Dying and Death: Part 2 – When do we talk about death?

Exitus letalis: When is death considered to have occurred? Death follows the dying process and marks the end of life. Death is consider ed to have occurred when a living organism stops all vital functions. Medically speaking, this refers to an irreversible loss of cardiovascular function and central nervous system activity.

A fall from a great height: Why does this lead to death? When people fall, they usually break their legs, spine, or pelvis . In most cases, these internal injuries lead directly to death, although the body may appear unharmed on the outside. However, broken bones can also perforate the skin, or broken ribs can tear open the aorta. The force of the impact causes internal organs such as the lung, spleen , liver, heart, and major blood vessels to rupture.

What happens in the body when someone bleeds to death? The human body contains approximately 5–7 litres of blood. If the body loses more than 1.5–2 litres, the person becomes weak , thirsty , and cold, experiences anxiety , and begins to breathe rapidly. Blood pressure drops, organs such as the heart and brain become deprived of oxygen, and the person loses consciousness . Death occurs shortly thereafter, e.g., because of heart failure due to cardiac ischemia. One cause of bleeding out can be vascular injuries; if the aorta is injured, death can occur within seconds. If only veins or small arteries are damaged, it can sometimes take hours.

Blood loss leads to haemorrhagic shock, which triggers the release of adrenaline and norepinephrine, among other substances. The release of these hormones increases the heart rate and constricts the blood vessels. In this way, the body attempt s to keep blood pressure constant for as long as possible. Because α- and β-adrenoreceptors are unevenly distribute d throughout the body, blood flow is redirected so that the heart and brain are prioritised. This leads to hypoxia in the periphery. The muscles are no longer supplied with enough blood, resulting in acidosis accompanied by severe ischemic pain. Consequently, the blood vessels become “leaky,” even more fluid escapes, and hypovolemia worsens further.

What happens during a fatal heart attack? When a coronary artery becomes blocked, heart muscle cells die due to ischemia. The more severe the ischemia, the more intense the pain and the resulting feelings of anxiety, chest pressure, nausea, and cold sweats. During a heart attack, the pain can radiate to the abdomen, neck, back, and arms; it can be so severe that it is described as a “destroying pain” (the person feels as if they are dying from the pain or loses consciousness as a result). Depending on the oxygen supply to the myocardium, the heart stops beating, arrhythmia occurs, and blood can no longer be pumped. The patient loses consciousness within seconds, and death occurs within a few minutes.

Why does hypothermia lead to death? When the body temperature drops below 35 °C, the muscles begin to shiver to stimulate endogenous heat production. The blood vessels constrict to keep the remaining warm blood inside the body. This leads to painful muscle ischemia. Apathy and ataxia also frequently occur.

When the body temperature drops below 28 °C, the mitochondria can no longer function properly, glucose sources run low, and the hypothermic patient loses consciousness. The pupils become fixed, cardiac arrhythmia sets in, and circulation collapses. This is referred to as hyperdynamic cardiac arrest, since no blood is being pumped out. Eventually, no oxygen reaches the brain, and death occurs.

What exactly happens when someone is drowning? When a person inhales underwater, their trachea and lungs fill up, triggering a cough reflex. The drown ing person choke s, coughs, in–hales, and then chokes again, repeatedly. Since gas exchange no longer occurs, the brain becomes oxygen-deprived after 1–2 minutes, and the drowning person loses consciousness. The colder the water, the more the circulation is restricted, and thus less oxygen is available for the cells. If drowning people are rescued from ice-cold water, it is still possible to revive them even after 30–60 minutes.

What occurs in the case of burn injuries? Burn victims die from internal suffocation . The carbon monoxide they inhale binds tightly to haemoglobin, preventing oxygen from being transported. Initially, this causes the victim to experience severe headaches; they then lose consciousness and eventually suffocate. Meanwhile, skin damage can cause intolerable pain. Once the burns have reached a certain depth and destroyed the nerves, the burn victim then feels nothing. If the body temperature rises above 50 °C, proteins denature leading to coagulative necrosis, which triggers a strong immune response. With the endothelium damaged, water and blood plasma leak into surrounding tissue s.

EXERCISE:

1. “Destroying pain” means, that a person feels as if they would die from the pain or loses consciousness as a result of the pain. A) True B) False

2. If drowning people are rescued from ice-cold water, it is not possible to revive them after 30–60 minutes. A) True B) False

3. A fall from a great height can lead to death, because internal organs rupture. In most cases, these internal injuries lead directly to death. A) True B) False

You’ll find the answer below.

BIBLIOGRAPHY 1. www.dghs.de

2. www.dict.cc

3. www.ethikrat.com

4. https://link.springer.com

5. www.planet-wissen.de

6. www.swr.de

7. www.webster-dictionary.org

8. www.welt.de

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTL. 1998 gründete sie lobitz seminare in Berlin, die Englischseminare für Health Professionals anbieten.

Kontakt: mail@lobitz-seminare.de

www.lobitz-seminare.de

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Lösung für Exercise:

1. A

2. B

3. A

Dying and Death: Part 2 – When do we talk about death?

Exitus letalis: When is death considered to have occurred?

A fall from a great height: Why does this lead to death?

What happens in…

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Dying and Death: Part 2 – When do we talk about death?

Exitus letalis: When is death considered to have occurred?

A fall from a great height: Why does this lead to death?

What happens in…

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