Thursday, 26 April 2012

How is death finally certified?




Permanent and irreversible stoppage of respiration, circulation and brain function so called the ‘Tripod of life’
  • Generally the practicing doctor diagnoses death by auscultation; but, this can be difficult in cases of excessive fat, emphysema, apex beat below the rib, poorly beating heart and shallow diaphragmatic respiration. All these conditions dampen the conduction of heart sound with body wall.
  • Diagnosis of recent death is also very difficult whenever the death of the person has not been observed. When a doctor is called to certify a patient ‘as dead’ that is brought by ambulance, he must insist that the body be removed to a well lit room where he can carry out his examination.
  • Even though the condition is satisfactory, there can be error during examination. The signs of life can be detected by special methods like oscilloscope, ECG, and EEG etc.
  • It can never be assumed that attempted resuscitation is pointless. On the other hand, resuscitative measures should always be continued for half an hour.
  • In cases of electric shock, asphyxia particularly drowning and drug overdose, resuscitative measures should always be done
  • There is segmentation of blood in retinal blood vessels in ophthalmoscopic examination. If still there is little doubt, the patient should be taken to intensive care unit for further investigation of heart and brain function.
(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publisher)

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