DEATH

Supervised by : Dr Hasan Alhawary

Mohammed Almarashadeh Malak Almarashadeh

Mohammed Aldahamsheh Doha Abuzarig

Ahmed Altarawneh Lama Altarawneh

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 DEATH
Thanatology: deals with all aspect of death and death is the end of daying
Definition : irreversible cessation of allintegrated functioning of the human
organism as a whole, mental or physical .
another definition : The absence of the 7 vital life -Nutrition processes! which
is : Movement , Reproduction , Growth , Respiration, Nutrition ,Excretion and
Sensitivity . It is a process rather than an event except in the exceptionally rare
situations where death may be almost instantaneous such as in case of
crushing of the brain in a vehicular accident . •
* process means not all cells death together (brain die first then gradually other
tissues will be dead).

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 Stages and categories of death

Stages Categories:
-Somatic ( clinical or systemic ) - violent deaths
(accidents, suicide and
- Molecular or cellular homicides)
*brain death - suspicious deaths
- unexpected deaths
*supravital period
- deaths without a physician
attendance
- deaths in an institution

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 SOMATIC DEATH
Definition : irreversible cessationof function of 3 systems:CNS, RS, CVS
(the“tripod” of life ) when there is cessation of vital processes‫ر‬of the body.
This is referred to as somaticdeath (systemic or clinicaldeath), which is
followed by progressive disintegration of body tissues and is called as cellular or
molecular death.
*Before the 1960’s, death was diagnosed only by cardiopulmonary criteria: CNS
criteria are new to the list.
Charctars : 1. the person irreversibly loses there sentient personality, being
unconscious, unable to be aware of (or to communicate with) its environment,
and unable to appreciate any sensory stimuli or to initiate any voluntary
movement 2. Tissues and cells continue to survive for variable period of time ,
depending upon their oxygen requirements .

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 SOMATIC DEATH
3. After somatic death :
-the tissues and cells can respond to chemical and electrical stimuli
-the pupil also dilate and constrict
4. Organs can be removed during this “ physiological gap “ from the cavedars for
the transplantation .
How to diagnose ? the death is diagnosed by establishing the following facts :
1 Cessation of heart beating :
- Absent of heart sound for 5 minutes
- Flat ECG

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 SOMATIC DEATH
2. Cessation of breathing 3. Cessation of brain activity : - Dilated fixed pupil and absence of
pupillary and corneal reflexes - Flat Electroencephalogram

Clinicaldeath : From the point of view of medicine,is preceded with the heart beat
cessation. Visible signs of the stateof failureof thelivingorganism actionssuch
as heart beating, respiratory function or blood circulation. It lasts for about four minutes, and it is
the interval in which life can be
brought back through CPR. After a short few minutes, death is
permanent, because the state of the body has gone from clinical
death to...

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BRAIN DEATH

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 BRAIN DEATH
The actual number of minutes for which total anoxia will cause
cortical damage is controversial;itwas formerly held that 3 minutes
was sufficient, , but this time hasbeen extended to 7 or 9 minutes.
After few minutes, the braincan’t be brought back to life
by any meansavailable today

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 BRAIN DEATH
• A three criteria for determining permanent non-function
of the brain:
I. Unreceptivity and II. No movements or
unresponsivity breathing

III. No reflexes

And an added confirmatory test proposed was ‘a flat’ or isoelectric

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 BRAIN DEATH
Currently, brain-stem has been the focus of attention where vital centers are situated
because various strata of brain .

• Therefore,circumstances may bethere,where cortex has been damaged but the lower
brain including brain-stem is still functioning

. In such a state, the victim will exist in a ‘vegetative state’, the so-called ‘living cadaver’. The
victim can remain in deep coma for a considerable period; may be for years. But they
are not on life-support machines.
• A cadaver is a dead human body used in scientific or medical research.
Cadaver comes from the Latin verb, which means “to fall.“

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 BRAIN DEATH
Vegetative state
- Destruction of cortex and hemispheres
- Intact ascending reticular activating substance

Brain stem death

- Irreversible damage to brain stem

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 BRAIN DEATH
However,when brain death spreads below the tentorium,i.e.
when base of the brain including midbrain,pons and
medulla suffer damage,loss of vital centers and
consciousness will cause the victim not only to be
irreversibly comatose but also to be incapable of
spontaneous breathing Without medical intervention,
the cardiac arrest invariably follows within minutes and
then the
‘ ’
usual process of cellular death progresses

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Once irreversible damage to the brain-stem has been established, the victim is
dead in the somatic sense ,though not yet dead in the cellular sense.
The loss of the' vital centers' that control respiration, and of the ascending
reticular activating system that sustains consciousness, cause the victim not
only to be irreversibly comatose,but also to be incapable of spontaneous
breathing and the heart stops. Need life support machines It is through this‘
physiological gap’that the advances in removing the organs from the ca davers
for the transplantation purposes have broken through. not yet dead in the
cellular sense

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BRAINSTEM DEATH
Brainstem death is clinical syndrome defined by
the absence of reflex with pathways through
the brainstem-the stalk of brain which connect
the spinal cord to the mid-brain, cerebellum and
cerebral hemisphere- in a deeply comatose,
ventilator dependent patient.

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 Brain death

Brainstem Corticle death Whole

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 No Abnormal Decorticate or Decerebrate
postures should be present.
Decorticate Decerebrate
posture is an abnormal posture is an abnormal body
posturing in which a posture that involves the arms
person is stiff with bent and legs being held straight
arms, clenched fists, and out, the toes being pointed
legs held out straight. The downward, and the head and
arms are bent in toward neck being arched
the body and the wrists [Link] muscles are
and fingers are bent and tightened and held rigidly. This
held on the chest. type of posturing usually
means there has been severe
damage to the brain
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The structural and functional damage of brain- stem may
be diagnosed depending upon the following observations:
Absence of spontaneous breathing
Dilated fixed pupils, not responding to sharp changes
intensity of light
Absence of motor responses within the cranial nerve
distribution on painful stimulation
Absence of corneal reflexes.
Absence of gag reflex or reflex response to bronchial
stimulation by a suction-catheter passed down the
trachea.
Absent of the oculo-cephalic reflex and vestibulo-
cocleuar
Fixed dilated pupils Corneal reflex

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 Doll eyes
Caloric test
Gag reflex Suction catheter
Apnea test
 Coma Absent brain
stem reflex
Diagnosis of Two elevation
Absent of any
brain stem respiratory drive separated by
death response 6 to 8 hrs

Confirmatory test Absence of

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CELLULAR DEATH

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what is
THE CELLULAR DEATH?
Cellular death (molecular death) is the death of cells and
tissues individually, in which they are no longer functioning
after the stoppage of vital functions (somatic death).

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How to diagnose
CELLULAR DEATH?
Microscopically Microchemically by detecting the
concentration of different
chemical constituents inside the cell.
Physically

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when does it
OCCUR?
Tissues vary in their response to anoxia. The cerebral cortex cells -for
example- die within a few minutes, while connective tissue cells, like bone
and skin, and even muscles, survive for many hours
It's a slow process that begins after the complete stoppage of vital
functions (somatic death), typically starting 1-2 hours later, or it could start
immediately.

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cellularandsomatic death
COMPARISON

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SUPRAVITAL PERIOD
molecular life

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death is a process

not an event!!!
clinical death supravital period biological death
a phenomenon in Occurs due to the
which the pulse rate degeneration of tissue or
and the beating of cells. In such a type of death,
heart stop organs become dead and
thus are not used for
transplantation
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what is the
SUPRAVITAL PERIOD?
Supravital period (molecular life) is the period between clinical
death and biological death, in which there are some surviving
tissues after the arrest of circulation. And it is a critical period in
the case of organ transplantation.

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SUPRAVITAL PERIOD
This gap between the somatic and molecular death is important for two
reasons:
Disposal of the body: In rare cases, the spontaneous movements of muscle
may occur after somatic death, and if such movements are witnessed or
perceived by laypersons, the event may give rise to apprehension that the
person was not actually dead but was prematurely disposed of.
Transplantation purpose: after somatic death, molecular death occurs. In this
period between somatic and molecular death, organs from a dead body can
be retrieved for transplantation in another person.
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 DiagnosingDeath
Medico-LegalImportance
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 Why is
diagnosing death considered a medico-legal necessity?
diagnosing death is not only a medical step but a medico-legal necessity.
Reasons include:
To detect the cause of death.
To determine the time of death.
For social and legal purposes.
For organ donation.
For recognizing apparent death.
For statistical health data.
For heritage reasons.

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Apparent Death
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 What is
apparent death
A state where vitalfunctionsare so depressed that
life signs are minimal, mimicking true death.

True death can only be confirmed by the

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Causes of apparent death
Electrocution
Hypothermia
(sometimesinducedartificially during operations)
Sun stroke
Drowning
Drug overdose
(e.g., barbiturates)
Head injury
Newborn infant
(maynotshowobvioussigns of life, yet prompt resuscitation can revive them)

Voluntary act (“death trance” in yoga practitioners)

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The cause and the mode
of death
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 The cause of the death
The specific injury, disease, or combination of both that
starts a chain of physiological disturbances
(brief or prolonged) leading to death.
Examples:
Gunshotwound to the heart
Myocardial infarction
Severe infection (sepsis)
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 The mode of the death
The abnormal physiological state produced by
the cause of death.
Mainmodes include:
Coma – failure of brain functions
Syncope – failure of cardiac functions
Asphyxia – failure of respiratory
system
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Mechanism of Death
the physiological derangement or biochemical disturbance
in relation to death.
Examples:
Metabolic acidosis
Alkalosis
Sepsis
Toxaemia
Paralysis
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 Manner of Death
Unlike cause or mode, the manner of death refers to the
circumstantial events and is a legal classification.
Types include:
1. Natural – due to disease
2. unnatural - due to injury
Accident – unintentional injury
Homicide – death caused by another person
Suicide – intentional self-inflicted death
Undetermined (2–5%)
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 Cause, Mechanism, and Manner of Death
Example
An individual can die of massive hemorrhage(the mechanism of death)
due to a gunshot wound to the heart (the cause of death), with the
manner of death being:
Homicide (someone else shot the individual) Suicide
(the individual shot them selves) Accident (the weapon
fell and discharged accidentally) Undetermined (it is
unclear what exactly happened)

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 YOU
ANK
TH