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Study of death in its medicoThanatology legal aspects thanatology Conditions mimicking Death Differential diagnosis of Death Hypothermia Electrocution Suspended animation Brain damage Narcotic poisoning thanatology Definition of Death Complete and irreversible loss of vital functions Ceasing of the body, as defined by to exist, physicians, to an extent that under end of individuality of a person the given circumstances, it is impossible for the person to revive or to be resuscitated Black’s Law Dictionary molecular somatic thanatology Death 1 Mode The value or item occurring most frequently in a series of observations or statistical data. 2 Manner or nature 3 Cause 4 Mechanism thanatology CNS function LIFE Circulation Respiration Tripod of life Life circulation Tripod of death death circulation thanatology Modes of death Cessation of CNS function Coma (ko’ma) CNS injury Narcotic poisoning Brain stem failure thanatology Modes of death Cessation of circulation Syncope (sing’kpee) Mechanical trauma Shock Myocardial infarction thanatology Modes of death Cessation of respiration Asphyxia CO poisoning Choking Hanging thanatology Modes of death Coma Syncope Tripod of death Asphyxia thanatology Cause of death Injury or disease which leads to death Stab in the heart Myocardial infarction Carbonmonoxide poisoning Road side accident Fall from height Carcinoma lung URAIZY thanatology International Form of Medical Certificate of Cause of Death I Disease or condition directly leading to death Antecedent causes (a) …………………...……….. due to or as a consequence of (b) ……………………………. due to or as a consequence of Morbid conditions, if any, giving rise to the above (c) ………….…………………. cause stating the underlying condition last …………………………….. II Other significant conditions contributing to ….…………………………. death but not related to the disease or condition ……………….…………… causing it ……….……………………. thanatology Manner or nature of death Natural - diseases and pathological conditions leading to death e.g. carcinoma breast plague CCF senility URAIZY thanatology Manner or nature of death Natural Unnatural – homicidal throttling stabbing poisoning thanatology Manner or nature of death Natural Unnatural - homicidal - suicidal cut throat barbiturate poisoning jumping from height thanatology Manner or nature of death Natural Unnatural - homicidal - suicidal - accidental CO poisoning road accidents thanatology Manner or nature of death Natural Unnatural - homicidal - suicidal - accidental - manipulative/exhibitionist CuSO4 intake Russian roulette Trapeze ‘chicken’ thanatology Manner or nature of death Natural Unnatural - homicidal - suicidal - accidental - manipulative/exhibitionist thanatology thanatology Sudden Natural Death First year of life Acute respiratory ... infection Bronchopneumonia Bronchitis; Bronchiolitis Inhalation of ... Vomitus; Foreign body Suffocation ... Accidental; Homicidal Congenital Heart ... Disease Transposition of great vessels; Fallot's tetralogy Endocardial fibroelastosis Rh-isoimmunization Diseases of CNS … Other Meningitis; encephalitis Adrenal Haemorrhage Gastro-enteritis Intussusception Malnutrition Trauma ... Poisoning ... Accidental Homicidal Aspirin; chloral hydrate thanatology Sudden Natural Death 2-20 years of life Ac Respiratory Infections … Inhalation of … Congenital Heart Disease … Fulminating influenza Bronchopneumonia; Bronchiolitis Asthma Vomitus; foreign bodies Fallot's Tetralogy Septal defects; Mycotic aneurysms CNS Disease … Meningitis; Encephalitis GIT Diseases … Appendicitis Trauma … Poisoning ... Iron; Aspirin; Drug addiction thanatology Sudden Natural Death 20-40 years of life CNS diseases … Subarachnoid haemorrhage Epilepsy CVS diseases … Mitral stenosis; Myocarditis Coronary artery disease Coarctation of aorta Resp system … Asthma Female … Abortion; Ruptured ectopic pregnancy ... Alcohol; Barbiturates Tranquilisers; Drug addiction Trauma Poisoning thanatology Sudden Natural Death 40-60 years of life CVS diseases … Coronary artery disease; Mitral stenosis Dissecting aneurysm CNS … Intra-cerebral haemorrhage Resp system … Pulmonary embolus GIT … Acute pancreatitis; perforated peptic ulcer Upper alimentary tract haemorrhage Rupture of oesophageal varices Poisoning ... Barbiturates; tranquilisers Alcohol; Viral diseases … viral hepatitis thanatology Sudden Natural Death Over 60 years of life Resp system … Bronchopneumonia; influenza CVS system … Intra-cerebral haemorrhage Hypertensive, neoplastic & Coronary artery disease; Rupture of heart Rupture of aorta or other great vessels Subarachnoid haemorrhage Hypertensive cardiac failure Resp system … Pulmonary embolus GIT … Peritonitis ... Barbiturates; Carbon monoxide Hypothermia Poisoning thanatology Post-mortem examinations 1972-81 trauma 31.68 Homicide 45.2 Accidents 28.8 undetermined 1.89 exhumation 1.47 non-viable 1.66 viable 1.83 natural 11.37 burns 0.53 poisoning 4.65 suicide 2.57 electrical 2.15 fire arm 7.03 strangulation 3.07 miscellaneous 3.45 road 26.65 Newborn 3.99 conducted at the Surgeon Medico-legal Punjab Office, Lahore thanatology fire arm 7.03 blunt force nongrievous 65.47 blunt force grievous 3.01 sharp force non-grievous 10.24 poisoning/alcohol 16.55 Medico-legal Certifications 1972-81 Total cases 56,056 rape 2.99 sodomy 0.59 firearm trauma 0.57 burns 0.39 sharp force grievous 0.19 Trauma cases all types 79.48 Trend observed in Surgeon Medico-legal Punjab Office, Lahore (data mainly from Lahore) thanatology Systems of death investigation Coroner system Medical Examiner system Police system Continental system thanatology Systems of death investigation Coroner system Doctors Information from Police ref for certif’n Coroner no autopsy Public Ref to Registrar for disposal autopsy unnatural causes natural causes Inquest findings – homicide, accident, suicide, misadventure, drugs, industrial, neglect, abortion, lack of attention at birth, ‘open’ Systems of death investigation Jurisdiction of Medical Examiner • any death from trauma, injury, violence, or poisoning attributable to accident, suicide or homicide; • sudden deaths to persons in apparent good health or deaths unattended by a physician; • deaths of persons in jail, prison, or another correctional institution, or in police custody; • deaths of patients/residents of state mental health or mental retardation facilities; • the sudden death of any infant less than eighteen months of age whose death might be attributable to SIDS; and • any other suspicious, unusual, or unnatural death.