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Sudden death

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  1. Sudden death -

  2. definition of sudden death • Unknown causes (non diagnosed ) • Fast (short –term death ) during 24 h • Natural death (no traumatic evidences ) • Unexpected (apparently healthy body ) • Medical understood

  3. Suspected death • Sudden death with criminal suspicion • All Sudden death is Suspected.but not all Suspected Is sudden • Some cases : - smothering (infants- elder ) - some cases of poisoning - some cases of traumatic injuries of head

  4. Classification of sudden death cases • Sudden infant death (up to 6 month age ) • Sudden death in early childhood ( 6 m – 6 year) - viral infections (cephalo-meningitis ; enteritis ; bronchitis) - visceral inversion – iliocolic introsusception • Sudden death in school age (6 - 12 year ) - rheumatic cardiac diseases - cardiac deformations • Sudden death before puberty (12 – 18 ) almost rare - neuropathy D - rheumatic cardiac diseases • Sudden death of adults

  5. Sudden infant death (SID s) • 2 W- 6 m age • Slept -Healthy babies • Male > female • Almost during autumn & spring • In poor environment & marasmatic babies

  6. Deferential diagnose of SIDs • Accidental smothering • Criminal smothering • Intended neglect

  7. Mechanism & causes • Hyper sensitivity • Viral infections • Immuno- system disorders • Dystrophy of internal layer of vessels ( sleeping on face )

  8. Sudden death of adults(cardio-vascular causes ) • Myocardial Ischemic D (MID) • Aortic Stenosis • Senile MyocardialDegeneration • Primary Myocardial D • Hypertension • Aneurism • Intracranial haemorag

  9. MID • Include : 2 groups 1- organic diseases of coronary system: - coronary thrombosis - coronary stenos by ruptured atherosclerosis board - myocardial infarct by completely coronary occlusion 2- functional diseases : - coronarism - damage of conducting system (pace-making nodes )

  10. Macro pathological changes in MID • All changes appear only if the patient keep alive more than 8 hours • 1- after 8 hours : red-yellowish swollen area rounded by petechial hemorrhages • 2- after 2-3 days : Grey- yellowish hard area lower than around • 3- after 3-7 days : Light-grey scar then tend to white coloration

  11. Laboratorial diagnose of MID • Micro scope (histopathology ) investigations • K > 51 m.mol / l ( blood of right ventricle ) • Na/k > 0.7 • Tropunin t-I ; SGPT ; SGOT • Myo -globin in pericardial fluid

  12. Early causes of death by MID • Arrhythmia • Cardiac shook • Pain – shook • Pulmonary oedema ( during recovery )

  13. Late causes of death by MID complications • Rupture of infarct area ( 3- 10 days ) • Valve- failer (Rupture of papillary muscles ) • Rupture of interventricular septum • Cardiac aneurysm • Arrhythmia • Thrombosis & embolism

  14. Aortic Stenosis • Affects males over 60 years old or younger with bicuspid V. • Ventricular hypertrophy > 700 g • Aortic Stenosis + Ventricular hypertrophy Blood insufficient

  15. Hypertensive heart disease • Left Ventricular hypertrophy > 600 g • Unstable, irritable endocardial cells arrhythmia , fibrillation • Atheroma is often associated with hypertension

  16. Senile MyocardialDegeneration • The heart is small • The surface vessels are tortuous • The myocardium is soft & brown

  17. Primary Myocardial D • Include : 1- moycarditis ( diphtherial – viral – sarcoid) 2- isolated Fiedler’ myocarditis 3- cardiomyopathy : A- hypertrophic , obstructive type (HOCM) B- congestive type (CCM) ( dilation of chambers ) • description of cardiomyopathy : 1- asymmetric thickening of ventricular walls 2-cardiomegaly > 1000g 3- microscopic disorder of myocardial fibers

  18. Aneurism • Atheromatous aneurism of the aorta : - common in elderly males - common in abdominal region of aorta - by autopsy : retroperitoneal hemmhorag • Dissecting aneurism of the aorta • Syphilitic Aneurism of the aorta • Berry aneurism : - young to middle age - congenital - in the circle of Willis - by autopsy : subarachnoid H

  19. Intracranial haemmoragcerebral H. • Common in old age with significant hypertension • Often in external capsule of hemisphere ( Charcot-Bouchard A.) • Can occur in cerebellum ; mid-brain cerebral thrombosis &infarction Cerebro vascular accident (CVA) is rare cause of S.D

  20. Respiration system • Pulmonary embolism : traumatic 80% ; non traumatic 20% • Massive haemoptysis from cavitating tuberculosis

  21. Gastrointestinal system • Sever bleeding from gastric or duodenal peptic ulcer • Mesenteric thrombosis & embolism • Strangulated hernia – torsion of bowel

  22. Gynecological conditions • Complication of abortion (illegal ) • Ruptured ectopic gestation