Bodies from water Flashcards
Definition of drowning
Asphyxia (suffocation) due to immersion of nostrils & mouth in a liquid.
OR
Suffocation caused by a liquid entering lungs and preventing the absorption of O2 leading to cerebral hypoxia and cardiac arrest.
OR
Death due to submersion in a liquid
Homicidal drowning is a rare method of homicide - true or false?
TRUE
Rare as an actual method of homicide but immersion is common method to dispose of body or attempt to conceal a homicide
What is example CoD from this circumstance:
Collapse “dead” into water
Atherosclerotic coronary artery disease (ACAD)
What is example CoD from this circumstance:
Fatal arrhythmia w/ collapse into water & terminal aspiration of water
ACAD with agonal contributory aspiration of water
What is example CoD from this circumstance:
Non-fatal arrhythmia with drowning
ACAD with contributory drowning
What is example CoD from this circumstance:
Swept away and unable to escape due to lack of cardiac reserve
drowning and contributory ACAD
What is example CoD from this circumstance:
Swept away and drowned while heart functioned normally
drowned
What 4 Qs must you ask on investigating an immersion death?
Was victim alive or dead on entering water?
What was the CoD? (drowning or other)
Why was victim in the water?
Why was the victim unable to escape or survive?
List some vital phenomena (show victim was alive in water)
Foam in airways emphysema aquosum foreign material inhaled/swallowed shoulder muscle bruising middle ear haemorrhage
foam in airways is a specific vital phenomena for immersion deaths - true or false
false
seen in overdose, head injury, epilepsy, LVF etc.
generally, how much faster does a naked body cool in water than in air?
cools 2x faster than in air
hypostasis always develops in drowning - true or false
false
it may never set in if body buffeted in turbulent sea
lividity may develop if body is in still water and is in floating position
decomposition is faster in water vs. air - true or false
false
decomposition is approx. 50% slower in water than air.
delayed by cold water temperature and moving currents
how long before finger pad wrinkling appears on an immersed body?
< few hrs
Between 12-30hrs, what signs might you see on an immersed body?
wrinkled fingers, palms and feet
A body immersed for 4-10 days will have which features of immersion?
early decomposition in dependent head, neck, abdomen and thighs
A body immersed for 2-4 weeks will have which features of immersion?
bloating of face and abdomen, venous marbling and peeling of epidermis on hands, feet and scalp slippage
A body immersed for 1-2 months will have which artefacts of immersion?
gross skin shedding, muscle loss and exposure of skeleton
Lividity and injuries are prominent where on the body and why?
the prominences of the face due to impacts on rocks and floating position with face down and chest and abdomen up (more buoyant)
arms and legs dangle down too so might have abrasions here
What would reduce a body’s buoyancy in water?
air in lungs being displaced by water
heavy items in pockets and heavy clothing
What is the average time for putrefactive gases to refloat a sunken body? When will a body not refloat?
Time depends on water temperature but average is 1-2 weeks in temperate climates.
An exposed body undergoes accelerated decomposition (faster time to resurface).
If body is associated with very heavy objects, gases cannot re-float body
A body is found washed ashore with rib fracture and intercostal bruising - was the fracture caused ante- or post-mortem?
ante-mortem
the bruising around the fracture tells you the person was alive when it happened.
Does not necessarily mean they were in a scrap prior to death but could be from entry impact
what is cutis anserina?
gooseflesh = rigor mortis of hair follicles - skin is dimpled due to pili muscle contraction
How soon after immersion is washerwoman change seen?
washerwoman change aka. maceration is seen within a few hours of submersion and can slough off
Body found in a freshwater reserve with early decomposition of the head and neck. There is also a green/brown layer of substance on the skin. Explain these findings.
Early decomposition of head/ neck/ abdomen/ thighs = 4-10 days immersion
green/brown layer due to algae and chromogenic bacteria in freshwater - this layer can be rubbed off but will take epidermis with it
What is adipocere and which areas does it preserve?
It is a waxy substance aka. grey fat that looks like a shell and preserves fatty areas (thin areas (e.g. over bone) are lost)
Immersion of face in cold water causes which kind of response?
Diving response
Sudden immersion in cold water causes which kind of response?
Cold-shock response
Which immersion response causes apnoea, peripheral vasoconstriction and bradycardia?
diving response
Which immersion response causes a reflex gasp, hyperventilation, tachycardia and hypertension?
cold-shock response
the hyperventilation or feeling or breathlessness makes swimming very difficult
Breath holding time is also reduced to 20s
a body temperature below x degrees = hypothermia?
<35 degrees C
Deep body temp <34C = ?
reduced conscious level and water aspiration
Body temp <28C = ?
VF
body temp <24C = ?
asystole
Describe the phases of drowning (5).
Struggle subsided with exhaustion.
Breath held but rising CO2 stimulates inhalation.
Gulping, coughing, vomiting and unconscious
Convulsions and involuntary respiratory movements.
Death within few mins
Describe the electrolyte imbalance that occurs in fresh water drowning.
Obstruction of airways by inhaled water.
Fresh (hypotonic) water is absorbed INTO the pulmonary circulation > haemodilution (hypervolaemia) > Na from blood into alveoli (hyponatraemia) > haemolysis > hyperkalaemia
Describe the electrolyte imbalance that occurs in salt water drowning.
Sea (hypertonic) water absorbed fluid FROM pulmonary circulation.
Haemoconcentration (hypovolaemia) > Na & Cl absorbed from alveoli into blood > hypernatraemia.
What probably accounts for longer survival time in saltwater?
lack of hypervolaemia and strain on heart
A person drowning in fresh water will die within 4-5 mins and experience haemodilution and fluid overload - true or false?
true Death in 4-5mins in fresh water Fresh water absorbed INTO pulmonary circulation Haemodilution and fluid overload Haemolysis and hyperkalaemia
A person drowning in slat water will die in 4-5mins and experience haemodilution - true or false?
false
salt water absorbs fluid FROM circulation > haemoconcentration
Absorption of Na, Cl into circulation
There is no point resuscitating a person who has been seen drowning. T/F?
FALSE
prolonged resuscitation is often successful in drowning! (due to diminished body metabolism and O2 use) - especially in children!!
What phenomenon is occasionally seen in those that fall into cold water feet first?
“instantaneous death”
Looks like a fatal form of cold-water shock response
Person falls suddenly, feet-first, into cold water; often hypersensitive to water due to alcohol
> very rapid death, no struggle
Reflex cardiac arrest by vagal inhibition
usual signs of drowning absent
A body recovered from water is seen to have white forth at nostrils and mouth - more exudes on compressing of chest during CPR - what has caused this?
Mixture of water, air, mucus & surfactant - whipped together by respiratory efforts
(surfactant + water = foam)
Describe emphysema aquosum.
Lungs are voluminous and ballooned (overlapping) Peripheral air trapping Marbled pleural surfaces Pitting Distended alveoli
Body recovered from water is seen to have over-inflated lungs at autopsy which obstruct view of the heart - what is this and what causes it?
Emphysema aquosum
It is peripheral air trapping due to active inspiration of air and water.
Areas of air trapping will appear pink and red areas show lung collapse
Presence of foreign material in airways and stomach suggests submersion in life - true or false?
true
Presence suggests submersion in life and absence suggests rapid death or already dead
Foreign material/debris can reach the pharynx, trachea/bronchi and oesophagus in someone who is submerged in life - true or false?
False
Debris can reach pharynx, trachea/bronchi and oesophagus in dead victim
Middle ear haemorrhage will look like ? on autopsy and occurs in which kind of deaths?
Blue discolouration in bony roof of middle ear
(?due to pressure changes or irritation via Eustachian tubes)
Can occur in drowning, head injury, asphyxia, electrocution
venous congestion might be found at autopsy if person drowns in salt or fresh water?
absorption of fresh water by pulmonary circulation -> venous congestion
Which muscles might show bruising on PM for drowning?
pectoral and scalene muscles can bruise if struggle occurred in water
In which type of water is pleural effusion more likely to occur?
pleural effusion can occur but seems to depend on period of immersion and is more likely in sea water > fresh
What are diatoms?
a class of unicellular algae which secrete indestructible siliceous exoskeleton
Presence of diatoms in bone marrow, liver and brain tells you what?
that blood was circulating at death (vital)
A person found washed up on beach. At autopsy, there is bruising on posterior thorax over spine and posterior surface of lungs. There are classical contra-coup contusions as well. What does this tell you?
The person likely fell backwards onto the water (hit it flat on back) hence posterior bruising and brain contusions
