1、Sudden DeathProf. Dr. Xinshan CHENDept. of Forensic Pathology,Tongji Medical College, HUST1. Conception of sudden death A person who looks like healthy but died suddenly and unexpectedly due to natural diseases. 1. introductionAccording to the definition, there are 3 important characteristics:The ti
2、me span is within 24h from the onset of symptom to death according to WHO standards, but most of them died within 2h. Some of them died within no more than 1 minute, which is called as instantaneous death.2. The characteristics of sudden death B. Death happened unexpected The person and his relative
3、s did not think he will die. lHowever, it is indeed sudden death if a person who died very quick and unexpected? Such as gunshot, heart rupture by a knife. It died also very quick and unexpected. Of cause, it is not. It refers who died of natural disease. C. It is nonviolent death due to natural dis
4、ease One died of natural disease is the most important among the 3 points. So the whole and correct definition of sudden death is sudden unexpected natural death, not only “sudden death”. But it is often written to be sudden death customarily. The difference between these 2 words must be noted. In f
5、orensic medicine, according to if there was witness when a person died, the case of sudden death was divided into 2 types: with witness and without witness. A. There was witness It is of significant to examining and expertise of sudden death if there was witness. B. Without witness The victims who h
6、ad no witness when they died are easily suspected as a violent death. C. There was inducing factor before death. D. There was not inducing factor before death. A. Almost all diseases can lead to sudden death, but cardiovascular disease ranks first place. then, central nervous system and respiratory
7、system. B. The incidence of sudden death varied with different persons such as different sex and age. E.g. sudden coronary death in men and pneumonia in children. (it will be discussed in the next step.)5. Inducing factor or precipitating factor What does it mean? An inducing factor is the factor wh
8、ich is perhaps no harm for a normal person, but it can induce or promote occurrence of sudden death who had disease. The common inducing factors are: emotional stress or exciting quarrel or arguments fighting fatigue drinking heavy physical activity The expertise of sudden death is very impotent. Bu
9、t sometime it is very difficulty, and even it is impossible at present. So it must be very careful. (1) The process of medicolegal expertise The process is just as other cases of forensic medicine. But there are some difference or special points.A. Investigation of cases and history It is especial i
10、mportant such as the time, site of death, symptoms before death, patients and familial medical history. B. Scene investigation Although the scene investigation is not as important as the cases of mechanical injury, but it is not forgotten. Sometime it is necessary to check if there is drugs, bloodin
11、g mark etc. C. The whole and systemic autopsy Including histopathological examination.D. Auxiliary examination Such as blood, urine. E. Compiling expertise report According to above-mentioned works of 4 steps, the expertise report is written. (2) The notices of expertise A. It is not the same thing
12、between the cause of death and pathological changes found at autopsy. This is because that the diseases found at autopsy couldnt be the cause of death. B. Be sure to rule out various violent cause of death. C. Be sure to rule out other natural causes of death. such as apoplexy, pneumonia, acute homo
13、rrhagic necrotic pancreatitis, and so on. D. It should be made clear to the several relationships. sudden death and injury, sudden death and poisoning, sudden death and inducing factors.F. One point must be observed in spite of that there are a variety of expertise reports. The medicolegal expertise
14、 report must be scientific, objective, practical and realistic, fair and reasonable.1. General informationA. Many diseases which can lead to sudden death. B. There is different incidence for different person in different area.C. There is different morbidity in different organs and systems. The commo
15、nest system is the diseases of cardiovescular system (CVS).2. The general introduction of common diseases led to sudden death(1) The disease of cardiovescular systemA. Sudden coronary death (SCD) SCD is defined as sudden death caused by coronary heart disease (CHD). It is the commonest in sudden dea
16、th due to cardiovascular diseases, accounting for about 40%-70%. Most of them were manhood from 30 to 59 years old.0 05 51010151520202525Case NoCase No20-20-30-30-40-40-50-50-60-60-70-70-AgeAgeM MF FPathological changes: They include coronary artery (CA) and myocardium.CA: There were only different
17、stenosis in the different branches of CA for the most cases of SCD. Only minority cases had acute coronary lesion such as thrombosis.Myocardium: Myocardium may be slight hypertrophy. The incidence of myocardial infarction (MI) was: lower in the forensic autopsied cases than in the clinical cases, lo
18、wer in our country than in the western country.l MI: acute, old; liquefaction necrosis, coagulation necrosisLeft Fig. Recanalization after organization in LAD with the formation of five vessels of varying sizes.Right Fig. Large amount of inflammatory cell (mainly lymphocytes) infiltration in adventi
19、tia of CA (lower) and in coronary plaque (upper). 2. Primary cardiomyopathy It is also one of commonest diseases which cause sudden death, especially in youth and athlete. Pathological changes: heart weight increased, ventricles dilated, myocardia was hypertrophy, fibrous tissue increased in interst
20、itial, etc. There are 5 kinds of primary cardiomyopathy: a Dilated cardiomyopathy,b Hypertrophic cardiomyopathy, c Restrictive cardiomyopathy,d Arrhythmogenic right ventricular cardiomyopathy,e Unclasiffied cardiomyopathy. Specific cardiomyopathy is similar to secondary Cardiomyopathy in the past, s
21、uch as alcohol cardiomyopathy,Peripartal cardiomyopathy, etc.Hyper-trophic C. 3. Dissecting aneurism It is a serious disease of aorta. 4. Hemorrhage in cranio-cerebral tissue 5. Pneumonia It was often seen in children and the old people. 6. Amniotic fluid embolism (It is one of main complications of puerperal in obstetrics and there was high mortality)
