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Deaths Due to Asphyxiant Gases
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
The characteristic external finding is the cherry-red color hypostasis (Figure 8.2). It is more evident if the level is >30%, below that level proper light is required for visualization or it may go unnoticed. If a person is dark skinned or anemic, it is difficult to appreciate but still it can be appreciated on the inner aspect of lips, tongue, nail beds and conjunctiva (Figure 8.3). Rigor mortis is usually delayed. Present of black color carbon particles present over the external nares and mouth if person was alive during the fire incidence and are not confirmatory but only suggestive to CO poisoning. Fine froth is seen at nostrils/mouth with features of pulmonary edema that occurs as a result of bronchial irritation due to smoke. If death is not immediate and patient survived for prolong time then skin lesion may develop that portray as discolored edematous area, bullae, necrosis or ulceration.
The appearance of the body after death
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
Rigor mortis is, at its simplest, a temperature-dependent physicochemical change that occurs within muscle cells as a result of lack of oxygen. The lack of oxygen means that energy cannot be obtained from glycogen via glucose using oxidative phosphorylation and so adenosine triphosphate (ATP) production from this process ceases and the secondary anoxic process takes over for a short time but, as lactic acid is a by-product of anoxic respiration, the cell cytoplasm becomes increasingly acidic. In the presence of low ATP and high acidity, the actin and myosin fibres bind together and form a gel. The outward result of these complex cellular metabolic changes is that the muscles become stiff. However, they do not shorten unless they are under tension.
Muscle
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
In the absence of ATP, the myosin cross bridges are unable to release the actin. As a result, the sarcomeres and, therefore, the muscle, remain contracted. This phenomenon is referred to as rigor mortis. Following death, the concentration of intracellular calcium increases. This calcium allows the contractile process between the previously formed high-energy myosin and the actin to take place. However, the muscle stores of ATP are rapidly depleted, the myosin remains attached to the actin and stiffness ensues. Rigor mortis begins 3 to 4 hours after death and becomes complete in about 12 hours. It subsides during the next several days as the contractile proteins begin to degrade.
Shared Decision-Making in the Determination of Death by Neurologic Criteria
Published in The American Journal of Bioethics, 2020
One barrier to good SDM in such cases is disagreement regarding the meaning of DNC. Some see DNC to be as clear-cut as death determined by cardiorespiratory criteria; however, they are mistaken. Death by cardiorespiratory cessation is a universally accepted state. In all cultures and religions, someone whose heart has stopped beating and who is not breathing is dead (except if they are on extracorporeal life support). Indeed, when someone dies from cardiorespiratory cessation, even those who are not healthcare professionals can rapidly determine that the patient is dead. Clinicians may be experts at determining death by cardiorespiratory cessation quickly (by looking at the ECG tracing, listening for heart sounds, feeling for a pulse, etc.); however, even a lay person can generally determine that a person is dead soon after the patient has died (not breathing, gray color, cold, stiff, etc.). There is little argument that a person in rigor mortis is dead.
Dangers of Withholding Treatment in Emergency and Prehospital Settings
Published in The American Journal of Bioethics, 2019
There are three special circumstances in which withholding emergency medical treatment is generally accepted: in an obviously dead patient (Iserson 2001), in disaster/battlefield triage (Iserson and Moskop 2007), and in situations that are dangerous for the providers (Iserson and Heine 2016). “Obviously dead” refers to patients with rigor mortis, dependent lividity, or who have been charred beyond recognition or decapitated. (These are four accepted emergency medical services reasons for not resuscitating patients [Iserson and Heine 2016].) When medical resources are overextended, as they are in a major disaster or on the battlefield, clinicians must withhold medical interventions for some patients. They ration medical resources by means of triage, sorting patients into the living, dead, and soon-to-be-dead. Emergency clinicians also withhold treatment when intervention puts them in unreasonable danger. This situation most commonly arises for prehospital personnel who arrive at "unsecured" scenes of violence or face physical peril during a rescue (Lazar 1995).
Association between Weather-Related Factors and Cardiac Arrest of Presumed Cardiac Etiology: A Prospective Observational Study Based on Out-of-Hospital Care Data
Published in Prehospital Emergency Care, 2018
Mario Hensel, Daniel Geppert, Jan F. Kersten, Markus Stuhr, Jürgen Lorenz, Sebastian Wirtz, Thoralf Kerner
Patient data were eligible if they were treated by an Emergency Physician due to OHCA of presumed cardiac etiology. Cardiac arrest was defined as the cessation of cardiac mechanical activities and confirmed by the absence of signs of circulation. The arrest was presumed to be of cardiac origin unless it was caused by trauma, drowning, drug overdose, asphyxia, exsanguinations, hanging, or any other obvious non-cardiac causes. Cases with pre-existing DNR (“do not resuscitate”) orders or patients with certain signs of death were excluded as well. For all cases where the OHCA was unwitnessed (n = 732 / 47%), temperature data and healthcare data were matched with a time-shift of one hour. This interval was empirically chosen assuming that no more time than one hour could have passed since onset of cardiac arrest, provided that no irreversible signs of death such as dependent lividity (starts 15–30 minutes postmortem) and/or Rigor Mortis (starts 1–2 hours postmortem) were detectable.