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Forensic Medicine > Bodies from Fire > Flashcards

Bodies from Fire Flashcards

1
Q

What are the 3 components of a fire

A

Oxygen
Heat
Fuel

All are required for a fire to propagate and burn
If any run out the fire will stop

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2
Q

List the phases of a fire

A

Incipient
Emergent smoldering
Growth of flames

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3
Q

Describe the incipient phase of a fire

A

This is when the fuel source is heated and becomes ready to burn
Start of the fire

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4
Q

Describe the emergent smoldering phase of a fire

A

There is inefficient combustion which leads to lots of smoke production
Low level burn - no flame but lots of smoke

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5
Q

Describe the flame growth phase of a fire

A

The burning is efficient - flames start to grow
The intensity of the flames doubles for every 10’C rise in temperature
Flashover occurs as the ignition temperature of surrounding materials is reached (more like an explosion)
Everything will start burning at this point

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6
Q

What is the cause of most fires

A

Accidents
Electrical malfunction, cigarettes, intoxication etc
Clothing may also catch fire

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7
Q

How might someone commit suicide by fire

A

Pour accelerate on clothes and light it
Or douse car with petrol and lighting it
Very rare in the West (may be seen in asian culture)

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8
Q

List the potential manner of death in a body from fire case

A

Natural - it can prevent them escaping (e.g. they’ve collapsed)
Accidental - cigarettes, intoxication, electrical fires etc
Suicide
Homicide

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9
Q

Fire is a common method of homicide = true or false

A

False
It is rare as the actual method
Unless someone dies in a deliberate arson case
More commonly used to try and conceal the body but often fails (fire not CoD but may hide another cause)

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10
Q

Through which mechanisms can the fire itself cause death

A

Carbon monoxide poisoning
Smoke inhalation
Burns
Heat shock

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11
Q

What 4 questions must you answer when investigating a body from fire

A

Was the victim alive at the start of the fire?

What was the cause of death?n (fire itself or other)

Why was the victim in the fire?

Why was the victim unable to escape?

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12
Q

The cause of death in a body from fire isn’t always due to the fire itself, what other causes are there

A

May have been a natural death and then the location caught fire
May be due to alcohol or drugs
May be a homicide that is being concealed - must consider this

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13
Q

How can you identify a body from fire

A

Circumstances - who was supposed to be in building at that time
Personal effects - jewelry or wallets on body may survive and can be identifiable
Fingerprints - actually rare for these to be destroyed completely
DNA - can be taken from tissue
Dental - match teeth to AM dental records (often the go-to)
X-Rays - match to medical history/ AM x-rays
Operations - identifiable devices, missing organs, pins/plates etc.

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14
Q

How can a prostheses or medical device help identify a body from fire

A

Can match the device to the person
Basic = the suspected victim has a knee replacement and you find a prosthetic joint (can match shape/size)
More specifically = most devices/prosthesis will have serial numbers which should be recorded in surgical notes (this can confirm ID)

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15
Q

What investigation are carried out on a body from fire

A

Medical history
Circumstances
Fire investigator’s examination of scene (origin, development, nature of fire such as heat and toxins produced)
Autopsy - full exam
Toxicology & laboratory investigations - samples taken at autopsy

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16
Q

What are fire artifacts

A

Damage to the body that occurs regardless of whether the person was alive or dead at the time (irrespective of CoD)
The effects of the fire continue after death

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17
Q

List common fire artifacts

A 
Pugilistic posture - boxer
Post mortem burning 
Hair singed & turns reddish-brown
Skin becomes blistered or may shrink, tighten & split
Heat fractures 
Heat haematoma -common in head 
Damage from falling masonry
Damage can be done during recovery of the body
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18
Q

List the features of PM burning

A

Thin reddened margin
Leathery brown, dry skin from smoldering heat
Tissue can be charred by high temp or direct flame
In severe cases the skin splits and is lost
This can progress to muscle loss, amputation of limbs (as tissues burn and bones fracture/disintegrate) and exposure of the body cavities

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19
Q

What is the pugilistic posture

A

A position commonly assumed by corpses after fire exposure
The flexor muscles contract and the body curls up (arms up, hands in fists, bent legs and bent at hips)
Looks like a boxer pose

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20
Q

Which signs tell you that the victim was breathing during the fire (not necessarily conscious)

A

Soot in airways below the level of vocal folds - has to have been inhaled to reach these levels
Thermal injury to larynx
Blood CO > 10%

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21
Q

Absence of soot below vocal folds, thermal larynx injury etc means the victim was already dead in the fire - true or false

A

False

Not necessarily - may have been a quick death so haven’t had time to inhale the smoke/CO etc

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22
Q

How can smoke inhalation cause death

A

Thermal injury to URT (heat shock = rapid death)
CO poisoning
Direct particulate injury (ash and debris)
Smoke poisoning due to release of toxic gases as things burn

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23
Q

What is carbon monoxide and why would you find in in bodies from fire

A

A colourless, odourless gas (silent killer)
Most potent of gases in smoke
It is released due to incomplete combustion of fuels
Fatal levels are found in victims from 50% of fatal house fires

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24
Q

Describe the mechanism of death following thermal injury to the URT

A

Breathing hot air may cause reflex vagal inhibition - lots of nerves in the URT
This will cause a very rapid death - within seconds

Thermal injury can cause laryngeal spasm and/or laryngeal oedema (fluid accumulation = swelling and occlusion)

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25
Q

The URT is very efficient at heat exchange - true or false

A

True

The LRT is relatively protected from thermal injury so rare to get heat damage

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26
Q

Thermal injury is common in which parts of the body

A

Face

URT

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27
Q

What air temperature is required to cause laryngeal injury

A

Dry air >150’C or moist air

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28
Q

How do you estimate CO levels in a body

A

Measure it’s concentration in the blood
Blood levels expressed as % of Hb that exists as COHb
Clinical effects are dose dependent

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29
Q

What % of Hb is considered a fatal dose of CO

A

50% and over

May be lower in the presence of existing heart/lung disease

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30
Q

A CO % of over 10% indicates what in a body from fire

A

That the victim was alive (breathing) during the fire

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31
Q

How does CO inhalation cause poisoning

A

It causes chemical poisoning of bloodstream
It binds to Hb in the blood which diminishes it’s O2 carrying capacity - CO binds in it’s place
It’s affinity for Hb is 200x greater than that of oxygen
Less O2 at tissues

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32
Q

What determines CO toxicity

A 
Rate of inhalation (conc of CO, duration of exposure)
Physical activity (e.g. trying to escape) - increases O2 demand so effect felt quicker
Individual susceptibility (heart, lung disease increases risk)
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33
Q

Describe the symptoms of CO poisoning

at different concentrations

A

20-30%: dizziness, SOB, headache, nausea, fatigue
May be seen in chronic exposure such as faulty heater

30-40%: impaired judgement, failure to escape, loss of consciousness

50%: generally accepted as fatal level

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34
Q

Why might someone have a CO concentration of under 10% in day to day life

A

May actually have a standard level of around 5% in life

HIgher in smokers
Also seen in city dwellers

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35
Q

If a body from fire has a CO concentration under 10% it means they were already dead in the fire - true or false

A

False
This may be seen if there was little or no CO produced in the fire (if there was abundant O2 as CO2 is made instead )
Or if death was rapid such as in heat shock
The victim wont have inhaled enough to raise levels

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36
Q

CO poisoning in a body from fire is associated with what other fire effect

A

Soot inhalation

Soot and CO both present in smoke so both usually present

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37
Q

How common is CO poisoning among building fire victims

A

85% show CO poisoning

50% have fatal levels

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38
Q

What is the classic sign of CO poisoning at autopsy

A

Cherry red/pink discolouration of the body
Seen in lividity and in the eyes externally
Even internal structures like muscles can be pink

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39
Q

What is the histological sign of thermal laryngeal injury

A

Tracheobronchial necrosis seen microscopically

May see some haemorrhage and inflammation in the larynx - due to lining damage from hot gas

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40
Q

How do particulates cause injury in fires

A

Superheated soot & other particulate debris passes deeper into URT than gases and cause injury

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41
Q

What determines particulate penetration

A 
The size of the particulate
The smaller they are the deeper they can go  
>10 um: to nares (nose)
5-7 um: to trachea & bronchi
1-3 um: reach alveoli
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42
Q

What effect does smoke poisoning typically have on a fire victim

A

Gases cause incapacitation but rarely death

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43
Q

Which gases cause smoke poisoning

A

CO, cyanide, HCl, nitrous oxide, aldehydes, benxene, ammonia, sulphur dioxide, phenol, Acrolein
The gas released is dependent on the fuel source

CO and cyanide are the main ones measured

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44
Q

Which fuels release CO2 when burnt

A

All combustibles containing carbon

May also release CO

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45
Q

Which fuels release NO2 when burnt

A

Cellulose
Polyurethanes
Acrylnitrile

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46
Q

Which fuels release HCl when burnt

A

PVC

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47
Q

Which fuels release hydrogen cyanide when burnt

A

Wool
Silk
Nylons
Polyurethanes

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48
Q

Which fuels release aldehydes when burnt

A 
Wool 
Cotton
Paper
Plasters
Wood
Nylon 
Polyester resin
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49
Q

Which fuels release benzene when burnt

A

Petroleum
Plastics
Polystyrene

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50
Q

Which fuels release ammonia when burnt

A

Melamine

Nylon

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51
Q

What are the main burns classifications

A

First degree - superficial

Second degree- partial skin thickness

Third degree - full skin thickness

Fourth Degree - through fat, down to muscle & tendon

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52
Q

What causes a first degree burn

A

Brief exposure to high intensity heat (flame)
or
Long exposure to low intensity heat - e.g. sunburn

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53
Q

Describe a first degree burn

A

Involves epidermis only (vessels, nerves etc are protected)
Will have redness, pain and swelling for 48-72hrs
Peels then heals in 5-10 days
No scarring - damage to skin is slight

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54
Q

Describe a second degree burn

A

Involves epidermis and a variable proportion of the underlying dermis (can affect vessels, nerves, follicles etc)
If it’s relatively superficial you get pain and blistering but it heals in 7-14 days
If deeper it is painless but healing is slow and will scar
May require grafting
Will cause fluid loss and metabolic imbalance

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55
Q

Why are deep burns painless

A

The burn goes deep enough to destroy the nerve fibers so you cannot feel it anymore

56
Q

Describe a third degree burn

A

Involves epidermis, dermis & underlying tissue
Not painful - destroys nerves and vessels
Tissue becomes avascular and waxy as heat damages vessels (secondary damage from ischaemia)
Will cause fluid and metabolic imbalances
Will require grafting if survived - skin unable to regenerate as it has been lost
May be fatal

57
Q

List common accidental causes of burns in children

A

Hot water scalds
Fires (open fire, electric & gas fire)
Clothing can catch fire

Usually a single event/burn

58
Q

List common deliberate causes of burns in children

A

Cigarette burns - typically in areas covered by clothing
Scalding
Hot objects (iron)

Sign of abuse - especially if multiple

59
Q

How do you express the extent of a burn

A

You express it as a % of the total body
Use rule of 9’s - body split into 9% regions
Head, each arm - 9%
Front torso, back and each leg = 18% (2x9%)
The victims palm size is roughly 1% of body so can use this

60
Q

What burn percentage has a poor prognosis

A

Anything over 50%

Lower in the elderly

61
Q

Which complications of burns occur in the first 48hrs

A

Fluid loss
Hypovolaemia - due to fluid loss
Shock
Renal failure

62
Q

Which complications of burns occur after 2-6 days

A 
Burn oedema 
Ischaemia - due to blood vessel damage 
Conversion - 1st can become 2nd degree following these secondary effects 
Airway oedema 
Respiratory failure
63
Q

Which complications of burns occur after 7 days or more

A

Infection

Tourniquet effect

64
Q

What is a surgical escharotomy

A

The skin is deliberately incised to release pressure from the tourniquet effect of the burn
Allows blood to flow back into the area

65
Q

What is a flash fire

A

A very brief, high intensity fire that is lethal
Has an explosive ignition - use up all the O2 quickly
May travel in a particular direction such as in a blast
Very high temperatures - 500-9500’C
Hydrocarbon vapors evaporate and it also produces soot, CO and toxic gases

66
Q

What is the true cause of spontaneous human combustion

A

Typically a natural death with PM burning
Most commonly a cigarette is dropped on the clothes which act as a wick - ignition source is on the body
Produces a slow smoldering fire
Body fat acts as slow burning fuel
The fire damage is localised to body and immediate surroundings but can be extensive

67
Q

How long does it take to cremate a body

A

It takes around 2-3 hours of burning at 800-900’C

Even then cremation is not complete as still have bone fragments

68
Q

What is left after a cremation

A

1 – 1.5 kg white calcinated bone & ash
Typically can still find ends of long bones, skull fragments, pelvic fragments
It is then crushed and put in the urn

69
Q

What causes a scald

A

Moist heat

such as steam or hot liquid

70
Q

What are the 3 main types of burn

A

Thermal
Electrical
Chemical

71
Q

Describe the appearance of a scald

A

Resembles first or second degree burn
Red, swollen, blistered, painful
Well demarcated
No singeing, charring or carbonisation

72
Q

Describe common scald patterns

A

Sparing in areas covered by clothes
Flow pattern - travels in gravity direction
Splash - often irregular
Glove and stocking - dipping hands and feet
Doughnut - caused by sitting in bath (contact areas like buttocks spared and areas out of water like knees spared)

73
Q

What determines tissue damage in an electrical injury

A

Voltage applied
Resistance of skin (wet or dry)
Resistance of tissues (blood, nerves and muscles allow fast flow)
Current which flows (voltage and resistance)
Duration of contact (longer = deeper burn)
Direction of flow

74
Q

How do you calculate voltage

A

Current x Resistance

75
Q

How do you calculate current

A

Voltage / Resistance

76
Q

Why is direction of energy flow important in electrical injuries

A

If it flows across a vital organ such as the heart, lungs or though head to brain then it can trigger fatal outcomes

77
Q

Dry skin has high resistance for electricity - true or false

A

True - takes longer to flow so causes more burning

Therefore electricity flows better and faster across wet skin

78
Q

How does electricity flow through the body

A

Body forms part of electrical circuit - completes it
Current flows from entry to exit along path of least resistance
Easily flows through tissues

79
Q

Which flow directions can lead to fatal electrocution

A

Hand to opposite foot – across chest so affects heart and can trigger VF
Across chest – can cause respiratory muscle paralysis
Through head – can affect cardiac & respiratory centres in brain stem

80
Q

What is the most common cause of electrocution

A

Most cases and deaths are accidental (often domestic electrocution)
Risk increased by wet hands and surfaces so bathroom and kitchen common sites
Much more energy flows through wet surfaces
Suicide is rare

81
Q

Prolonged contact with electricity causes what

A

Burning

This can continue PM

82
Q

Why is the 240V, 50Hz current found in the home dangerous

A

Likely to cause cardiac arrhythmia & arrest - V.F
Spasm of hand & forearm muscles causes victim to ”hold-on” to the source which makes the injury worse
Low domestic voltage doesn’t throw you away which prolongs contact

83
Q

Describe the appearance of electrical injuries

A

Often no visible mark (especially if broad areas of contact or moist skin)
May have burn marks at entry and exit sites (often hands and feet)

84
Q

What effect does electrical current have on muscles and nerves

A

They are readily paralysed as electricity passes through

85
Q

How does a firm contact electrical injury appear

A

Collapsed blister in the center
Peripheral ring of pallor (target shaped lesion)
Surrounding zone of erythema
Metallisation of skin - green/blue discolouration if copper wire or metal impregnated into skin

86
Q

What is a firm contact electrical injruy

A

When the body is in direct and firm contact with the source of electricity

87
Q

What is a loose contact electrical injury

A

When the sparks leap gap between source and entry point on body
Distance depends on voltage
Can cause spread out lesions as sparks hit

88
Q

Describe the appearance of a loose contact electrical injury

A

Melts epidermal keratin which cools to form a localised hard brown nodule
Surrounding pallor

Multiple spark lesions from HV can give crocodile skin appearance

Clothes may ignite if sparks hit them

89
Q

How common are lightning strikes

A

Cause hundreds of deaths worldwide

Particularly in the tropics

90
Q

Why are lightning strikes so dangerous

A

Gigantic voltages and current flow

So much energy that it just pours over the person

91
Q

What are the 2 types of lightning strike

A

Direct strike- passes over/through victim

Indirect transmission e.g. crane driver (travels through crane to them)
or a side flash from other object such as a tree

92
Q

How does a lightning strike victim appear

A

Clothing blown off, scorched or torn by blast
Skin burn near metal objects - jewelry, buttons or watches will become superheated and cause the burn
Arborescent markings (tree pattern -rare)

93
Q

Which sites pose the risk of high voltage electrocution

A

Pylons and substations

May see in accidents at work

94
Q

What are the effects of a high voltage electrocution

A

May cause spark lesions - can travel far as HV
HV may fling victim clear - may survive as contact not prolonged
Prolonged contact causes gross burning

95
Q

What determines the extent of tissue damage in a chemical burn

A

Nature of chemical
Quantity applied
Strength / concentration
Duration of application

96
Q

What are the effects of suicidal ingestion of corrosives

A 
Rare occurrence 
Pain, vomiting, 
SOB, difficulty swallowing
Perforation of oesophagus or stomach
shock
97
Q

What causes chemical burns

A

Corrosive chemical such as acids and alkalis

Usually accidental

98
Q

Describe the appearance of a burn caused by nitric acid

A

Forms a yellow/brown scab

99
Q

Describe the appearance of a burn caused by sulphuric acid

A

Black/brown scab

100
Q

Describe the appearance of a burn caused by hydrochloric acid

A

White to grey scab

101
Q

Describe the appearance of a burn caused by carbonic acid

A

Light grey to light brown scab

102
Q

An acid with pH <2 has what effect on the body

A

It produces coagulative necrosis

103
Q

An alkali with pH >11.5 has what effect on the body

A

It produces liquefactive necrosis

Often penetrates more deeply

104
Q

List common caustic alkalis

A 
Caustic soda (NaOH)
Ammonium hydroxide (AmOH4)
105
Q

Describe the appearance of an alkali burn

A

Grey-white mucoid burn

106
Q

How is clothing typically affected in a fire

A

Clothing may not survive well

Some fragments may be preserved in the flexures of the body as a little more protected - neck, axilla, groin etc

107
Q

How can a victims watch be useful in a fire case

A

Watches can be stopped by the heat of the fire
This can then be used to confirm time of death or peak of fire
Can also be used for identification - recognised by family members

108
Q

How can sex be identified in a body from fire

A

The uterus and ovaries are rarely destroyed by fire as they are deep seated, dense and fibrous

109
Q

Fire tends to fix the tissues - true or false

A

True

Bodies from fire don’t decompose as this heating preserves it

110
Q

Which tissue is usually the more resistant in a fire

A

The teeth

Almost always survive a fire

111
Q

What is considered an incompatible tooth difference in identification

A

If a tooth is present in death but absent in life (excluding dental implants but these will be obvious on X-ray )
Person cannot have got their tooth back so must be someone else

112
Q

What is considered a compatible tooth difference in identification

A

Tooth present in life but not in death
The person may have lost it prior to death but after last living x-ray
Does not rule them out as the victim

113
Q

Why is hair colour not a reliable source if identification in a body from fire

A

Hair colour can change with singeing

Often turns a reddish brown colour

114
Q

Where does skin typically start splitting in a body from fire

A

Across the axillae and forearms (elbow level)

Behind the knees and across the groin

115
Q

Why does the skin split in a body from fire

A

Skin contracts in the heat and becomes very dry

This causes it to split eventually

116
Q

What causes a heat haematoma in a body from fire

A

Contraction of the dura and the brain
The blood in the sinuses (in dura and skull) is forced inward by the contraction which can form an extradural haematoma (accumulates between skull and dura)

117
Q

What causes the laminated appearance of bone in a body from fire

A

It appears layered or laminated as the layers of bone will burn away sequentially
Outer layers present in some areas but burns down to inner layers in others

118
Q

How can you tell if a skin split is post mortem

A

The underlying, exposed fat will not be soot covered if PM

Seen if the splitting occurs after the fire has gone out

119
Q

What can cause the skull to fracture in a body from fire

A

When the inner fragile table is exposed (scalp and outer table is burnt away) it fractures easily
Heat fracture occurs in other bones too

120
Q

A subdural haemorrhage in a body from fire is a fire artifact - true or false

A

False - in some cases it may be a genuine injury
Will be associated with ante-mortem fractures or other injury
Can tell fracture is ante-mortem if the associated scalp/fire damage is not extensive enough to have caused heat fracture

121
Q

A extradural haemorrhage in a body from fire is a fire artifact - true or false

A

True

Usually a result of a heat haematoma

122
Q

What is heat shock

A

A reflex cardiac arrest caused by the inhalation of hot gases

123
Q

How do burns cause electrolyte imbalances

A

Fluid and salt is loss through the wound

Seen in 2nd degree burns and higher

124
Q

What do multiple burns make you suspicious of

A

Deliberate burning and abuse

125
Q

How can burns lead to ischaemia

A

Some burns will damage the underlying blood vessels

This can lead to ischaemia of the area after the burn

126
Q

What causes the tourniquet effect in burns

A

The burn tissue swells and becomes tight
This can cut off blood supply to the area - risk of necrosis
Can also affect breathing if it occurs on the torso

127
Q

What are the typical causes of car fire

A

Suicide
RTA
Protection against fire in place in most modern cars

128
Q

What is cintering

A

White fragile bone that crumbles easily - post burning

129
Q

Are dentures useful in identification

A

Yes they can be
Provided the person is wearing their own teeth!
As not permanent fixtures they are not absolute but usually a very good clue

130
Q

If the person was dead at the start of the fire what does it suggest

A

Homicide concealment

Natural death followed by fire

131
Q

Where is soot deposition most concentrated

A

Usually around mouth and nose as smoke is drawn in here by breathing

132
Q

Soot can be swallowed - true/false

A

True

May be seen in oesophagus and stomach on autopsy

133
Q

What part of the fire causes the burn itself

A

The flame

134
Q

What factors must you determine with respect to a burn

A

Depth
Extent
Whether it was AM or PM

135
Q

How does electricity cause a burn

A

The flow of electricity generates heat

Forensic Medicine (13 decks)

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