What does it mean to be

dead?
 Clinical vs Biological Death
 What happens when an individual’s breathing and heartbeat stop?
The first stage is called Clinical Death.
 This results in oxygen not entering the body and the organs,
especially the brain, which affects brain function. If this condition is
not quickly corrected, then biological death will occur.
 Clinical death is not necessarily permanent. An individual’s brain can
stay alive for about 4-6 minutes (sometimes beyond this) after
breathing and heartbeat have stopped. This isn’t much time, but it is
our “Window of Survival.”
 If appropriate medical care is initiated within the first minutes of
cardiac arrest, the individual has a much greater chance of survival. If
more than 4-6 minutes elapse, however, the individual will most likely
experience permanent and irreversible brain damage or Biological
Death.

Somatic Death??? Bishop's tripod of life: Circulation, Respiration, Brain

Molecular Death?? Death of cells & tissues (after 1-2 hrs of stoppage of vital functions
with residual oxygen, but nervous tissues die rapidly)
 Signs indicating Clinical death

• The patient is without pulse or blood pressure and is completely

unresponsive to the most painful stimulus.
• The pupils are widely dilated
• Some reflex reactions to external stimulation are preserved. For
example, during intubations, respiration may be restored in response to
stimulation of the receptors of the superior laryngeal nerve, the nucleus of
which is located in the medulla oblongata near the respiratory center.
• Recovery can occur with resuscitation (process of reviving someone).

Intubation is the process of inserting a

tube, called an endotracheal tube (ET),
through the mouth and then into the
airway. This is done so that a patient can
be placed on a ventilator to assist with
breathing.
Cardiopulmonary resuscitation (CPR)
 Medical/Legal Definition
All Cerebral function has ceased and is irreversible

• Criteria for “Brain Death”

– Bilateral (ie. Both eyes), dilated
(open), and fixed (unresponsive)
pupils
– Voluntary and involuntary reflexes
gone
– Can’t breathe without a machine
– No heart activity and
– No Brain waves
 Process of Dying
1. Sequential Loss of Life Functions
2. Terminal Apnea = Last Breath
3. Agonal State=“death rattle”=noise, liquid, bubbling
4. Clinical Death=No Pulse, No Breath
5. Brain Death=No Central Nervous Activity
(Coma=Life Activities continue only with aid of machines)
When people are no longer able to swallow or cough, saliva builds up in the back of the
throat and the airways causing a "rattling" sound when air passes through.

 Brain death is a state of irreversible cessation of the total function of the

cerebrum (upper brain), the cerebellum (little brain) and the brain stem while
the cardiovascular function is artificially maintained by controlled ventilation.
 The cerebral functions are irreversibly lost when the brain lacks blood and oxygen
supply for a few (at most 10) minutes.
 After this time, the brain is cut off from the blood circulation and its cells
degenerate and die, even if the rest of the body is still being supplied with blood
by means of artificially maintained ventilation and cardiac action.
 It is possible to remove still intact organs for transplantation purposes from a
brain-dead patient.
 While brain stem reflexes can still be triggered in unconscious patients, they are
absent in brain-dead patients. These reflexes include:

 Pupillary reflex: In healthy persons, both pupils are normally equally wide; they
narrow when exposed to light. Brain-dead patients lack this reflex; their pupils are
no longer reactive to light.
 Doll's eye reflex (oculocephalic reflex): If a patient is unconscious but not brain-
dead they react to tipping of their head with slow eye movement in the opposite
direction. The eyes of a brain dead patient however do not react to this test and
remain in their initial position.
 Corneal reflex: When the outer layer of the eye (cornea) comes in contact with a
foreign object, the eyes close as an automatic reflex. When the physician tests
this reaction by touching the cornea of a brain-dead patient with a cotton swab,
this reflex is absent.
 Response to pain in the face: Even patients who are in deep coma respond to
painful stimuli that are applied to the face with distinguishable twitching of the
muscles and defence reactions of the head and neck muscles. Brain-dead
patients lack these reflexes.
 Gag- and cough reflex (tracheal and pharyngeal reflex): Touching the back of
the pharynx induces a gag reflex in healthy and unconscious persons. This reflex
is absent in brain-dead patients.
 is a contraction of the throat that happens when something touches the roof of your mouth,
the back of your tongue or throat, or the area around your tonsils.
 Coma
 A coma is a deep state of eyes-closed unconsciousness where a person is not
able to respond to people or the environment around them. In a coma, a
patient is alive and there is some brain activity.
 Patients in a coma might have brain stem responses, spontaneous breathing
and/or non-purposeful motor responses??.
 Coma has three possible outcomes:
progression to brain death
recovery of consciousness,
evolution to a state of chronically depressed consciousness, such as a
vegetative state (brainstem functioning)- some form of consciousness
and unaided breathing.

 in someone with a dead cerebrum but a living brainstem, spontaneous

breathing may continue unaided,
 whereas in whole-brain death (which includes brainstem death), only life
support equipment would maintain ventilation.
 Speed of Death
• Instantaneous=instant death (explosion)

• Acute=Fairly Rapid (Gunshot)

• Result of Shock=Body shuts down (heart attack, no blood to cells)

• Progressive Dying=illness with death in days, months, years

(Cancer)
 Ways to Determine Time of Death

Time of Death (Hours)

• The degree of digestion of stomach contents and
test bodily fluids
 Ways to Determine Time of Death

– Algor Mortis
• The change in body temperature.
• Falls at about 1.5OC/hour
– Livor Mortis (lividity or hypostasis)
• Settling of red blood cells; this reddens the skin
• Begins within ½ hour, most evident within 12 hours – after
that, livor mortis will not move regardless of how the body is
moved
– Rigor Mortis
• Board-like stiffening in about 12 hours, lasts another 12
hours, and releases in another 12 hours
 Algor Mortis
Algor Mortis is the cooling of the body after death.
[Latin algor, coolness + mortis, of
 Begins immediately after death death]
 Metabolism in body tissues stops
 No more heat-generating chemical reactions
 No more homeostasis by brain of body temp
 Diffusion of heat until at equilibrium with room temperature
 Faster in windy conditions and in water
 Children and thin people cool faster
 The body drops approximately 1.5 degrees for each hour after death.

The general equation used to measure time of death based on body

temperature is the Glaister Equation:
 Livor Mortis
Latin: livor – "bluish color", mortis – "of death")
 Begins within ½ hour after death and
most evident in first 12 hours
 Heart Stops
 Vessels breakdown
 Red blood cells are dense and settle
according to gravity in body
 Appears on skin as purplish-red
discoloration
 Can give indication of body position at
time of death
 Does not happen in areas that are in
contact with the ground or other objects
 Can see if body has been moved after
death
 Rigor Mortis
"stiffness of death"

 Rigor mortis usually occurs about 2-3 hours after death

 No blood pumped
 No oxygen to muscles
 Bacteria doing anaerobic respiration
 Make Lactic Acid
 Low pH causes Actin and Myosin to contract muscles, so they
stiffen until ATP gone and fibers decompose
 Stiffening begins at jaw and migrates down
 Around 36 hours after the onset of rigor mortis, the body again
relaxes and is pliable
 If the body feels warm and no rigor is present, death occurred under 3
hours before.
 If the body feels warm and stiff, death occurred 3-8 hours earlier.
 If the body feels cold and stiff, death occurred 8-36 hours earlier.
 If the body is cold and not stiff, death occurred more than 36 hours
earlier.
 The use of Rigor Mortis as a time of death indicator is less than ideal
because of the large spans of time it encompasses. The windows can
vary by as much as 24 hours. There are also several factors that can
severely impact the onset and timeline of Rigor:
 temperature
 illness
 activity before death
 physical conditions where the body are found
 Decomposition
Mortis are also listed as stages of decomposition, which occur within 1-
48 hours after death. Later stages of decomposition must be used as
estimates after the 48 hour window.
There are two main ways the body decomposes: Autolysis and
Putrefaction.
 Both of these processes take place by chemical reaction, so both are
subject to the typical kinetic controls of a chemical reaction.
 Autolysis- Just after death, the cell membranes breakdown and
release enzymes that start self-digestion.
 Putrefaction- is the predominant cause of tissue degradation and is
due to bacterial activity.

5 stages of decomposition
1. Initial decay
2. Putrefaction
3. Black putrefaction
4. Butyric fermentation
5. Dry decay
 Initial Decay

• 0-3 days after death

• Bacteria in digestive tract start eating intestines, break through and
begin feeding on surrounding organs
• Individual cells break down,
releasing cell contents and
enzymes into body
 Putrefaction

• 4-10 days after death

• Body will be bloated from build-up of gases in body
• Gases released by bacteria living in intestines
• Skin blisters
• Build-up of fluids from ruptured cells and intestines
• Skin begins slipping
 Black Putrefaction

• 10-20 days after death

• Body begins to collapse, and black surfaces are exposed
• Bloated body collapses and leaves a flattened body
• Large volume of body fluids drains from body
 Butyric Fermentation

• 20-50 days
• Remaining flesh on body is removed and body dries out
• Cheesy smell (caused by butyric acid)
• Surface of body in contact with ground may mold as body ferments
 Dry decay

• 50-365 days after death

• Body is dry and continues to decay very slowly because of lack of
moisture
• Mostly reduced to hair and bones
• Eventually the hair will disappear
 How people survive without breathing for so long?
In 2016, ALEIX SEGURA of Spain set the Guinness World Record by holding
his breath for 24 minutes and 3 seconds.

 Hyperventilation: Free divers often spent about 20 minutes hyperventilating

pure oxygen before their attempt, an activity that saturated their body with
oxygen and scrubbed themfree of carbon dioxide.
 Physical adaptations: Brazilian fisherman who dove for their prey had
significantly larger lungs than those who stayed on the surface.
 Psychological state: This is important when attempting extended breath
holding: free divers often report reaching a place of great relaxation during
dives in order to minimize their metabolic functions and preserve oxygen.

 Miraculous Case: The 1986 case of Michelle Funk is one of these unusual
cases. The 2-year-old girl was submerged in icy water for over an hour but, in
a turn of events described as “miraculous” as she survived with all brain
function seemingly intact. She had become so profoundly hypothermic so
quickly that she managed to stave off brain damage — sort of flash freezing
her cells and allowing them to keep functioning once rewarmed.