Death or Thantology types,modes ppt.pptx

ppt

1. DEATH OR THANTOLOGY

2. Definition : Thanatology ( Greek - Thanatos : Death) Logus : Science is the scientific study of death, types of death including its cause and phenomena, b odily changes or events that accompany death in cadaver (postmortem changes ) in all its aspects and their MLI.

3. Definition of Death: Black’s Laws Dictionary defines death as “the cessation of Life” Others defines as – “ irreversible cessation of life”. Physicians declares death with complete cessation of all the vital functions of nervous, circulatory & Respiratory systems. “Death is permanent & irreversible cessation of the functions of the 3 interlinked vital systems of the body namely, the nervous, circulatory & respiratory systems”. “TRIPOD OF LIFE”

4. Harvard Committee on Brain Stem death: 1. Unresponsitivity 2. No movements or breathing 3. No reflexes In addition to these – Flat ECG & EEG Section 2(b) of Registration of Birth & Death Act 1969 defines death as “ permanent disappearance of all evidence of life at any time after live birth has taken place”

5. Medico-legal implication of Death : Declaration of Death Certificate of Death Disposal of the body/cadaver Organ Transplantation Death & IPC - Section 46 IPC Question of Survivorship Legal presumption – if person is unheard for 7 years , court on application by close relatives , may presume Death have been taken place under Section 108 , Indian Evidence Act 1872

6. Types of Death: Somatic or systemic or clinical: Loss of sensibility & inability to move(movement of limbs & chest while breathing). Complete and irreversible cessation of functions of circulatory , respiratory and central nervous system Physical stoppage of function of heart,lungs,brain. But , Individual cells may not die, may responds to chemical , thermal or electric stimuli. ii. Molecular or cellular: Molecular death means death of individual cells of different tissues or organs. In the absence of circulation & respiration , different cells dies at different time after somatic death – depending on metabolic activity & availability of oxygen. Brain cells dies earlier than any other organs.

7. The gap between somatic death and molecular death is important for two reasons: 1.Disposal of body 2.Tranplantation purpose (cadaveric organ transplantation )

8. BRAIN DEATH : 3 TYPES: Cortical Brain Death Brain Stem Death Whole brain Death 1. Cortical Brain Death or Cerebral death- In this Brain stem is INTACT, with continues heart sounds & respiration – maintaining Cardiac activity & Respiration - patient is in Vegetative State. i.e Persistent Vegetative State (PVS) – Continues Cardiac & Respiratory activity + total LOSS of sense of perceiving & feeling things. Also Called as “Living Cadavers” – these vegetative peoples are not considered as DEAD. Clinically patient is in condition of irreversible coma and shows signs of severe brain dysfunction

9. 2.BRAIN STEM DEATH Practically - Brain stem Death is considered as death of a person because the vital centres that controls Respiration , Cardiac & other centres that controls the awakens are lost irreversibly & permanently. Transplantation of Human Organs & Tissues Act defines Brainstem death as – “ the stage at which all functions of the brainstem are permanently & irreversibly ceased”. 3. Whole Brain Death : Also called as mixed brain death. Combination of Cortical & Brain stem death.

10. Brain stem death “ the stage at which all functions of brain stem have permanently and irreversibly ceased and is so certified “ Practically brainstem death is considered as death of a person.

11. Diagnosis of Brain Stem Death : Early determination– i ) promotes harvesting of organs for transplantation purpose. ii) discontinuation of life supporting equipment. iii) determination of time since death. Consists of Establishing following things : Patient is in deep comatose state , unable to breath spontaneously , in unconscious state – need to be maintained on ventilator. Absence of Brain Stem reflexes. Negative Apnoeic Test. Exclusion of other causes of coma – Ex : Apparent Death , Drugs , Prolonged Hypoxia , Trauma, Hypothermia , Intoxication , Metabolic & Endocrine disturbances.

12. Brainstem reflexes 1.Absence of pupillary response . (Light reflex) 2.Absence of corneal reflex. 3.Absence of vestibulo-occular reflex- Irrigation of Ice cold water into External ear. (tympanic membrane) 4.Absence of grimace reflex – Pinching over the Face. 5.Absence of cough/gag reflex – Tickle Soft palate/throat 6.Absence of spontaneous respiration. APNOEIC TEST: After giving 100% oxygen for 5 min, patient is disconnected from the ventilator for 10 min – if No R espiratory movement occurs. If no spontaneous breathing of any sort occurs within those 10 min – confirms Death.

13. Harvard criteria of Brain death : 1.Unreceptivity & unresponsivity –total unawareness to external stimuli &unresponsive to painful stimuli 2.No movements 3.Apnea- absence of spontaneous respiration at least one hour 4.Absence of elicitable reflexes 5.Isoelectric EEG

14. Brain Death Certification Two medical practitioners must perform the brainstem death tests. The patient’s attending physician should participate in the determination of death wherever possible. The doctors involved should be experts in the technique of brain death assessment. Each doctor should perform the tests twice.

15. Organ transplantation The success of homograft mainly depends on 1.Type of tissue involved . 2.Rapididity of its removal after circulation has stopped . Cornea - within 6 hrs Skin - within 24 hrs Bones - within 48 hrs Kidneys , heart , intestine , liver - soon after circulation stops

16. Causes of Death : 1. Immediate Causes 2. Basic/Antecedent/Underlying causes 3. Contributory Causes Immediate Causes: immediate or terminal events leading to death. Ex: Myocardial Infraction 2. Contributory Causes: Pathological process involving in or complicating or contributing to the death . Ex: DM , HTN

17. 3. Basic Cause: Pathological process or injury responsible for death. Injury or any disease has initiated the chain of morbid events leading directly to death. Ex : Circumstance of accident or violence Hepatic or Renal pathology.

18. APPARENT DEATH (Suspended Animation)

19. S uspended A nimation "A state of body in which the vital functions are at a low pitch that the body functions cannot be determined by ordinary methods of clinical examination ". In this , the circulation, respiration d o not stop but is being maintained in there minimum. By Clinical examination : Pulse - not felt/palpable BP – not recordable Heart sounds – Not audible

20. CAUSES OF SUSPENDED ANIMATION

21. TYPES: 1. Voluntary - here person practiced it Voluntarily Ex- Y ogi, S adhu , Sanyasi 2.Involuntary- here person lands in apparent death Spontaneously

22. MODES OF DEATH The mode of death refer to "an abnormal physiological state that pertained at the time of death" There are three types of death and Bichat had classified them as:

23. A = A sphyxia C = C oma S = Syncope Asphyxia i.e failure of function of respiratory system . Coma i .e failure of function of brain. Syncope i.e failure of function of heart.

24. Asphyxia State in living organism there is a acute lack of oxygen available for cell metabolism Associate with inability of body to eliminate excessive carbon dioxide Condition resulting from interference with Respiration or sudden stoppage of functioning of lungs causing Unconsciousness & Death.

25. Mechanism of Asphyxia: Sudden stoppage of or failure of functioning of lungs Impaired Blood Oxygenation TISSUSE ANOXIA Nervous tissue(Brain) is affected first followed by other tissues by disturbing their functions. Failure of Vital Centre & DEATH. In all Asphyxia , after stoppage of respiration Heart may continue to beat for several minutes. RULE OF THUMB : Cardiac Arrest – breathing stops within 20 seconds Respiratory Arrest – Heart stops within 20 minutes.

26. Clinical Features : 3 stages – may last for 3 to 5 minutes Stage of Dyspnoea Stage of Convulsions Stage of Exhaustion & Respiratory Failure 1. Stage of Dyspnoea : Due to excessive accumulation of carbon dioxide , stimulates Respiratory centre - resulting in increased rate & respiratory movements. 2. Stage of Convulsions : due to lack of Oxygen – laboured respiration , clouding of consciousness, convulsion, S phincteric relaxation, Congestion & Cyanosis of face & Hands. stage last for 1-2 minutes. 3. Stage of Exhaustion & Respiratory Failure : Last for 2 to 3 minutes. Respiratory & others Nervous centres are completely paralyzed. Muscles are flaccid , Reflexes are lost , Breathing – Gasping , Pulse - Feeble

27. Coma Unarousable & Unconscious state of person characterized by complete insensibility. When patient is partially conscious & response to deep &painful stimuli is called stupor Result of sudden stoppage of functioning of Brain.

28. Coma Unarousable & Unconscious state of person characterized by complete insensibility. When patient is partially conscious & response to deep &painful stimuli is called stupor Result of sudden stoppage of functioning of Brain.

29. Syncope Syncope result from stoppage of functioning of heart with consequencent cessation of circulation In syncope there occurs loss of consciousness with posture collapse due to an acute decrease in cerebral blood flow

30. Mechanism of Syncope (Fainting) :

31. CAUSES : Anaemia due to sudden & Excessive haemorrhage. Asthenia due to deficient power of Heart Muscle. Myocardial Infraction Poisoning with Cardiac poisons Sudden fright , emotion Injury (blow to epigastrium) CLINICAL FEATURES : Pallor of face & lips . 6. Dimness of vision 2. Dilated Pupils 7. Skin-cold with perspiration 3 . Gasping Respiration 8. Nausea , Vomiting 4 . Pulse - Weak/Feeble/Slow 9. Fall in BP 5 . Delirium, Convulsion 10. Death

32. Manner of death The way / design / fashion in which cause of death comes into being / reality. Types Natural Unnatural – 3 types Homicidal Suicide Accident

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