The Diagnosis of Death
The duty of a medical doctor is actually not confined only inside treatment of his patients, yet also there are several various other duties to be performed. One among them is actually death diagnosis, along with also in case of any unnatural death, reporting the same to the concerned authorities. When a person losses consciousness, a doctor should examine the victim to diagnose the condition along with also to do the needful. If the victim is actually dead, of which is actually the doctors duty to declare of which the person is actually dead. If a doctor is actually not available at the site, the situation has to be handled even by a layman. Hence of which is actually very essential to know the basic techniques of first-aid along with also death diagnosis.
We all know of which, death is actually the termination of the biological functioning of the living organism. of which is actually the ultimate of every living creature on the earth. Once we are born, of which is actually definite of which one day our soul will leave the material body for ever. Scientifically, death is actually due to complete along with also irreversible cessation of the vital functions of the brain, heart, along with also lungs.
STAGES OF DEATH
The death occurs in two stages:
1.Somatic, systemic or clinical death
2.Cellular or molecular death
In somatic death, though life ceases inside organism as a whole, of which can persist in different body parts, organs, tissues along with also cells. The body cells can survive for varying periods along with also can respond to various chemical, thermal along with also electrical stimuli. The period of survival of cells depends upon the oxygen demand. along with also when the cells along with also tissues die, of which is actually considered as molecular death. Normally, molecular death is actually complete within 3 to 4 hours of somatic death. However, in common parlance, death means somatic death.
WHAT CAUSES DEATH?
Irrespective of the remote causes, a person dies as a result of failure of any one of these organs like brain, heart, lung. of which is actually called the proximate cause of death. The remote causes may be due to injury, infection, blood loss, poisoning, drugs, tumors, malnutrition, dehydration, starvation etc. A sudden death may be due to failure of systems like cardiovascular, respiratory, CNS, abdominal, endocrinal, iatrogenic, special cases in children, malnutrition, disease, accident, injury, predation, suicide, homicide, war, along with also also due to some indeterminate causes.
SIGNS OF DEATH
The signs of death can be studied under three headings: Immediate signs, early signs along with also late signs.
Immediate signs: These signs indicate somatic or clinical death.
- Insensibility (Loss of sensation, movements along with also reflexes)
- Loss of EEG rhythm
- Cessation of circulation indicated by flat ECG along with also absence of respiration.
yet signs like loss of sensation, movements, loss of respiration, absence of pulse along with also heart sounds etc are also seen in conditions like prolonged fainting attacks, vagal inhibition, epilepsy, narcosis, electrocution. Hence, such signs cant be considered with cent percent surety. They could however be taken as conclusive only when associated with total loss of EEG rhythm for a continuous period of 5 minutes along with also a flat ECG for 5 minutes.
Early signs: These signs denote molecular or cellular death, which follow about 12 to 24 hours.
- Algor motris: of which is actually the cooling of the body after death.
- Postmortem lividity: of which is actually the discoloration after death. of which starts within 1 to 3 hours along with also gets fixed in 6 to 8 hours.
- Rigor mortis: of which is actually the stiffness of body after death. of which starts 2 to 3 hours after death along with also takes 12 hours to develop, persists for another 12 hours, along with also takes 12 hours to pass off completely.
Late signs: These signs represent the decomposition or decay of the dead body, or in certain situations, modification of the dead body into adipocere or mummification. Late signs follow after about 24 hours. The putrefaction of the body is actually indicated by the appearance of greenish discoloration which appears 12 to 24 hours after death. Marbling is actually the network like markings on the skin, which comes after 12 hours along with also becomes prominent in 36 to 48 hours after death. Maggots also starts appearing as a result of putrefaction.
of which is actually the irreversible end of all cerebral activity, yet brain stem is actually still working. When the brain death occurs, the victim can be kept alive by maintaining the working of heart along with also lungs with the help of sophisticated instruments along with also some drugs. The body can survive by maintaining the supply of the oxygenated blood to the brain stem. When the brain stem also stops working, of which is actually taken as a significant indication of death.
of which condition is actually also called apparent death. Here the vital functions of the body are at such a low pitch of which they cant be detected by routine methods of clinical examination. Suspended animation may persist for a few seconds to several minutes. of which condition can be noticed in apparently drowned, newborn, after anesthesia, cerebral concession, electrocution, heatstroke, mesmeric trance, overdose of barbiturates, opium, deep shock etc. Suspended animation can be revived by resuscitation techniques.
DIAGNOSIS OF DEATH
Diagnosis of death is actually not easy when of which is actually performed immediately after death, specially by a inexperienced person. Rarely, some difficulty can be raised due to suspended animation, excessive doses of sedatives along with also hypnotics, hypothermia, alcohol intoxication etc. When you are asked to do the death diagnosis, the situation should be handled skillfully. The room where the victim is actually resting should not be overcrowded. Allow only a few people to be present at the site. There should be proper light, air entry along with also free via noises along with also various other disturbances.
Inspection: The inspection should be finished in a few seconds without wasting much time. Look at the victim via head to foot along with also look for any body movements of chest, abdomen, wings of nose etc. Then feel the radial pulse. If of which is actually not felt, go for carotid pulse lateral to the thyroid cartilage (never press both carotids at the same time, feel only one side without much pressing). Then take the stethoscope along with also auscultate the chest for heart sounds along with also respiratory sounds. If there is actually sings of cardiorespiratory failure, give mouth to mouth or mouth to nose respiration along with external cardiac massaging to resuscitate the cardio-respiratory function.
If no response even after the cardiac resuscitation, of which is actually the doctors duty to confirm death of the victim. Just as before confirm the cessation of respiration by keeping the stethoscope on chest/larynx for 5 minutes along with also also cessation of cardiac activity by keeping stethoscope on the precordium for 5 minutes. Feather test can be done to see for any current of air through the nose. Open the eyelids along with also move the head via side to side. If the eyeball is actually fixed along with also moves along with the head, of which is actually a sign of death.
Take a clinical torch along with also check the eye for pupillary constriction when the light enters the eye. When the body dies, the pupil dilates along with also the cornea looses its glossy appearance. yet of which may not be clear immediately after death. along with also in those who are having eye lesions specially the aged with diabetes, the findings may be confusing. When a person dies, the pallor appear in a few minutes. Look for the capillary filling after blanching the victim's nails. In a dead body, the capillary refilling is actually not seen.
In case of doubt ECG along with also EEG monitoring can be done. A flat ECG for 5 minutes is actually an accepted evidence of death. Absence of EEG waves for a few minutes confirms death. However, EEG along with also ECG are not required to give a death certificate since death diagnosis is actually possible by clinical examination in majority of cases. However, these tests are having a confirmatory value.
LEGAL ASPECTS OF DEATH
Legal aspects of death varies among different countries. There are difference in opinion on the definition of brain death. However, as per the modern thinking, a person is actually presumed to be dead if he cant spontaneously pickup along with also survive when the artificial means are withdrawn. The irreversible brain damage can be confirmed by a flat EEG.
In case of any signs of unnatural death or when the death is actually unexpected, the cause of death has to be confirmed by a medico-legal autopsy. Unnatural death may be an accident, suicide, homicide, or even may be a natural death yet unexpected along with also taken place under doubtful circumstances. All cases of unnatural death cases should undergo a medico-legal autopsy to identify the exact cause of death, time of death, position of the body at the time of death etc. Hence of which is actually the duty of a medical practitioner to inform the authorities whenever he comes across any unnatural death.