.
Def of Somatic Death (Clinical Death)
- Complete and irreversible cessation of vital functions of brain, heart and lungs (the tripod of life)
Phases of Death
1st Phase: Somatic Death (Clinical Death)
2nd Phase: Molecular Death (Cellular Death)
Charcters of Somatic Death
what happens to tissues & Cells after somatic death? and what does it depend on?
- Tissues and cells continue to survive for variable periods of time, depending upon their oxygen requirements.
- After somatic death, Tissues and cells can respond to chemical and electrical stimuli
- Pupils also dilate and constrict.
- Organs can be removed during this “physiological gap” from the cadavers for transplantation.
Dx of Somatic Death
what are simulating conditions to Somatic Death?
Def of Molecular Death (Cellular Death)
It is the ultimate death of all cellular elements.
Characters of Molecular Death
Time of living of various tissues after Somatic Death
It is reported that nervous tissue dies rapidly.
- Vital centers of brain die in about 5 minutes
- While muscle tissue lives up to 3 to 4 hours after cessation of circulation.
when is Molecular Death completed?
- Within 2 to 4 hours of somatic death
- Can be confirmed by absence of any response to an electrical, thermal or chemical stimulus in tissues.
MLI of distinction between somatic and molecular Death
Types of Signs of death
- Immediate Changes (Somatic Death)
- Early Changes (Molecular Death)
Immediate Changes of Death
- Insensibility and Loss of Voluntary Power.
- Irreversible Cessation of Circulation and Respiration.
- Brain/Brainstem Death
- Cerebral/Cortical Death
Characters of Cortical/Cerebral Death
- Brainstem is intact
- With continuous heart sounds and respiration
- No muscular movement with generalized flaccidity.
Def of Cortical Death
- Severe brain damage, which does not involve the brainstem, may result in a persistent vegetative state “Living Cadaver”.
Characters of patients with Cortical Death
These patients:
- Breathe spontaneously
- Open and close their eyes
- Swallow
- Make facial grimaces
- do have a preserved sleep-wake cycle.
- However, they show no behavioral evidence of awareness (Patient does not speak or obey commands).
is EEG enough to diagnose death?
No
Dx of Cortical Death
Caracters of Brainstem Death
Dx of Brainstem Death
what are examples of brainstem reflexes lost in Brainstem Death?
s
Exclusion criteria before certifying brainstem death
what is Whole Brain Death?
- It is a combination of both cortical and brain stem death.
What has Whole Brain Death allowed?
- This has allowed feasibility of removal of vital organs such as heart, kidney, liver, etc. from a donor body for purpose of organ transplantation successfully without any ethical or legal complications.
what is Time of Death?
when is Harvest of organs after death allowed?
“after established brain stem death”
Viability of the cornea after death
The cornea of eye may still be suitable for transplant up to 24 hours after death.
Early Changes of Death
- Changes in skin and facial pallor
- Primary flaccidity
- Contact flattening
- Ocular signs
Changes in skin and facial pallor
(Early Changes of Death)
- Skin becomes pale due to Stoppage of circulation
& Drainage of blood from capillaries and small vessels - The skin loses its elasticity, and face looks younger
due to loss of creases. - Lips appear brownish, dry and hard due to drying.
why does skin lose its elasticity in (Early Changes of Death)?
due to loss of creases.
why does skin become pale in (Early Changes of Death)?
- Stoppage of circulation
- Drainage of blood from capillaries and small vessels
Primary Flacidity in (Early Changes of Death)
What causes 1ry Flacidity in (Early Changes of Death)?
All muscles of the body lose their tonicity and become flaccid (complete relaxation)
- As control from higher brain centers is lost.
Though, muscles are physically capable of responding to electrical/mechanical stimuli.
when does 1ry flacidity occur?
- occurs immediately after death.
“ ends after 2 hours in winter.
Signs of 1ry flacidity in (Early Changes of Death)
- Jaw drops
- Pupils dilate
- Limbs fall flat
- Thorax collapses
- Sphincters relax
- There may be involuntary passage of urine and feces
Describe Contact Flattening
- The areas which remain in contact with ground become flat and blood from vessels of these areas is pressed out,
- This continues even after formation of postmortem staining over surrounding areas.
Example of Contact Flattening
- flattening of convex parts of body (e.g., buttocks, calves etc.) when cadaver lies on its back.
Ocular Signs in Early Changes of Death
- Loss of corneal reflex
- Pupils
- Loss of intraocular tension
Loss of Corneal reflex in Early Changes of Death
It may be seen in all cases of deep coma (not a reliable sign)
Pupils in Early Changes of Death
Loss of IOP in Early Changes of Death
- Intraocular tension falls rapidly after death.
- It becomes zero in 4-8 h (10-22 mm Hg during life),
- The eyeballs look sunken in orbit.
Def of Suspended Animation (Apparent Death)
- It is a death like state in which vital signs of life (heartbeat and respiration) are not detected by routine clinical methods as functions are reduced to a minimum compatible with life.
- It lasts for seconds to hours.
Types of Suspended Animation (Apparent Death)
MLI of Suspended Animation (Apparent Death)
- The patient can be resuscitated by Cardiac massage or electric stimulator or Artificial respiration.
- The death certificate should not be issued without
ECG or EEG record.
what is the origin of Euthanasia?
Def of Euthanasia
- Intentional killing by act or omission of a dependent human being for his or her alleged benefit.
- In Egypt, there is no legislation permitting euthanasia.
Types of Euthanasia
Reasons for Euthanasia
- Unbearable pain (Euthanasia relieves suffering).
- The patient’s condition is terminal with no hope of recovery.
Def of Sudden Natural Death
- It is unexpected death of an apparently healthy person.
- WHO defines it as “sudden death that occurs within 24 h from onset of symptoms
MLI of Sudden Natural Death
Causes of Sudden Natural Death
most common causes are cardiovascular as coronary artery disease.
