1 - Investigation of Death Flashcards
What is death
Complete, irreversible and persistent cessation of circulation, respiration and nervous system, with failure of body to act as an integrated system
What can cause difficulties in death confirmation
- Drugs: Sedatives, Hypnotics, Tranquilizers, etc.
- Apparently dead: Deep Coma, Electrocution,
Drowning, Hypothermia, Cachexia, etc. - Advances in resuscitation techniques
What criteria are needed to diagnose death?
- Listen to lungs and heart sounds for 2-5 minutes
- Feel radial, then carotid pulses
- Check light reaction in both pupils
- U n-recordable arterial B.P.
- Flat ECG & EEG
- Examine retina with Ophthalmoscope (trucking)
What is meant by the manner of death
natural or unnatural (suicide, homicide or accident)
What is meant by the cause of death
underlying lesion(s) responsible for death
What is meant by the mechanism of death
terminal pathophysiologic event
What is the mechanism and manner of death for coronary atherosclerosis, IHD, MI?
Mechanism: cardiac arrhythmias, LV failure
Manner: natural
What is the mechanism and manner of death for stab/gunshot wounds
Mechanism: hypovolemic shock
Manner: homicide, suicide, or accident
What is the mechanism and manner of death for hanging
Mechanism: asphyxia, reflex cardiac inhibition, cerebral ischemia
Manner: suicide
What is the mechanism and manner of death for fire death
Mechanism: CO intoxication*, hypovolemic shock, injury to vital organs
Manner: accident
What are the immediate, early and late post-mortem changes?
Immediate: clinical signs of death
Early: primary flaccidity, contact flattening and pallor, cooling, PM rigidity, hypostasis
Late: decomposition
What is post-mortem cooling?
- No further heat production
- Initial plateau 1-2 hours (almost no fall)
- Steady fall (1-1.5 degrees per hour)
- Slower fall the final few hours
- Hot Climate (No Cooling!)
What does this image show
Hypostasis (lividity)
Contact pallor
What does the precipitation of blood inside dependant BV indicate
body position during early hours of death (~ up to 10 hours) and if ever changed
What does dual distribution of blood precipitation indicate
body movement post-mortem
What colour does blood precipitate as
Deep purple
What does a blue colour indicate
asphyxia
what does a pink colour indicate
CO or CN
What does a faint colour indicate
Hemorrhage
When is the onset of blood percipitaion
1-2hrs
When does blood complete precipitation
8-12hrs, then do not redistribute
What is post-mortem rigidity (rigor mortis)
Progressive muscular rigidity affecting both voluntary
and involuntary muscles and replacing primary flaccidity
What causes post-mortem rigidity
Depletion of ATP in the muscles
When is the onset, completion, and depletion of post-mortem rigidity
onset: 2-3 hrs
complete: 8-10 hrs
disappear: 18-24 hrs
What does post-mortem rigidity depend on
- temperature
- muscle activity
- age
What is decomposition?
final soft tissue breakdown
what is the effect of bacterial enzymes post-mortem
disintegration of soft tissues
what causes discolouration of the body post-morten
hemolysis
what causes distension and bad smell
gases
Where do you examine on a dead body
- whole body, including the back
- especially: scalp, inner mouth, neck, palm, wrists
What do you look for on a dead body
- unusual skin discolouration: cyanosis, hypostasis, bruises, pallor
- petechial HGEs: conjunctiva, face, lips, behind ears, and upper chest
- inconsitency between PM changes and PM interval
- external signs of disease
- injection marks (recent/old)
What do you see in this image
deep cyanosis
What do you see in this image
petechial hemorrhages
What do you see in this image
scalp lacerated wound
What do you see in this image
inner-lip lacerated wound
What do you see in this image
Defensive cut wounds
What do you see in this image
CO Poisoning (pink)
Determine the cause of death in this image
Asphyxia
Determine the cause of death
while sleeping, nosebleed due to gases (bloody froth)
Determine the cause of death
hanging with breif suspension
Determine the cause of death
Hanging with prolongued suspension
*A 5 5-y r-old male was brought dead to ER following an episode of severe chest pain.
*He had history of HTN and DM.
*External examination revealed a couple of skin abrasions on his left eye brow and tip of nose
ischemic heart disease/myocardial infarction
superficial injury to prominent parts from falling
- A 19-yr-old man was brought dead to ER by his father.
- There was excessive white froth around mouth and nostrils
- Examination showed a recent injection mark on his left arm and gangrenous areas on both feet
drug overdose
thrombophlebitis (injection mark)
heroin overdose (frothing due to pulmonary edema vagal stimulation by morphine)
A young man was brought dead to hospital after he was found collapsed in his room by his flat mate. Apparently the deceased was trying to fix the A/C unit in his room.
Examination did not show remarkable findings apart from 2 pale dry lesions of 1-2 mm diameter in palm of the right hand
electric injury/burn from electrocution
- A young woman was brought to ER by her relatives who gave account of finding her unconscious in her bed
- They mentioned that she had history of cardiac illness
- Examination did not show any injuries around the
extremely pale body, but it was noticed that her underpants were soiled with fresh blood stains and small blood clots
abortion (could be criminal)
What are the 4 basic/general ethical principles
- no maleficence (no harm)
- beneficence (do good)
- justice (be fair)
- respect of autonomy (free decision)
