Death
0 Death is the cessation of vital functions.
0 Somatic death: It is the state of irreversible loss of respiratory, circulatory and central nervous system functions.
0 Cellular death : After somatic death and the disruption of intersystem coordination at the cell-tissue level, it is called cellular death by disrupting intracellular functions.
0 Agony: Before death, the period in which death is inevitable and absolute, inter-system coordination and organ functions deteriorate, consciousness and decision-making ability deteriorate is called agony phase. Findings in this phase:
• Significant decrease in the person's activity
• Paleness with cold hands and feet
• Disruption in cardiac rhythm
• Cold sweats
• Salivary unit in the throat and wheezing due to decreased swallowing reflex
• Meaningless movements involuntary in arms and legs
• Disturbances in the five senses and lowering of the lower jaw and opening of the mouth (jaw throwing)
Brain death
It defines the condition in which irreversible structural brain damage is detected, brain stem functions are stopped by clinical examinations, and the circulatory and respiratory centers cease to function irreversibly.
• The most important test in the diagnosis of brain death is the apnea test. Indicates the absence of spontaneous breathing.
• Cranial nerves are tested for brain stem functions.
• The absence of cerebral blood flow can be demonstrated by radiological methods. Although angiography is the most reliable method, it is not useful because it is invasive. MRI angiography is a non-invasive examination and is more useful.
• Brain death should be differentiated from vegetative living state or locked-in syndrome.
• Brain death diagnosis is especially important for cases that can be donors for organ and tissue transplantation.
• According to the new law, 2 physicians, one an anesthesiology and reanimation or intensive care specialist, and the other a neurology or neurosurgery specialist.
Vegetative Life Status:
The damage is in the cerebral cortex.
There are no higher functions.
Brain stem functions continue.
Signs of Death
1- Definitive signs of death: It is the cessation of circulation and respiration.
2- Possible signs of death:
Disappearance of all reflexes.
Muscle relaxation: Before dead stiffness develops, muscle tone disappears immediately after death.
Changes in the eyes: Due to fluid loss, the eyeball softens, the cornea becomes cloudy, the pupils appear dilated (pupillary shrinkage with the development of dead stiffness).
Loss of skin elasticity.
Examinations Used in the Diagnosis of Death
Circulation Examination:
Control of peripheral pulses.
Cardiac auscultation
ECG
Blood HPmeasurement
Oscillometric Method: They measure the oscillation / vibration of the blood pressure on the vessel wall.
Icard Method: When an average of 5 cc (0.7 cc/10 kg) of ammoniacal fluoresceine solution is given subcutaneously or intravenously, if there is an emerald green (yellow-green) color change in the conjunctiva within 0.5-2 hours, circulation continues.
Rebouillat Experiment: If the swelling and stiffness under the skin disappear when 1-2 cc of ether is injected subcutaneously, circulation continues.
Magnus Test: When the finger is tightly tied with a rope, paleness in the place where the rope is tightened and bruising on the fingertip indicates that the circulation continues and the person is alive.
Radiological Examinations:
The presence of cerebral blood flow can be visualized by angiography or MRI / CT angiographies.
Respiratory Examination:
Auscultation
Inspection
Apnea test
Neurological Examination:
Control of pupillary reflexes
Corneal reflex control
Vestibulo-ocular reflex control
Laryngo-pharyngeal reflex (gag reflex)
Head pair control
Control of tendon reflexes
EEG
