MIDTERM Flashcards
-This is a condition wherein the fatty tissues of the body are transformed to soft brownish-white substance
SAPONIFICATION OR ADIPOCERE FORMATION
soft brownish-white substance known as
adipocere
The layer of subcutaneous tissue is the frequent site of its formation.
SAPONIFICATION OR ADIPOCERE FORMATION
is a soapy or waxy material, rancid in smell, dissolves in alcohol and ether when burned produces yellow flame.
ADIPOCERE
known as corpse wax or grave wax or mortuary wax
ADIPOCERE
-The principles involved in artificial mummification are:
(a) Acceleration of the evaporation of the tissue fluid of the body before the actual onset of decomposition.
(b) Addition of some body preservatives to inhibit decomposition and to allow evaporation of fluid. This is made by treatment of the body with arsenic, formalin, resinous or tarry materials.
ARTIFICIAL MUMMIFICATION
When a person is buried in hot, arid, sandy soil, there will be insufficient moisture for the growth and multiplication of putrefactive bacteria. The body will become dehydrated and mummified which is caused by the forces of nature.
NATURAL MUMMIFICATION
KINDS OF MUMMIFICATION
(1) NATURAL MUMMIFICATION
(2) ARTIFICIAL MUMMIFICATION
-is the complete dehydration of all body tissue which results in the shivering and preservation of the body. A cadaver left in an extremely dry, hot area will mummify in about a year and will remain in this condition for several years if undisturbed by animal or insect
-is observed in warm countries where evaporation of body fluid takes place earlier and faster than decomposition. Death in deserts, like in Egypt, the body has more tendency to mummify.
MUMMIFICATION
-is the breaking down of the complex proteins into simpler components associated with the evolution of foul smelling gasses and accompanied by the change of color of the body.
PUTREFACTION
SPECIAL MODIFICATION OF PUTREFACTION
A. MUMMIFICATION
B. SAPONIFICATION OR ADIPOCERE FORMATION
-This appears during the later stage of its formation when the blood has coagulated inside the blood vessels or has diffused into the tissues of the body
DIFFUSION LIVIDITY
-Any change of position will not change the location of the lividity.
DIFFUSION LIVIDITY
-The blood merely gravitates into the most dependent portions of the body but still inside the blood vessels and still fluid in form.
HYPOSTATIC LIVIDITY
-Any change of position of the body leads to the formation of the lividity in another place.
-This occurs during the early stage of its formation.
HYPOSTATIC LIVIDITY
TYPES OF POST MORTEM LIVIDITY
- HYPOSTATIC LIVIDITY
- DIFFUSION LIVIDITY
The investigator can press on the skin in the dependent regions and if the skin blanches, death has probably occurred less than
12 HOURS
Post Mortem Lividity is also known as
CADAVERIC LIVIDITY
POST-MORTEM SUGGILLATION
POST-MORTEM HYPOSTASIS OR
LIVOR MORTIS
It is a purplish discoloration of the body that occurs on those parts of the body which are nearest the floor.
POST-MORTEM LIVIDITY
This discoloration is caused by the settling of the blood by gravity into those areas. During life the blood is under pressure and circulating. After death, the pressure falls to zero and the blood begins to settle by gravity so that no matter what the position the body may be in those positions of the body which are lowest will be the areas the blood will settle. Under most conditions this discoloration will begin to be apparent from one to two hours after death.(Montojo,n.d.)
POST-MORTEM LIVIDITY
-A muscular change characterized by the softness and flaccidity of the muscles in which no longer responses to electrical or mechanical stimuli due to dissolution of the muscle protein that have been previously coagulated during the stage of rigor mortis.
STAGE OF SECONDARY FLACCIDITY OR SECONDARY RELAXATION
-This stage is onset of putrefaction
STAGE OF SECONDARY FLACCIDITY OR SECONDARY RELAXATION
THE ENTIRE MUSCULAR TISSUE PASSES THREE STAGES AFTER DEATH
A. STAGE OF PRIMARY FLACCIDITY
B. STAGE OF POST-MORTEM RIGIDITY
C. STAGE OF SECONDARY FLACCIDITY OR SECONDARY RELAXATION
-It is the instant stiffening of a certain group of muscles which occurs immediately at the moment of death, although its cause is unknown, it is associated with violent death due to extreme nervous tension and injury to the central nervous system
CADAVERIC SPASM OR INSTANTANEOUS RIGOR
-The stiffening of the body may be manifested when the body is frozen, but exposure to warm condition will make such stiffening disappear. The cold stiffening is due to the solidification of fat when the body is exposed to freezing temperature.
COLD STIFFENING
-A condition characterized by hardening of the muscles due to coagulation of muscle proteins when the dead body is exposed to intense heat as by burning or immersion in a hot liquid
- is commonly observed when the body of a person is placed in boiling fluid or when the body is burned to death.
HEAT STIFFENING
CONDITIONS SIMULATING RIGOR MORTIS
- HEAT STIFFENING
- COLD STIFFENING
- CADAVERIC SPASM OR INSTANTANEOUS RIGOR
Post-mortem rigidity is also known as
“Rigor Mortis”
-It is the stiffening of the muscle of the body after death due to chemical changes within the muscle tissue itself. It develops first in the face and jaws (smaller muscles). The rigidity gradually extends downward involving the neck, chest, arms, abdomen and finally the legs and feet. It begins to leave the body and it disappears in the same order that it made its onset, First, the face and neck will again become flaccid and then the other portions of the body will become limp in the same order that the rigidity developed.
STAGE OF POST-MORTEM RIGIDITY
In warm countries, this stage sets in from 2-3 hours after death. It is fully developed in the body after 12 hrs. It may last from 18 – 36 hours and its disappearance is concomitant with the onset of putrefaction.
STAGE OF POST-MORTEM RIGIDITY
-It is the stage of muscular change upon death characterized the relaxation of muscles and loss of their natural tone, so the jaw or head drops down, the thorax collapses and the limbs becomes flaccid and the splinters relax.
STAGE OF PRIMARY FLACCIDITY (post-mortem muscular irritability)
-This is the reason why the dead person may still urinate, defecate or excrete waste product of metabolism through pores on the skin. When muscles are subjected to mechanical or electrical stimuli, the muscles will contract owing to the presence of life of the individual cells. This stage lasts for 3-4 hours after death.
STAGE OF PRIMARY FLACCIDITY (post-mortem muscular irritability)
-After death, there is complete relaxation of the whole muscular system. The entire muscular system is contractile for three to six hours after death, and later rigidity sets in. Secondary relaxation of the muscles will appear just when decomposition has set in.
CHANGES IN THE MUSCLE
The normal body temperature in a living person is ______ but upon death, the temperature gradually decreases. The fall of temperature of ______ is considered as a certain sign of death (Lagonera, 2010).
37°C or 98.3°F
15 to 20°F
-The progressive fall of the body temperature is one of the most prominent signs of death. After death, the metabolic process inside the body ceases. Heat production in the body stops and its temperature is lowered gradually to that of the surroundings. The rate of cooling of the body is not uniform. It is rapid during the first two hours after death and as the temperature of the body gradually approaches the temperature of the surroundings, the rate becomes slower.
ALGOR MORTIS OR COOLING OF THE BODY
-There is no movement of the image formed by reflecting artificial or sun light on the water or mercury contained in a saucer and placed on the chest or abdomen if respiration is not taking place. The reflection is utilized to magnify the / movement of the surface of mercury or water.
WINSLOW’S TEST
-Place a glass half full of water at the region of the chest. If the surface of the water is smooth and stable, there is no respiration taking place, but if it waves or water movement is observed, then respiration is taking place.
EXAMINATION WITH A GLASS OF WATER
-Place a fine feather or a strip of cotton in front of the lips and nostrils. If there is movement of the feather or cotton not due to external air, respiration is present. However, this is not a reliable test as the slightest movement of outside air or nervousness of the observer will move the feather or cotton fibers.
EXAMINATION WITH A FEATHER OR COTTON FIBER
-The surface of a cold-looking glass is held in front of the mouth and nostrils. If there is dimming of the mirror after a time, there is still respiration. The dimming of the cold mirror is due to the condensation of the warm moist air exhaled from the lungs if respiration is still going on. Ordinarily there is no dimming of the mirror when the subject is dead.
MIRROR TEST
However, it must not be forgotten that the dimming of the mirror may be due to the expulsion of the air from the lungs due to the contraction of the diaphragm in rigor mortis.
MIRROR TEST
this is not a reliable test as the slightest movement of outside air or nervousness of the observer
EXAMINATION WITH A FEATHER OR COTTON FIBER
METHODS OF DETECTING CESSATION OF RESPIRATION
a. Expose the chest and abdomen and observe the movement during inspiration and expiration.
b. Examine the person with the aid of a stethoscope which is placed at the base of the anterior aspect of the neck and hear sound of the current of air passing through the trachea during each phase of respiration.
C. MIRROR TEST
D. EXAMINATION WITH A FEATHER OR COTTON FIBER
E. EXAMINATION WITH A GLASS OF WATER
F. WINSLOW’S TEST
-Like heart action, cessation of respiration in order to be considered as a sign of death must be continuous and persistent.
STOPPAGE OF RESPIRATION
- A person can hold his breath for a period not longer than 3-1/2 minutes. In case of electrical shock, respiration may cease for sometimes but may be restored by continuous artificial respiration.
STOPPAGE OF RESPIRATION
A person can hold his breath for a period not longer than
3-1/2 minutes
- Living: will feel the rhythmic pulsation of the vessel due to the flow of blood.
- Dead: No such pulsation will be observed
PALPATION OF THE RADIAL PULSE WITH FINGERS
- If heated material is applied on the skin in the living person, there will be blister formation, congestion, and other vital reactions of the injured area will be observed.
- Dead: will not produce true blister, no sign of congestion, or other vital reactions.
APPLICATION OF HEAT ON THE SKIN
- The fingers are spread wide and the finger webs are viewed through a strong light.
- Living: the finger webs appear red
- Dead: yellow
DIAPHANOUS TEST
- lf pressure is applied on the fingernails of a living person intermittently, there will be a zone of paleness at the site of the application of pressure which become livid on release.
- There will be no such change of color if the test is applied to a dead man.
PRESSURE ON THE FINGERNAILS
- This consists of the injection of a solution of fluorescein subcutaneously.
- If circulation is still present, the dye will spread all over the body and the whole skin will have a gleenish-yellow discoloration due to flourescein.
ICARD’S TEST
This test should be applied only with the use of the daylight as the color is difficult to be appreciated with the use of artificial light.
ICARD’S TEST
- Living: the blood escapes in jerk and at a distance
- Dead: the blood vessel is white and there is no jerking escape of blood but may only ooze towards the nearby skin.
OPENING OF SMALL ARTERY
- A ligature is applied around the base of a finger with moderate tightness
MAGNUS’ TEST
- In a living person there appears a bloodless zone at the site of the application of the ligature and a livid area distal to the ligature.
- If the ligature is applied to the finger of a dead man, there is no such change in color.
MAGNUS’ TEST
EXAMINATION OF THE PERIPHERAL CIRCULATION
- MAGNUS’ TEST
- OPENING OF SMALL ARTERY
- ICARD’S TEST
- PRESSURE ON THE FINGERNAILS
- DIAPHANOUS TEST
- APPLICATION OF HEAT ON THE SKIN
- PALPATION OF THE RADIAL PULSE WITH FINGERS
EXAMINATION OF THE HEART
- PALPATION OF THE PULSE
- AUSCULTATION FOR THE HEART SOUND AT THE PRECORDIAL AREA
- FLUOROSCOPIC EXAMINATION
- BY THE USE OF ELECTROCARDIOGRAPH (ECG)
- The heartbeat is accompanied by the passage of electrical charge through the impulse conducting system of the heart which may be recorded in an electrocardiograph machine.
BY THE USE OF ELECTROCARDIOGRAPH (ECG)
will record the heart beat even if it is too weak to be heard by auscultation.
BY THE USE OF ELECTROCARDIOGRAPH (ECG)
-This is the best method of determining heart action but quite impractical.
BY THE USE OF ELECTROCARDIOGRAPH (ECG)
- The rhythmic contraction and relaxation of the heart is audible through the stethoscope.
-Heart sound can be audible during life even without the aid of a stethoscope by placing the ear at the precordial area.
AUSCULTATION FOR THE HEART SOUND AT THE PRECORDIAL AREA
- Pulsation of the peripheral blood vessels may be made at the region of the wrist or at the neck.
-The pulsation of the vessels is synchronous with the heartbeat. Occasionally the pulsation is very imperceptible and irregular that the examiner experiences much difficulty.
PALPATION OF THE PULSE
METHODS OF DETECTING THE CESSATION OF HEART ACTION AND CIRCULATION
A. EXAMINATION OF THE HEART
B. EXAMINATION OF THE PERIPHERAL CIRCULATION
-It may arise especially hysteria, uremia, catalepsy, and electric shock.
APPARENT DEATH OR STATE OF SUSPENDED ANIMATION
-There are records of cases wherein a person was pronounced dead, placed in a coffin, and later angrily rise from it and walk unaided.
-The relative has sent death notice and placed wreaths near his coffin (Daily Mail England, 1948).
APPARENT DEATH OR STATE OF SUSPENDED ANIMATION
-It is important to determine the condition of suspended animation to prevent premature burial.
APPARENT DEATH OR STATE OF SUSPENDED ANIMATION
-This condition is not really death but merely a transient loss of the vital functions of the body on account of disease, external stimulus, or other forms of influence.
APPARENT DEATH OR STATE OF SUSPENDED ANIMATION
3 KINDS OF DEATH
- SOMATIC DEATH OR CLINICAL DEATH
- MOLECULAR OR CELLULAR DEATH
- APPARENT DEATH OR STATE OF SUSPENDED ANIMATION
- After cessation of the vital functions of the body there is still animal life among individual cells.
-After somatic death occurs there is death of all individual cells like nerve and brain cells within the body.
MOLECULAR OR CELLULAR DEATH
- Its exact occurrence cannot be definitely ascertained because its time of appearance is influenced by several factors like previous state of health, infection, climatic condition, cellular nutrition, etc.
MOLECULAR OR CELLULAR DEATH
Type of death when all vital organs cease to function
PHYSIOLOGIC DEATH
- Type of death characterized by the absence of cognitive function or awareness, although artificial support system may maintain organs functioning.
BIOLOGIC DEATH
SOMATIC OR CLINICAL TYPES OF DEATH
I. SOCIOLOGICAL DEATH
II. PSYCHIC DEATH
III. BIOLOGIC DEATH
IV. PHYSIOLOGIC DEATH
- Condition of death wherein the patient regresses, gives up or surrenders accepting death prematurely and refuses to continue living.
PSYCHIC DEATH
- Type of death wherein withdrawal and separation from the patient by others producing a sense of isolation and abandonment, unvisited and let alone to die.
SOCIOLOGICAL DEATH
- This is the state of the body in which there is complete, persistent and continuous cessation of the vital functions of the brain, heart and lungs which maintain life and health.
SOMATIC DEATH OR CLINICAL DEATH