Death and signs of death

A segment of a seminar presentation by 400 level medical students of USMANU DANFODIYO UNIVERSITY SOKOTO on "Signs of death and post mortem changes"

1. DEATH AND SIGNS OF DEATH ABIOLA MUBARAK MOHAMMED

2. OUTLINE INTRODUCTION TYPES OF DEATH CAUSES OF DEATH STAGES OF DEATH PROCESS OF DEATH SIGNS OF DEATH DEATH CERTIFICATE CONCLUSION 2

3. INTRODUCTION Death is the termination of all biological functions that sustain a living organism The word dead comes from old English dead, which in turn comes from proto-Germanic *dauthuz. This comes from the proto-Indo-European stem *Dheu meaning the “ process, act, condition of dying” 150,000 people die around the world each day 3

4. INTRODUCTION In modern times, death has been thought to occur when the vital functions cease—breathing and circulation (as evidenced by the beating of the heart). This view has been challenged, however, as medical advances have made it possible to sustain respiration and cardiac functioning through mechanical means. Thus, more recently, the concept of brain death has gained acceptance. In this view, the irreversible loss of brain activity is the sign that death has occurred 4

5. INTRODUCTION Even the concept of brain death has been challenged in recent years, because a person can lose all capacity for higher mental functioning while lower-brain functions, such as spontaneous respiration, continue. For this reason, some authorities now argue that death should be considered the loss of the capacity for consciousness or social interaction . The sign of death, according to this view, is the absence of activity in the higher centres of the brain, principally the neocortex. 5

6. TYPES OF DEATH CLINICAL/SYSTEMIC/SOMATIC DEATH BIOLOGICAL/MOLECULAR DEATH 6

7. CAUSES OF DEATH 7

8. SIGNS OF IMPENDING DEATH Loss of appetite Excessive fatigue and sleep Increased physical weakness Mental confusion or disorientation Laboured breathing (Cheyne-Stokes & Death rattle) Social withdrawal Changes in urination habit Swelling in the feet and ankles Coolness in the tips of the fingers and toes Mottled veins 8

9. DEATH AS A PROCESS Thanatologists (those who study the surroundings and inner experiences of persons near death) have identified several stages through which dying persons go: Denial and isolation (No, not me!); Anger, rage, envy, and resentment (Why me?); Bargaining (If I am good, then can I live?); Depression (What's the use?); and Acceptance. . 9

10. DEATH AS A PROCESS (cont’d) LIFE For normal functioning, all cells of the body require oxygen. If oxygen is not provided, death may appear with in 4-5 minutes (insult to cerebral tissue) BRAIN This is the most susceptible tissue to anoxia (absence of oxygen) 10

11. DEATH AS A PROCESS (cont’d) Eventually all cells will die if deprived of oxygen. The brain and heart are the most sensitive TIME IS CRITICAL 0-1 min: cardiac irritability 0-4 min: brain damage not likely 4-6 min: brain damage possible 6-10 min: brain damage very likely > 10 min: irreversible brain damage 11

12. DEATH AS A PROCESS (cont’d) The Terminal States These are the boundary lines between life and death. The stages include Pre-agony Agony Clinical death (reversible injury) Biological death (irreversible injury) 12

13. DEATH AS A PROCESS (cont’d) Pre agony – falling of arterial pressure, loss of consciousness, decrease of metabolism Agony – further fall in the blood pressure, cessation of breathing and a sudden return to life (the surge – last spark of life) , steep reduction of all vital functions after Clinical – reversible cessation of vital functions of the brain, heart and lungs. Life ceases in the body but persists in component parts of the body 13

14. DEATH AS A PROCESS (cont’d) Biological – this is the death of the tissues and cells individually. It signifies the loss of life in the component parts of the body 14

15. SIGNS OF DEATH 15

16. SIGNS OF DEATH (cont’d) IMMEDIATE Loss of vital functions of the brain (cerebral cortex & brain stem) Flat Electroencephalography (EEG) Cessation of circulation through the retina Lack of responsiveness to internal and external environment No muscular movement with generalized flaccidity Absence of all brainstem reflexes 16

17. SIGNS OF DEATH (cont’d) CESSATION OF CIRCULATION If heart sounds are not heard for a continuous period of 5 min , cessation of circulation is diagnosed Absence of radial or carotid arteries pulsations Flat Electrocardiography CESSATION OF RESPIRATION It must be complete and continuous to constitute a proof for death. Absence of air-entry may be demonstrated by auscultation for 5 min 17

18. DEATH CERTIFICATE This is a document issued by a medical practitioner certifying the deceased state of a person or popularly to a document issued by a person such as a registrar of vital statistics that declares the date, location and cause of a person’s death as later entered in an official register of deaths 18

19. DEATH CERTIFICATE In Nigeria, the National Population Commission is saddled with the responsibility of registering and issuing of death certificate in Nigeria A death certificate is issued to serve as proof of registration of death 19

20. DEATH CERTIFICATE NATURE OF A CERTIFICATE Bio data of Deceased Name of person reporting death Date & Time of death Cause of death ( primary & secondary causes ) Date of registration Name of certifier Signature of Registrar 20

21. DEATH CERTIFICATE 21

22. Conditions for Registration of Death in Nigeria The death must be registered by the registrar of birth in the are where the death took place An applicant must have proof of death An applicant must be a blood relative of the deceased Death must be reported within 7 days from the date of death Death reported after 30 days from date of death and within 12 months may be registered at a fee as may be prescribed by the commission Death reported after 12 months from date of death can only be registered with written authority of the deputy Chief Registrar 22

23. “All interest in disease and death is only another expression of interest in life.” - Thomas Mann  (1875 - 1955) The Magic Mountain Microsoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation. All rights reserved

24. REFERENCES Frederick, Calvin J. "Death and Dying." Microsoft® Encarta® 2009 [DVD]. Redmond, WA: Microsoft Corporation, 2008. “How to Get a Death Certificate in Nigeria” NF author www.nigerianfinder.com/how-to-get-a-death-certificate-in-nigeria/ Autopsy Pathology. Dr Umar Mohammed. Morbid Anatomy and Forensic Medicine UDUSOK Medical Theory of Death. Probable and Absolute Signs of Death –Budko A. Yurievna Signs of Death. www.linkis.com/blogspot.com/7yi98 24