Forensic Medicine Lecture 5 (Death Certificate) PDF

LECTURE (5) Death certificate   It is the source for State and national mortality statistics and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and internat...

LECTURE (5) Death certificate   It is the source for State and national mortality statistics and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.  These mortality data are valuable to physicians indirectly by influencing funding that supports medical and health research that may alter clinical practice and directly as a research tool. ①  Physiological derangements or biochemical disturbances by which a cause of death exerts its lethal effect (s) (e.g. cardiac arrest, respiratory arrest); must not be used as underlying cause of death  Failure of function of brain ‫توقف مراكز املخ احليوية عن العمل‬  Failure of function of heart ‫توقف القلب وادلورة ادلموية‬  Failure of respiratory system ‫توقف التنفس وادلورة التنفس ية‬ ②  any death that is exclusively ( 100 % ) the  Any death that is not the direct and direct result of the progression of a complete result of a natural , medically natural , medically recognized disease recognized disease. process.  Fulminant hepatitis due to acute  Fulminant hepatitis due to hepatitis B infection would be classified acetaminophen overdose (homicide, as natural suicide or accident) would be classified as unnatural ③ ‫السبب االصلي للوفاة‬ ‫السبب المباشر للوفاة‬  The condition that triggered the chain of  The final complication resulting from the events leading to death; the most underlying cause of death, occurring condition; etiologically specific closest to the time of death and directly causing death ‫هو المرض او االصابة التي بدأ منها تتابع االحداث‬ ‫المرضية التي ادت الي الوفاة‬ ‫هو المرض الذى ادى مباشرة الى الوفاة‬ ‫ظروف الحادث او العنف التي ادت الي االصابة المميتة‬   for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death)  The underlying cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death)  for reporting all other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I.   Presumed onset of the condition (not the diagnosis of the condition) and the date of death.  This should be entered for all conditions in Part I.  These intervals usually are established by physician on the basis of available information.  General terms, such as minutes, hours, or days, are acceptable, if necessary. If the time of onset is entirely unknown, state that the interval is ‘‘Unknown. ’’ Do not leave these items blank.  This information is useful in coding certain diseases and also provides a useful check on the accuracy of the reported sequence of conditions. ① Cardiac arrhythmia DUE TO Rheumatic ① Cardiorespiratory arrest valve disease ② Cardia c arrhythmia ② Respiratory failure DUE TO ③ Respiratory failure asthma/COPD ④ End stage liver /kidney disease ③ ESLD DUE TO Chronic alcoholism ⑤ Pneumonia ④ ESRD DUE TO Diabetes/HCVD ⑥ Multi-organ system failure ⑤ Pneumonia DUE TO Alzheimer’s ⑦ Sepsis dementia. ⑥ Sepsis DUE TO complications of DM  as a cause of death, include the following:  Site, grade , benign or malignant , cell type.  If a woman dies during pregnancy or within 42 days of the termination of a pregnancy, the fact that the woman was pregnant should be indicated on the certificate, even if the direct cause of death is not related to the pregnancy or to childbirth.  Should state the manifestation or body site, e.g. pneumonia, pyelonephritis.  Specify the infecting organism, e.g. pneumococcus, influenza a virus.  The source and/or route of infection, if known, e.g. food poisoning, needle sharing,  For example, stab wound of chest), always report the trauma (for example, transection of subclavian vein), and impairment of function (for example, air embolism)  If the immediate cause of death arose as an error or accident in surgery or other medical procedure or treatment, it is important to report what condition was being treated, what medical procedure was performed, what the complication or error was, and what the result of the complication or error was.  Example :A man suffers a trans-abdominal gunshot wound with perforation of the colon.”  After months of treatment, he develops peritonitis, septicemia, DIC, hepatic and renal failure, bronchopneumonia, and adult respiratory distress syndrome, and dies. The gunshot wound remains to be underlying cause of death.  Generally, old age is not acceptable as a cause of death.  Old age considered as a sole cause of death in limited circumstances : ① You have personally cared for the deceased over a long period ② You have observed a gradual decline in your patient general health and functioning ③ You are not aware of any disease or injury contributed to death ④ You are certain that there is no reason that the death should be reported as unnatural   Listing mechanism of death without  Use of abbreviations as a mean of underlying disease as cause of death. identifying diseases.  Improper temporal sequencing of  Listing mechanism of death followed by events. the proper underlying cause of death.  Listing two causally unrelated, etiologic  Time interval not mentioned al y specific diseases as cause of death  A 50-year-old woman was admitted to the hospital vomiting blood and was diagnosed as having bleeding esophageal varices.  Investigation revealed portal hypertension.  The woman had a history of hepatitis B infection. Three days later, she died.  A 68-year-old male was admitted to the hospital with progressive right lower quadrant pain of several weeks’ duration. The patient had lost approximately 40 pounds, with progressive weakness and malaise.  On physical examination, the patient had an enlarged liver span that was four finger breadths below the right costal margin.  His ECG showed a right bundle branch block. CT scan showed numerous masses within both lobes of the liver. A needle biopsy of the liver was diagnostic of moderately differentiated hepatocellular carcinoma, and patient was started on chemotherapy. Three months after the diagnosis, patient developed sharp diminution of liver function as well as deep venous thrombosis of his left thigh, and he was admitted to hospital.  On his third day, the patient developed pulmonary embolism and died 30 minutes later.  This 53-year-old male was admitted to the hospital following 2 days of intermittent mid epigastric and left-sided chest pain. The pain radiated to his left arm.He gave a history that included 2 years of occasional chest discomfort, a near syncopal episode 6 months prior, hypertension, a 30-year history of one-pack per-day cigarette smoking, congenital blindness, and insulin-dependent diabetes mellitus. He was noted to be markedly obese and to have severe hypercholesterolemia.  At the time of admission the ECG suggested myocardial ischemia. Two days later, he experienced an episode of severe chest pain that did not respond to nitroglycerin and was accompanied by ST- segment elevation. A cardiac catheterization demonstrated severe multivessel coronary artery stenosis. He underwent quadruple coronary artery bypass surgery. Shortly, after being taken off the cardiopulmonary bypass machine, he went into cardiac arrest. As resuscitation was being attempted by open cardiac massage, a rupture developed in his left ventricular wall that resulted in rapid exsanguination and death.