法医-猝死Sudden-Death-课件

SuddenDeathProf.Dr.XinshanCHENDept.ofForensicPathology,TongjiMedicalCollege,HUSTSuddenDeathProf.Dr.Xin1Conceptionofsuddendeath

Apersonwholookslikehealthybutdiedsuddenlyandunexpectedlyduetonaturaldiseases.§1.introductionConceptionofsuddendeath§1.2

Accordingtothedefinition,thereare3

importantcharacteristics:

A.Deathhappenedverysuddenlyandquickly

Thetimespaniswithin24hfromtheonsetofsymptomto

deathaccordingtoWHOstandards,butmostofthem

diedwithin2h.Someofthemdiedwithinnomorethan1

minute,whichiscalledasinstantaneousdeath.2.

ThecharacteristicsofsuddendeathAccordingtothedefini3

B.Deathhappenedunexpected

Thepersonandhisrelativesdidnotthinkhewilldie.However,itisindeedsuddendeathifapersonwhodiedveryquickandunexpected?Suchasgunshot,heartrupturebyaknife.Itdiedalsoveryquickandunexpected.Ofcause,itisnot.Itreferswhodiedofnaturaldisease.B.Deathhappenedunexpect4C.Itisnonviolentdeathduetonaturaldisease

Onediedofnaturaldiseaseisthemostimportantamongthe3points.Sothewholeandcorrectdefinitionofsuddendeathissuddenunexpectednaturaldeath,notonly“suddendeath”.Butitisoftenwrittentobesuddendeathcustomarily.Thedifferencebetweenthese2wordsmustbenoted.C.Itisnonviolentdeathd53.ThecaseofsuddendeathInforensicmedicine,accordingtoiftherewaswitnesswhenapersondied,thecaseofsuddendeathwasdividedinto2types:withwitnessandwithoutwitness.A.TherewaswitnessItisofsignificanttoexaminingandexpertiseofsuddendeathiftherewaswitness.

3.Thecaseofsuddendeath6B.Withoutwitness

Thevictimswhohadnowitnesswhentheydiedareeasilysuspectedasaviolentdeath.

C.Therewasinducingfactorbeforedeath.

D.Therewasnotinducingfactorbeforedeath.

B.Withoutwitness74.ThecauseofdeathA.Almostalldiseasescanleadtosuddendeath,butcardiovasculardiseaseranksfirstplace.then,centralnervoussystemandrespiratorysystem.B.Theincidenceofsuddendeathvariedwithdifferentpersonssuchasdifferentsexandage.E.g.suddencoronarydeathinmenandpneumoniainchildren.(itwillbediscussedinthenextstep.)4.ThecauseofdeathA.Almos85.InducingfactororprecipitatingfactorWhatdoesitmean?

Aninducingfactoristhefactorwhichisperhapsnoharmforanormalperson,butitcaninduceorpromoteoccurrenceofsuddendeathwhohaddisease.

5.Inducingfactororprecipit9Thecommoninducingfactorsare:emotionalstressorexcitingquarrelorargumentsfightingfatiguedrinkingheavyphysicalactivityThecommoninducingfactorsar106.Expertiseofforensicmedicine

Theexpertiseofsuddendeathisveryimpotent.Butsometimeitisverydifficulty,andevenitisimpossibleatpresent.Soitmustbeverycareful.

(1)TheprocessofmedicolegalexpertiseTheprocessisjustasothercasesofforensicmedicine.Buttherearesomedifferenceorspecialpoints.6.Expertiseofforensicmedic11A.InvestigationofcasesandhistoryItisespecialimportantsuchasthetime,siteofdeath,symptomsbeforedeath,patientsandfamilialmedicalhistory.

B.Sceneinvestigation

Althoughthesceneinvestigationisnotasimportantasthecasesofmechanicalinjury,butitisnotforgotten.Sometimeitisnecessarytocheckifthereisdrugs,bloodingmarketc.

A.Investigationofcasesand12C.Thewholeandsystemicautopsy

Includinghistopathologicalexamination.D.Auxiliaryexamination

Suchasblood,urine.E.Compilingexpertisereport

Accordingtoabove-mentionedworksof4steps,theexpertisereportiswritten.

C.Thewholeandsystemicauto13(2)Thenoticesofexpertise

A.Itisnotthesamethingbetweenthecauseofdeathandpathologicalchangesfoundatautopsy.Thisisbecausethatthediseasesfoundatautopsycouldn’tbethecauseofdeath.B.Besuretoruleoutvariousviolentcauseofdeath.C.Besuretoruleoutothernaturalcausesofdeath.suchasapoplexy,pneumonia,acutehomorrhagicnecroticpancreatitis,andsoon.(2)Thenoticesofexpertise14D.Itshouldbemadecleartotheseveralrelationships.

suddendeathandinjury,suddendeathandpoisoning,suddendeathandinducingfactors.F.Onepointmustbeobservedinspiteofthatthereareavarietyofexpertisereports.Themedicolegalexpertisereportmustbescientific,objective,practicalandrealistic,fairandreasonable.D.Itshouldbemadeclearto153.Commondiseasesofsuddendeath1.GeneralinformationA.Manydiseaseswhichcanleadtosuddendeath.B.Thereisdifferentincidencefordifferentpersonindifferentarea.C.Thereisdifferentmorbidityindifferentorgansandsystems.Thecommonestsystemisthediseasesofcardiovescularsystem(CVS).3.Commondiseasesofsudden162.Thegeneralintroductionofcommondiseasesledtosuddendeath(1)ThediseaseofcardiovescularsystemA.Suddencoronarydeath(SCD)

SCDisdefinedassuddendeathcausedbycoronaryheartdisease(CHD).Itisthecommonestinsuddendeathduetocardiovasculardiseases,accountingforabout40%-70%.Mostofthemweremanhoodfrom30to59yearsold.2.Thegeneralintroductionof17法医-猝死Sudden-Death-课件18Pathologicalchanges:

Theyincludecoronaryartery(CA)andmyocardium.CA:TherewereonlydifferentstenosisinthedifferentbranchesofCAforthemostcasesofSCD.Onlyminoritycaseshadacutecoronarylesionsuchasthrombosis.Myocardium:Myocardiummaybeslighthypertrophy.Theincidenceofmyocardialinfarction(MI)was:lowerintheforensicautopsiedcasesthanintheclinicalcases,lowerinourcountrythaninthewesterncountry.MI:acute,old;liquefactionnecrosis,coagulationnecrosisPathologicalchanges:19法医-猝死Sudden-Death-课件20ThrombosisintherightcoronaryarteryThrombosisintherightcorona21LeftFig.RecanalizationafterorganizationinLADwiththeformationoffivevesselsofvaryingsizes.RightFig.Largeamountofinflammatorycell(mainlylymphocytes)infiltrationinadventitiaofCA(lower)andincoronaryplaque(upper).LeftFig.Recanalizationaft22MyocardialinfarctMyocardialinfarct23

2.PrimarycardiomyopathyItisalsooneofcommonestdiseaseswhichcausesuddendeath,especiallyinyouthandathlete.

Pathologicalchanges:heartweightincreased,ventriclesdilated,myocardiawashypertrophy,fibroustissueincreasedininterstitial,etc.2.Primarycardiomyopathy24Thereare5kindsofprimarycardiomyopathy:

aDilatedcardiomyopathy,bHypertrophiccardiomyopathy,cRestrictivecardiomyopathy,dArrhythmogenicrightventricularcardiomyopathy,eUnclasiffiedcardiomyopathy.SpecificcardiomyopathyissimilartosecondaryCardiomyopathyinthepast,suchasalcoholcardiomyopathy,Peripartalcardiomyopathy,etc.Thereare5kindsofprimaryc25DilatedC.Hyper-trophicC.DilatedC.26ArrhythmogenicrightventricularcardiomyopathyArrhythmogenicrightventricul273.DissectinganeurismItisaseriousdiseaseofaorta.4.Hemorrhageincranio-cerebraltissue5.Pneumonia

Itwasoftenseeninchildrenandtheoldpeople.6.Amnioticfluidembolism

(Itisoneofmaincomplicationsofpuerperalinobstetricsandtherewashighmortality)3.Dissectinganeurism28DissectinganeurismDissectinganeurism29SeverebronchopneumoniaSeverebronchopneumonia30SuddenDeathProf.Dr.XinshanCHENDept.ofForensicPathology,TongjiMedicalCollege,HUSTSuddenDeathProf.Dr.Xin31Conceptionofsuddendeath

Apersonwholookslikehealthybutdiedsuddenlyandunexpectedlyduetonaturaldiseases.§1.introductionConceptionofsuddendeath§1.32

Accordingtothedefinition,thereare3

importantcharacteristics:

A.Deathhappenedverysuddenlyandquickly

Thetimespaniswithin24hfromtheonsetofsymptomto

deathaccordingtoWHOstandards,butmostofthem

diedwithin2h.Someofthemdiedwithinnomorethan1

minute,whichiscalledasinstantaneousdeath.2.

ThecharacteristicsofsuddendeathAccordingtothedefini33

B.Deathhappenedunexpected

Thepersonandhisrelativesdidnotthinkhewilldie.However,itisindeedsuddendeathifapersonwhodiedveryquickandunexpected?Suchasgunshot,heartrupturebyaknife.Itdiedalsoveryquickandunexpected.Ofcause,itisnot.Itreferswhodiedofnaturaldisease.B.Deathhappenedunexpect34C.Itisnonviolentdeathduetonaturaldisease

Onediedofnaturaldiseaseisthemostimportantamongthe3points.Sothewholeandcorrectdefinitionofsuddendeathissuddenunexpectednaturaldeath,notonly“suddendeath”.Butitisoftenwrittentobesuddendeathcustomarily.Thedifferencebetweenthese2wordsmustbenoted.C.Itisnonviolentdeathd353.ThecaseofsuddendeathInforensicmedicine,accordingtoiftherewaswitnesswhenapersondied,thecaseofsuddendeathwasdividedinto2types:withwitnessandwithoutwitness.A.TherewaswitnessItisofsignificanttoexaminingandexpertiseofsuddendeathiftherewaswitness.

3.Thecaseofsuddendeath36B.Withoutwitness

Thevictimswhohadnowitnesswhentheydiedareeasilysuspectedasaviolentdeath.

C.Therewasinducingfactorbeforedeath.

D.Therewasnotinducingfactorbeforedeath.

B.Withoutwitness374.ThecauseofdeathA.Almostalldiseasescanleadtosuddendeath,butcardiovasculardiseaseranksfirstplace.then,centralnervoussystemandrespiratorysystem.B.Theincidenceofsuddendeathvariedwithdifferentpersonssuchasdifferentsexandage.E.g.suddencoronarydeathinmenandpneumoniainchildren.(itwillbediscussedinthenextstep.)4.ThecauseofdeathA.Almos385.InducingfactororprecipitatingfactorWhatdoesitmean?

Aninducingfactoristhefactorwhichisperhapsnoharmforanormalperson,butitcaninduceorpromoteoccurrenceofsuddendeathwhohaddisease.

5.Inducingfactororprecipit39Thecommoninducingfactorsare:emotionalstressorexcitingquarrelorargumentsfightingfatiguedrinkingheavyphysicalactivityThecommoninducingfactorsar406.Expertiseofforensicmedicine

Theexpertiseofsuddendeathisveryimpotent.Butsometimeitisverydifficulty,andevenitisimpossibleatpresent.Soitmustbeverycareful.

(1)TheprocessofmedicolegalexpertiseTheprocessisjustasothercasesofforensicmedicine.Buttherearesomedifferenceorspecialpoints.6.Expertiseofforensicmedic41A.InvestigationofcasesandhistoryItisespecialimportantsuchasthetime,siteofdeath,symptomsbeforedeath,patientsandfamilialmedicalhistory.

B.Sceneinvestigation

Althoughthesceneinvestigationisnotasimportantasthecasesofmechanicalinjury,butitisnotforgotten.Sometimeitisnecessarytocheckifthereisdrugs,bloodingmarketc.

A.Investigationofcasesand42C.Thewholeandsystemicautopsy

Includinghistopathologicalexamination.D.Auxiliaryexamination

Suchasblood,urine.E.Compilingexpertisereport

Accordingtoabove-mentionedworksof4steps,theexpertisereportiswritten.

C.Thewholeandsystemicauto43(2)Thenoticesofexpertise

A.Itisnotthesamethingbetweenthecauseofdeathandpathologicalchangesfoundatautopsy.Thisisbecausethatthediseasesfoundatautopsycouldn’tbethecauseofdeath.B.Besuretoruleoutvariousviolentcauseofdeath.C.Besuretoruleoutothernaturalcausesofdeath.suchasapoplexy,pneumonia,acutehomorrhagicnecroticpancreatitis,andsoon.(2)Thenoticesofexpertise44D.Itshouldbemadecleartotheseveralrelationships.

suddendeathandinjury,suddendeathandpoisoning,suddendeathandinducingfactors.F.Onepointmustbeobservedinspiteofthatthereareavarietyofexpertisereports.Themedicolegalexpertisereportmustbescientific,objective,practicalandrealistic,fairandreasonable.D.Itshouldbemadeclearto453.Commondiseasesofsuddendeath1.GeneralinformationA.Manydiseaseswhichcanleadtosuddendeath.B.Thereisdifferentincidencefordifferentpersonindifferentarea.C.Thereisdifferentmorbidityindifferentorgansandsystems.Thecommonestsystemisthediseasesofcardiovescularsystem(CVS).3.Commondiseasesofsudden462.Thegeneralintroductionofcommondiseasesledtosuddendeath(1)ThediseaseofcardiovescularsystemA.Suddencoronarydeath(SCD)

SCDisdefinedassuddendeathcausedbycoronaryheartdisease(CHD).Itisthecommonestinsuddendeathduetocardiovasculardiseases,accountingforabout40%-70%.Mostofthemweremanhoodfrom30to59yearsold.2.Thegeneralintroductionof47法医-猝死Sudden-Death-课件48Pathologicalchanges:

Theyincludecoronaryartery(CA)andmyocardium.CA:TherewereonlydifferentstenosisinthedifferentbranchesofCAforthemostcasesofSCD.Onlyminoritycaseshadacutecoronarylesionsuchasthrombosis.Myocardium:Myocardiummaybeslighthypertrophy.Theincidenceofmyocardialinfarction(MI)was:lowerintheforensicautopsiedcasesthanintheclinicalcases,lowerinourcountrythaninthewesterncountry.MI:acute,old;liquefactionnecrosis,coagulationnecrosisPathologicalchanges:49法医-猝死Sudden-Death-课件50ThrombosisintherightcoronaryarteryThrombosisintheright