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Stages of Death and Dying

July 28, 2012 by  

Death and Dying

Into the dark; into the light. Into the unknown.

What happens when we die is easier to explain than deciding if we are dead. There are certain stages our bodies go through once the heart stops beating. But is a non-beating heart is not always considered death.

It was difficult to decide when life begins. We looked at several options. As it happens, it is no less difficult to figure out when life ends.

Here’s what is included in this lesson:

  • What is death?
  • How they tested for life 100 years ago
  • Stages of death and dying
  • Rigor & other mortis-es
  • Clinical death
  • Brain dead

Read chapter 19 of Berk’s Development Thru The Lifespan

Here are the resources you need. Click for a link for a pdf or scroll down).

CLUSTER

SLIDES

TERMS

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  • appropriate death = good death; free of distress
  • acceptance
  • accident death
  • advance medical directive = general term for living will, health-care proxy & power of attorney
  • agonal phase
  • algor mortis
  • anger
  • anticipatory grieving = feeling loss before death of person with long illness
  • Balfour’s test
  • bargaining
  • bereavement = feelings of grief, desolation and loss
  • bloating
  • brain death
  • burial options
  • burial rituals
  • clinical dead
  • cloudy eyes
  • comfort care (palliative care) = reducing pain in terminal patients by medication dosage
  • compressed capillaries
  • CPR
  • cremation
  • death anxiety = persistent neurotic belief that you’re about to die
  • death certificate
  • death chill
  • death rattle
  • decomposition
  • denial
  • depression
  • died of old age
  • disarticulated bones
  • discoloration
  • dual-process model of coping = grief theory that people dynamically switch between loss & restoration
  • durable power of attorney = legal document to assign another to make decisions for you
  • electrical stimulation
  • embalming
  • euthanasia = ending a life to avoid pain; considered murder or suicide
  • forensic pathology
  • freeze-dried bodies
  • glassy pupils
  • grief
  • homicide
  • hospice
  • irreversible
  • Kubler-Ross, Elizabeth
  • lifespan development
  • liquefaction
  • lividity
  • living will
  • livor mortis
  • manners of death
  • mortality
  • mourning
  • natural death
  • odds of dying
  • palliative care (comfort care) = typically pain medication for terminal patients
  • pallor mortis
  • passive euthanasia = withholding or refusing food & medicine
  • permanent vegetative state
  • persistent vegetative state
  • postslaughter meat
  • primary flaccidity
  • putrefaction
  • resuscitation
  • rigor mortis
  • skeletonization
  • stages of grief
  • stethoscope
  • suicide
  • thanatology = scientific study of death
  • undetermined cause of death
  • vegetative state
  • voluntary active euthanasia = a type of assisted suicide; means provided, patient controls it
  • wake

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NOTES

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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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QUIZ

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  • 1. Which is a major cause of death (top 3)?
    • a.         car accidents
    • b.         plane crashes
    • c.         HIV/AIDS
    • d.         stroke
  •  2. No voluntary brain activity is required for:
    • a.         clinically dead
    • b.         Balfour death
    • c.         brain dead
    • d.         mostly dead
  •  3. Sticking a flagged-needle into the heart is part of:
    • a.         Kuber-Ross’s test
    • b.         Morgan’s test
    • c.         Balfour’s test
    • d.         CPR test
  • 4. In Algor Mortis, the body loses heat at a rate of:
    • a.         .5 degrees per hour
    • b.         1.5 degrees per hour
    • c.         2 degrees per hour
    • d.         2.5 degrees per hour
  •  5. Which do labored breathing, loss of cough reflex and congestion cause:
    • a.         kidney failure
    • b.         rigor mortis
    • c.         death rattle
    • d.         lividity

For the answers: Click Here

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DISCUSSION ITEM

  • What are your favorite quotes about death?

 

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