SUDDEN DEATH FROM SUDDEN DEATH FROM NATURAL CAUSENATURAL CAUSE

Sudden Death:Sudden Death:

Unexpected deathUnexpected deathDeath is said to be sudden when a person not Death is said to be sudden when a person not known to have been suffering from any known to have been suffering from any dangerous disease,injury or poisoning is found dangerous disease,injury or poisoning is found dead or dies within 24 hours of onset of terminal dead or dies within 24 hours of onset of terminal illness.illness.WHO definition:WHO definition:

“ “A sudden death is someone who dies within 24 A sudden death is someone who dies within 24 hrs.of symptoms appearing.”hrs.of symptoms appearing.”Forensic sense: may die with in seconds to Forensic sense: may die with in seconds to minutes of onset of symptoms.minutes of onset of symptoms.

Natural Death:Natural Death:

““Natural death means that the death was Natural death means that the death was entirely by the disease,and the trauma or entirely by the disease,and the trauma or poison did not plays any part in bringing poison did not plays any part in bringing the action.”the action.”

Causes of sudden death:Causes of sudden death:

CVS : 45-50%CVS : 45-50%

Respiratory : 10-15%Respiratory : 10-15%

CNS : 10-18%CNS : 10-18%

GIT : 6-8%GIT : 6-8%

Others : 5-10%Others : 5-10%

1.Disease of the CVS: 45-50%1.Disease of the CVS: 45-50% -CAD-CAD -Hypertensive heart disease-Hypertensive heart disease -valvular heart disease:AS/AR/MS/MR-valvular heart disease:AS/AR/MS/MR -Coronary embolism-Coronary embolism -Acute endocarditis-Acute endocarditis -Myocarditis-Myocarditis -Congenital heart disease-Congenital heart disease -Cardiomyopathies etc-Cardiomyopathies etc

Respiratory system: 10-15%Respiratory system: 10-15% -Pneumonia, bronchitis, pulm.tuberculosis,pulm.embolism,lung -Pneumonia, bronchitis, pulm.tuberculosis,pulm.embolism,lung

abscess, pneumothorax, impaction of the foreign body in the larynx abscess, pneumothorax, impaction of the foreign body in the larynx etc.etc.CNS : 10-18%CNS : 10-18%

- cerebral hemorrhage, cerebellar hemorrhage, brain - cerebral hemorrhage, cerebellar hemorrhage, brain abscess,tumor,meningitis,epilepsyabscess,tumor,meningitis,epilepsy

GIT : 6-8%GIT : 6-8% - severe bleeding from the gastric /duedenal ulcer- severe bleeding from the gastric /duedenal ulcer -perforation of peptic ulcer-perforation of peptic ulcer -Acute hemorrhagic pancreatitis-Acute hemorrhagic pancreatitis - Rupture of enlarged spleen- Rupture of enlarged spleen - Appendicitis etc- Appendicitis etc

Genitourinary system: 3-5%Genitourinary system: 3-5% - Rupture of ectopic pregnancy- Rupture of ectopic pregnancy - Eclampsia- Eclampsia - Chronic nephritis- Chronic nephritis - tumors,TB of kidneys- tumors,TB of kidneys

Others: 5-10%Others: 5-10% -DM, Hyperthyroidism, cerebral malaria, shock, mismatched bllod -DM, Hyperthyroidism, cerebral malaria, shock, mismatched bllod

transfusion, anaphylaxis due to drugs transfusion, anaphylaxis due to drugs

Death : post mortem changeDeath : post mortem change

Changes in the eyes:Changes in the eyes: -loss of corneal reflex-loss of corneal reflex -loss of luster of cornea-loss of luster of cornea -cornea becomes opaque -cornea becomes opaque -eyes look sunken-eyes look sunken -pupils: constricted-pupils: constricted

Changes in the skin:Changes in the skin: -skin becomes pale and ash white-skin becomes pale and ash white -loss of elasticity-loss of elasticity -loss of lustre-loss of lustre

ALGOR MORTIS:ALGOR MORTIS:

Cooling of the dead body / ‘chill of death’Cooling of the dead body / ‘chill of death’

The body after death,within a very short The body after death,within a very short interval loses the heat which it possessed interval loses the heat which it possessed at the moment of death.at the moment of death.

Factors influencing cooling:Factors influencing cooling:1. Greater the diff. in temperature between the body and 1. Greater the diff. in temperature between the body and

the surroundings the more rapid is the rate of coolingthe surroundings the more rapid is the rate of cooling2. Children and old people cool more rapidly than adults.2. Children and old people cool more rapidly than adults.3. Fatty body cools more slowly then lean body.3. Fatty body cools more slowly then lean body.4. A body kept in well ventilated room cool rapidly then that 4. A body kept in well ventilated room cool rapidly then that

kept in a closed roomkept in a closed room5. A body immersed in cold water cools rapidly then kept 5. A body immersed in cold water cools rapidly then kept

outsideoutside6. Female cools rapidly then male6. Female cools rapidly then male7. The rate of cooling is slow when the body is clothed or 7. The rate of cooling is slow when the body is clothed or

covered. covered.

Estimation of time of death:Estimation of time of death:

Procedure:Procedure:

1.record the rectal temperature of the dead body. 1.record the rectal temperature of the dead body. At hourly intervalAt hourly interval

2. Use long chemical thermometer (25cms long)2. Use long chemical thermometer (25cms long)

3. Rough idea of the time of death can be 3. Rough idea of the time of death can be obtained by formula:obtained by formula:

normal body temp. – rectal temp.normal body temp. – rectal temp.

rate of temperature fall per hourrate of temperature fall per hour

4.Useful when the temp. is normal at death4.Useful when the temp. is normal at death

In case of death due to air embolism, fat In case of death due to air embolism, fat embolism, certain infections, thyrotoxicosis embolism, certain infections, thyrotoxicosis sharp rise of temperature occurssharp rise of temperature occurs

In case of death due to CCF, massive In case of death due to CCF, massive hemorrhage, shock and collapse there hemorrhage, shock and collapse there may be sharp fall in temperature.may be sharp fall in temperature.

Other methods of recording the Other methods of recording the temperature:temperature:

Inferior surface of the liver : Inferior surface of the liver : making small incision on the rt. Upper making small incision on the rt. Upper

quadrant of the abdomen , opening the quadrant of the abdomen , opening the peritoneal cavity and inserting peritoneal cavity and inserting thermometer in contact with the inferior thermometer in contact with the inferior surface of the liver surface of the liver Ear:Ear:

small thermometer on or thru’ t.membranesmall thermometer on or thru’ t.membraneNasal passageNasal passage

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Cadaveric lividity:Cadaveric lividity:

Post – mortem hypostasisPost – mortem hypostasisSuggilationSuggilationPost mortem stainingPost mortem stainingDarkening of deathDarkening of deathDef:Def:

“ “A bluish or purplish discoloration of the skin of A bluish or purplish discoloration of the skin of dependent parts of the body after death except dependent parts of the body after death except the parts pressed upon by more or less hard the parts pressed upon by more or less hard substances due to accumulation of fluid blood in substances due to accumulation of fluid blood in the capillary of the skin and subcutaneous t/s the capillary of the skin and subcutaneous t/s under the influence of gravity.”under the influence of gravity.”

Mechanism:Mechanism:

.stoppage of circulation > .stoppage of circulation >

.stagnation of blood in blood vessels and .stagnation of blood in blood vessels and its tendency to sink by force of gravity >its tendency to sink by force of gravity >

.blood tends to accumulate in the small .blood tends to accumulate in the small blood vessels of the dependent part > blood vessels of the dependent part >

.filling of these vessels produce a bluish .filling of these vessels produce a bluish discoloration of adjacent skindiscoloration of adjacent skin

Medicolegal importance:Medicolegal importance:

It is a reliable sign of deathIt is a reliable sign of deathIt helps to estimate time since death.It helps to estimate time since death.It indicates the posture of body at the time of It indicates the posture of body at the time of deathdeathMay indicate cause of death from its color:May indicate cause of death from its color:

In asphyxial death: bluish/ voilet/purpleIn asphyxial death: bluish/ voilet/purple In Carbon monoxide poisoning: cherry redIn Carbon monoxide poisoning: cherry red In phosphorus poisoning: bright redIn phosphorus poisoning: bright red In burns and exposure to cold: redIn burns and exposure to cold: red

Time of appearance of hypostasis:Time of appearance of hypostasis:

Begins to appear with in hours of deathBegins to appear with in hours of death

More marked with in 5-12 hoursMore marked with in 5-12 hours

Internal hypostasis:Internal hypostasis:

‘‘Sometimes hypostasis may occur in dependent Sometimes hypostasis may occur in dependent part of the visceral organs which is known as part of the visceral organs which is known as internal hypostasis.’internal hypostasis.’May be confused with the congestion associated May be confused with the congestion associated with pathological change.with pathological change.Difference are:Difference are:

- In hypostasis occurs only on the dependent - In hypostasis occurs only on the dependent part , in congestion all over the organpart , in congestion all over the organ

- no swelling - no swelling in congestion there may be swellingin congestion there may be swelling

Cadaveric lividity / Bruise :Cadaveric lividity / Bruise :

SiteSite

SituationSituation

AppearanceAppearance

Color change Color change

On incisionOn incision

RIGOR MORTIS:RIGOR MORTIS:

CADAVERIC RIGIDITYCADAVERIC RIGIDITY

““This is the stiffening of muscles of the This is the stiffening of muscles of the dead body due to permanent depletion of dead body due to permanent depletion of ATP.”ATP.”

Mechanism:Mechanism: -contraction and relaxation of the voluntary -contraction and relaxation of the voluntary

muscles occurs due to energy produced by the muscles occurs due to energy produced by the ATP .ATP .

-when death occurs there will be gradual -when death occurs there will be gradual disappearance of ATP , disappearance of ATP ,

- when all the ATP disappears from the muscle it - when all the ATP disappears from the muscle it follows dehydration resulting in conversion of follows dehydration resulting in conversion of muscle protein “actin & myosin “ into dehydrated muscle protein “actin & myosin “ into dehydrated stiff gel stiff gel

- consequently muscle contracts and passes into - consequently muscle contracts and passes into the irreversible state of RIGOR MORTIS.the irreversible state of RIGOR MORTIS.

Order of appearance of rigor Order of appearance of rigor mortis:mortis:

Muscle of the eyelidsMuscle of the eyelids

Muscle of the back of the neck and lower jawMuscle of the back of the neck and lower jaw

Muscles of front of neckMuscles of front of neck

Muscles of faceMuscles of face

Muscles of chest ,abdomen and upper Muscles of chest ,abdomen and upper extremitiesextremities

Muscle of lower extremitiesMuscle of lower extremities

Finally small muscles of finger ,toesFinally small muscles of finger ,toes

Duration of RIGOR MORTISDuration of RIGOR MORTIS

Summer : 18 – 36 hrs.Summer : 18 – 36 hrs.

Winter : 24 – 48 hrs.Winter : 24 – 48 hrs.

Medicolegal importance:Medicolegal importance:

It is a reliable sign of deathIt is a reliable sign of death

To estimate the time of deathTo estimate the time of death

Indicates posture of body at time of death.Indicates posture of body at time of death.

D/D of RIGOR MORTISD/D of RIGOR MORTIS

Cadaveric spasmCadaveric spasm

Heat stiffeningHeat stiffening

Cold stiffeningCold stiffening

Gas stiffeningGas stiffening

Cadaveric spasm:Cadaveric spasm:

Rare conditionRare condition

The muscles that were contracted during life The muscles that were contracted during life becomes stiff and rigid immediately after death becomes stiff and rigid immediately after death without passing into the stage of relaxation.without passing into the stage of relaxation.

Predisposing factors:Predisposing factors:

-Sudden death-Sudden death

-Emotional tension-Emotional tension

-Severe pain-Severe pain

-sudden asphyxial death-sudden asphyxial death

Medicolegal importance:Medicolegal importance:

Indicates nature and cause of death:Indicates nature and cause of death:

suicide / homicidesuicide / homicide

It is antemortem in origin, which continues It is antemortem in origin, which continues after death, reflects the last act of the after death, reflects the last act of the subject, performed before and at the time subject, performed before and at the time of death.of death.

Heat stiffening:Heat stiffening:

Seen in body from burning,high voltage Seen in body from burning,high voltage electric shock or falling into hot liquidelectric shock or falling into hot liquid

Here body proteins are coagulated by heat Here body proteins are coagulated by heat when exposed to temperature above 65 when exposed to temperature above 65 degree centigrade. .> stiffening is degree centigrade. .> stiffening is producedproduced

Pugilistic attitude:Pugilistic attitude:

-here body assumes an attitude called so.-here body assumes an attitude called so.

- legs are flexed at the hips and knees, - legs are flexed at the hips and knees, arms are flexed at elbows with clenched arms are flexed at elbows with clenched fist , like the attitude of boxerfist , like the attitude of boxer

# normal rigor mortis does not occur# normal rigor mortis does not occur

Cold stiffening:Cold stiffening:

When body are exposed to freezing When body are exposed to freezing temperature, t/s becomes frozen and stiff temperature, t/s becomes frozen and stiff like RIGOR MORTISlike RIGOR MORTIS

If placed in warm water or atmosphere - If placed in warm water or atmosphere - disappearsdisappears

Rigor mortis / Cadaveric spasm:Rigor mortis / Cadaveric spasm:

Defn Defn Time of onsetTime of onsetMuscles involvedMuscles involvedMuscle stiffeningMuscle stiffeningPredisposing factorsPredisposing factorsBody heatBody heatMechanismMechanism Medicolegal importanceMedicolegal importance

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