A segment of a seminar presentation by 400 level medical students of USMANU DANFODIYO UNIVERSITY SOKOTO on "Signs of death and post mortem changes"

1. ABIOLA MUBARAK MOHAMMED

2. OUTLINE
 INTRODUCTION
 TYPES OF DEATH
 CAUSES OF DEATH
 STAGESOF DEATH
 PROCESS OF DEATH
 SIGNS OF DEATH
 DEATH CERTIFICATE
 CONCLUSION
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3. INTRODUCTION
 Death is the termination of all biological
functions that sustain a living organism
 The word dead comes from old English dead,
which in turn comes from proto-Germanic
*dauthuz.This comes from the proto-Indo-
European stem *Dheu meaning the “process,
act, condition of dying”
 150,000 people die around the world each
day
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4. INTRODUCTION
 In modern times, death has been thought to
occur when the vital functions cease—breathing
and circulation (as evidenced by the beating of
the heart).This view has been challenged,
however, as medical advances have made it
possible to sustain respiration and cardiac
functioning through mechanical means.Thus,
more recently, the concept of brain death has
gained acceptance. In this view, the irreversible
loss of brain activity is the sign that death has
occurred
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5. INTRODUCTION
 Even the concept of brain death has been
challenged in recent years, because a person can
lose all capacity for higher mental functioning
while lower-brain functions, such as spontaneous
respiration, continue. For this reason, some
authorities now argue that death should be
considered the loss of the capacity for
consciousness or social interaction.
 The sign of death, according to
this view, is the absence of activity
in the higher centres of the
brain, principally the neocortex.
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6. TYPES OF DEATH
 CLINICAL/SYSTEMIC/SOMATIC DEATH
 BIOLOGICAL/MOLECULAR DEATH
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7. CAUSES OF DEATH
Causes of
Death
Natural
Senescence
Unnatural
Homicide
Accidental
death
Suicide
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8. SIGNS OF IMPENDING DEATH
1. Loss of appetite
2. Excessive fatigue and sleep
3. Increased physical weakness
4. Mental confusion or disorientation
5. Laboured breathing (Cheyne-Stokes & Death rattle)
6. Social withdrawal
7. Changes in urination habit
8. Swelling in the feet and ankles
9. Coolness in the tips of the fingers and toes
10. Mottled veins
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9. DEATH AS A PROCESS
 Thanatologists (those who study the
surroundings and inner experiences of persons
near death) have identified several stages
through which dying persons go:
1. Denial and isolation (No, not me!);
2. Anger, rage, envy, and resentment (Why me?);
3. Bargaining (If I am good, then can I live?);
4. Depression (What's the use?); and
5. Acceptance.
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10. DEATH AS A PROCESS (cont’d)
LIFE
 For normal functioning, all cells of the body
require oxygen. If oxygen is not provided,
death may appear with in 4-5 minutes (insult
to cerebral tissue)
BRAIN
 This is the most susceptible tissue to anoxia
(absence of oxygen)
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11. DEATH AS A PROCESS (cont’d)
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12. DEATH AS A PROCESS (cont’d)
TheTerminal States
 These are the boundary lines between life
and death.
 The stages include
a) Pre-agony
b) Agony
c) Clinical death (reversible injury)
d) Biological death (irreversible injury)
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13. DEATH AS A PROCESS (cont’d)
 Pre agony – falling of arterial pressure, loss of
consciousness, decrease of metabolism
 Agony – further fall in the blood pressure,
cessation of breathing and a sudden return to
life (the surge – last spark of life), steep
reduction of all vital functions after
 Clinical – reversible cessation of vital
functions of the brain, heart and lungs. Life
ceases in the body but persists in component
parts of the body
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14. DEATH AS A PROCESS (cont’d)
 Biological – this is the death of the tissues
and cells individually. It signifies the loss of
life in the component parts of the body
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15. SIGNS OF DEATH
Immediate
Loss of vital
functions of the
brain
Permanent
cessation of
circulation
Permanent
cessation of
respiration
Late
Changes in skin
Changes in
muscles
Ocular changes
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16. SIGNS OF DEATH (cont’d)
IMMEDIATE
 Loss of vital functions of the brain (cerebral
cortex & brain stem)
 Flat Electroencephalography (EEG)
 Cessation of circulation through the retina
 Lack of responsiveness to internal and external
environment
 No muscular movement with generalized
flaccidity
 Absence of all brainstem reflexes
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17. SIGNS OF DEATH (cont’d)
 CESSATION OF CIRCULATION
 If heart sounds are not heard for a continuous period
of 5 min, cessation of circulation is diagnosed
 Absence of radial or carotid arteries pulsations
 Flat Electrocardiography
 CESSATION OF RESPIRATION
 It must be complete and continuous to constitute a
proof for death.
 Absence of air-entry may be demonstrated by
auscultation for 5 min
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18. DEATH CERTIFICATE
 This is a document issued by a medical
practitioner certifying the deceased state of a
person or popularly to a document issued by
a person such as a registrar of vital statistics
that declares the date, location and cause of
a person’s death as later entered in an official
register of deaths
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19. DEATH CERTIFICATE
 In Nigeria, the National Population
Commission is saddled with the responsibility
of registering and issuing of death certificate
in Nigeria
 A death certificate is issued to serve as proof
of registration of death
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20. DEATH CERTIFICATE
 NATURE OF A CERTIFICATE
 Bio data of Deceased
 Name of person reporting death
 Date &Time of death
 Cause of death (primary & secondary causes)
 Date of registration
 Name of certifier
 Signature of Registrar
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21. DEATH CERTIFICATE
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22. Conditions for Registration of
Death in Nigeria
 The death must be registered by the registrar of
birth in the are where the death took place
 An applicant must have proof of death
 An applicant must be a blood relative of the
deceased
 Death must be reported within 7 days from the
date of death
 Death reported after 30 days from date of death
and within 12 months may be registered at a fee
as may be prescribed by the commission
 Death reported after 12 months from date of
death can only be registered with written
authority of the deputy Chief Registrar
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23.  “All interest in disease and death is only
another expression of interest in life.”
-Thomas Mann (1875 - 1955)
The Magic Mountain
Microsoft ® Encarta ® 2009. © 1993-2008 MicrosoftCorporation.All rights reserved

24. REFERENCES
 Frederick,Calvin J. "Death and Dying." Microsoft®
Encarta® 2009 [DVD]. Redmond,WA: Microsoft
Corporation, 2008.
 “How to Get a Death Certificate in Nigeria” NF
author www.nigerianfinder.com/how-to-get-a-
death-certificate-in-nigeria/
 Autopsy Pathology. Dr Umar Mohammed. Morbid
Anatomy and Forensic Medicine UDUSOK
 MedicalTheory of Death. Probable and Absolute
Signs of Death –BudkoA.Yurievna
 Signs of Death. www.linkis.com/blogspot.com/7yi98
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