NDIANG’UI
UNEXPECTED DEATHS
24th September 2009
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SUDDEN UNEXPECTED DEATHS
A wide range of deaths are encountered in the field of
forensic pathology, most of them sudden and
unexpected.
*Most of the times its due to natural causes
They have medical legal implications
Laws affecting medical legal autopsy postulate for
autopsy to performed on all cases of sudden and
unexpected deaths
death certificate should not be issued until case is
reported to police
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Cont…
WHO – Sudden death is that death that occurs within
24 hrs from the onset of the symptoms.
Some authors have considered to be 6 – 12 hours from the
onset
Usually the problem is distinguishing between
natural and unnatural causes and sometimes between
trauma and disease
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Cont…
E.g
homicides involving arsenic or cyanide may mimic
natural death
A person known to have a disease and suffers injury,
questions arise;
Was the traumatic event solely responsible for the death?
Was the cause of death solely due to disease and would have occurred irrespective
of the injury?
Did the injury contribute to death to a lesser or greater degree?
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Cont…
What do you make of an assaulted victim who dies
later after stroke or the negligent minor accident that
has a fatal pulmonary embolism!!
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Causes of sudden death
The immediate cause of death is almost always to be
found in the CVS (heart , great vessels and the
peripheral vasculature)
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Cont….
CVS
Coronary artery
Coronary atherosclerosis
Coronary artery embolism
Dissecting aneurysm
Heart
MI
Hypertensive heart disease
Valvular heart disease
myocarditis
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Cont…
Great vessels
Dissecting aneurysms
Respiratory
Pulmonary embolism
Haemoptysis
Spontaneous pneumothorax
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Cont…
CNS
Subarachnoid haemorrhage
Cerebral haemorrhage
Epilepsy
Cerebral embolism
GIT
Haemorrhage (ulcers, varices, tumours)
Acute haemorrhagic pancreatitis
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Cont…
Mesenteric thrombo embolism
Alcoholic liver disease
Endocrine
Thyroid
Adrenal
Pancrease
Parathyroid
GUT
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Autopsy in sudden death
Autopsy should be systematic
History – the amount of history available during
autopsy is variable. Effort should be made to get
history from relatives, physician, police
Age, gender, lifestyle
Circumstances of death
Medical hx
Drugs-prescription or otherwise
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Cont…
Actual autopsy
A full autopsy that is systematic
External exam
Internal examination
CVS
Respiratory
CNS
GIT
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Cont…
When an autopsy fails to reveal structural
abnormalities that establish the cause of death, the
following are indicated;
Toxicology
Histology
Microbiology
Biochemistry
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Autopsy Consideartions
The outcome in Sudden Death
of autopsy may indicate;
Presence of structural abnormalities that establish
beyond doubt the cause of death because the disease
process is incompatible with life
The autopsy changes are adequate to account for the
death
The cause of the death is established with aid of
positive or negative anatomical findings, histological,
biochemical and toxicological investigations
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Neither the anatomical or lab investigations can explain
the cause of death
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What is the value of microscopic examination and
toxicology investigations in sudden death ?
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SUDDEN INFANT DEATH
SYNDROME (SIDS)
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Definition - SIDS
Sudden Infant Death Syndrome
(crib death) - the sudden death of an
infant, usually under 1 year of age, which remains
unexplained after a complete postmortem
investigation, including an autopsy, examination
of the death scene and review of the case history
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SIDS Statistics
Classified as a disorder
Leading cause of death in infants 1 month to 1
year old
95% occur between 1 & 6 months of age - peak
period between 2 & 4 months
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SIDS -
Sudden & silent in an apparently
healthy infant
Unpredictable & unpreventable
Quick death with no signs of
suffering - usually during sleep
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General Characteristics of SIDS
Usually occurs in colder months
Mothers younger than 20 years old
Babies of mothers who smoke during pregnancy
or are exposed to second hand smoke
60% male Vs 40% female
Premature or low birth weight
Upper respiratory infections, 60% in prior weeks
Occurs quickly and quietly during a period of
presumed sleep
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Findings
Normal state of hydration & nutrition
Small amount of frothy fluid in or about mouth &
nose
Vomitus present
Postmortem lividity &/or rigors
Livormortis
Disfiguration/Unusual position - dependant
blood pooling/pressure marks
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Cont…
Pulmonary congestion & edema
Intrathoracic petechiae 90% of time
Stomach contents in trachea
Microscopic inflammation in trachea
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Typical SIDS Infant Scenario
Almost always occurs during sleep or
appearance of sleep
Usually healthy prior to death
May have had a cold or recent physical stress
May have been place down for nap, found not
breathing or appearing dead
Parents not hearing signs of struggle
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Cont…
Observe for
Location of infant
Presence of objects in area infant found
Unusual conditions
High room temperature
Odors
Anything out of ordinary
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