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Day 20 Notes: Death & Dying

July 24, 2012 by  

Death and Dying

Death & Dying

Includes a discussion of when life ends, how to measure life-death, cultural rituals and stages of death and dying.

Here’s an outline:

  • What is death?
    • How Know Dead
      • Old family member dies at home
      • Call priest
      • Check with no stethoscope
      • Hold mirror to mouth
      • Feather above nose
      • Balfour’s test
        • Stick heart with flag-needle
        • Watch needle for movement
    • When are you dead?
      • No personality
    • Legally Alive but…
      • Vegetative state (1-3 weeks)
      • Severe brain damage
      • Partial arousal
      • Persistent vegetative state (4+ wk)
      • Permanent vegetative state (1 yr)
    • Clinically Dead
      • No heart beat = oxygen delivery
      • No breathing = oxygen supply
      • Reversible?
    • Resuscitation
      • 4-6 minutes
      • CPR, ventilator
      • Heart-lung machine
    • No heartbeat
      • Unconsciousness 15-20 sec
      • Brain (full recovery) 3 minutes
      • Loses ability to work together
      • Hippocampus neurons 10 min
      • 30 minutes for rest of body, except spinal cord
      • Skin 24 hours
      • Bone & tendons 8-12 hours
      • Limbs 6 hours
      • Can be reattached
    • Brain Dead
      • Irreversible
      • No brain activity
      • Voluntary
      • Involuntary
      • Can take body parts
    • Before you bury
      • Wake
      • Just in case
      • Viewing
      • Sitting with
      • Party for
      • In remembrance
      • Life celebration
    • Process of Dying
    • Pre-Dying
      • As you die sleep more
      • Less desire for food
      • Less desire for water
      • Muscles don’t work well
      • Swallowing
      • Dry mouth
      • Choking
      • Bladder & bowel
      • Difficulty breathing
      • Muscles spasms
      • Convulsions
      • Pain
    • Agonal Phase
      • Right before death
      • Ears get cold (less circulation)
      • Can’t get comfortable
      • Disoriented
      • Labored breathing
      • Death rattle = fluid in lungs
      • Lose cough reflex
      • Mucus builds up; congestion
      • Doesn’t seem painful
      • Sense of peace
    • What triggers death?
      • Lack of oxygen
      • Brain stops getting oxygen
      • As brain stops working, systems shut down
      • Different cells die at different rate
      • Which cells deprived of oxygen
      • Kidney & liver = 24-36 (transplant)
      • Heart = 4-6 hours (transplant)
      • Brain = 3-7 minutes
    • Pallor mortis
      • 15 minutes after death
      • No blood flow
      • Capillaries close to skin
      • Lose flesh tone
      • Pale
      • No help calculating time of death
      • Occurs too quickly
      • People with heart failure are alive but look gray & blue lips
    • Livor mortis
      • Indicates no need to start CPR
      • 20 minutes
      • AKA, lividity
      • Discoloration
      • Black & blue
      • Green then purple then black
      • Settling of blood discolors body
        • congealed capillaries 4-6 hrs
        • maximum lividity 6–12 hrs
      • Blood pools
      • Interstitial tissue (between cells)
      • Color from reduced hemoglobin
      • No discoloration if body in contact with ground or object
      • Compressed capillaries
    • Algor Mortis
      • Death chill
      • Loss of body heat
      • 1.5 degrees per hour
      • Drops til room temp
      • 98.6 to 70 =19 hours
      • Pupils glassy
    • Pre-Rigor mortis
      • Within minutes of death
      • Muscles relax
      • No acetylcholine
      • Bowels & bladder empty
      • Eyeballs flatten (no blood pressure)
      • Pupils get cloudy
      • Good predictor of Time Of Death
      • Red blood cell; potassium breaks down
    • Rigor mortis
      • 3-4 hours
      • Stiffening of body
      • Completely stiff at 12 hours
      • Dissipates by 48 hours
      • Process
        • No ATP
        • Calcium ions diffuse
        • Myosin & actin bind
      • Steps
        • Contraction, can’t reset
        • No unbinding
        • AKA, primary flaccidity
        • Begins with eyelids, neck & jaw
        • lactic acid levels
        • Spreads to other muscles
    • Postslaughter meat
      • Chill to59°F
      • Cold shortening
      • Electrical stim. (deplete ATP)
      • Alternating current
      • Contract & relax
    • Forensic Pathology
      • Time of death
      • Holds its position after rigor sets
      • If body moved after death but before rigor, look at lividity
    • Putrefaction
      • Decomposition of proteins
      • Direct chemical process
      • Assisted by bacteria in body
      • Produce gasses & smells
      • Bloating – gasses into veins
      • Tongue swells-protrudes
      • Eyes bulge
      • Liquefaction of most organs
      • Bacteria break down tissue
      • Pancreas – “digests itself”
      • 2-3 days stomach discolor-swells
      • 3-4 days veins discolored
      • 5-6 days skin blisters; falls if touch
      • 14 days stomach fully extended
      • 21 days nails fall off; soft tissues
      • 28 days no face; liquefied organs
      • 30 Days hair, nails & teeth fall out
      • Look larger compared to dried out skin
      • Liquefaction complete
      • Body bursts open
      • Only skeleton remains
    • Skeletonization
      • Skeleton is exposed
      • 3 wks to 3 years
      • Ends with disarticulated bones
    • Death Certificate
      • Who
      • Where
      • How
      • Died of old age
      • Common until 1950s
      • No longer allowed
      • 5 Manners of Death
        • Natural (cancer, etc.)
        • Accident (fall of ladder)
        • Homicide
        • Suicide
        • Undetermined
    • Best Guess
      • Just on odds, most likely die from:
        • Heart disease
        • Stroke (all 4 types)
        • Pneumonia
      • Odds of dying
        • War 1 in 217,231
        • Lightning 1 in 83,930
        • Hot tap-water 1 in 64,788
        • Airplane crash 1 in 4,023
        • Car accident 1 in 247
    • Burial Options
      • Freeze-dry (liquid nitrogen)
      • Leave body out for vultures (Zoroastrians in India)
      • Cremation
      • Embalming
    • Burial Rituals
      • Bury with favorite things
      • Favorite people
      • Servants standing up to serve
      • Queen Victoria
      • buried with husband’s (Prince Albert) bathrobe
      • & plaster cast of his hand
    • Cultures
      • Cannibalistic rituals?
      • Leave exposed to elements
      • Donate body to science
      • Burial at sea
    • Elizabeth Kubler-Ross
      • Psychiatrist
      • Theoretical progression
      • Denial
      • Anger
      • Bargaining
      • Depression
      • Acceptance

 

 

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