Kinds of autopsies ok

Hospital or non-official autopsy Medico-legal or official autopsy

Forensic Medicine Flashcards by Lauren Ise

______crime-solving: relating to the application of science to decide questions arising from crime or litigation
•[Mid-17th century. From Latin 2. ____ “of legal proceedings,” originally “of the forum (as a place of discussion),”

fo·ren·sic

2. forensis

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Branch of medical science which deals with the application of medical knowledge to elucidate legal problems
•“Forum”
•All branches of medicine can have forensic aspect.
•The main objective is the TRUTH based on the evidence.

Forensic medicine

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= in 1975 found bamboo pieces from Qin dynasty dating 220BC w/c had info on rules and regulations for examining injuries

China

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= Code of Hammurabi (king of Babylon) w/c dates 2200BC about rights and duties of physicians including malpractice

Iraq

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= laws of Manu dating 10BC about competencies of witnesses in courts

India

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= papyri dating 4th century AD about forensic medical examination or investigation

Roman Egypt

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FUNCTIONS OF MEDICO-LEGAL DIVISION

AUTOPSY
•PHYSICAL EXAMINATION
•ANTHROPOLOGY
•ODONTOLOGY
•HISTOPATHOLOGY
•SEROLOGY
•DNA
•SOCO
•COURT DUTY
•RESEARCH, LECTURES

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Conducts physical examination on living persons (7 working days)
Conducts genital examination to determine sexual abuse and time of infliction of injury.
Conducts physical examination persons involved in physical injury cases to determine the presence and extent of injuries
Conducts autopsies to determine the exact cause, manner, mechanism and approximate time of death. (7 working days)
Conducts exhumation to determine the cause of death and identity of persons

Medico-Legal Officer

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•Examination of human dentition and applying the characteristics in identification of individuals (5 working days)

Odontological Examination

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•To determine the cause of death thru microscopic tissue examination (28 workings days)

Histopathological Examination

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To determine presence of human blood,type and characteristics
To determine the presence of semen (4 working days)

Serological Examination

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Conducts SOCO processing to identify, collect, examine, and present before the courts evidence at the crime scene
Conducts Field Laboratory Work
Appears and testifies in court as expert witness
Lectures to different police/military institutions, government agencies and private/public schools
Orients and trains new personnel and on-the-job trainees on the mission, functions and capabilities of the division;

Medico-Legal Officer

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MEDICO-LEGAL DEATHS

•1. VIOLENT DEATHS
-accidents
- suicides
 - homicides
•2. SUSPICIOUS DEATHS
•3. SUDDEN UNEXPECTED DEATHS/MEDICALLY UNEXPLAINED DEATHS
•4. UNATTENDED DEATHS
•5. DEATH IN CUSTODY
•6. POISONING
•7. POSSIBLE THREAT TO PUBLIC  
      HEALTH
•8. DEATH RELATED TO EMPLOYMENT
•9. DEATH ASSOCIATED TO  
      THERAPEUTIC AND DIAGNOSTIC
       PROCEDURE
•10. UNLAWFUL TERMINATION OF  
        PREGNANCY
•11. BODIES TO BE CREMATED
•12. UNCLAIMED CADAVERS
•13. SUSPICIOUS CHILD DEATHS
•14. UNEXPECTED DEATH OF PUBLIC
         OFFICIAL

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Five categories of medico-legal cases

memorize

Violent deaths
Suspicious deaths
Sudden and unexpected
Unattended death
Death in custody

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Objectives of medico-legal examination of a body are:

To determine the cause of death
To determine the manner of death
Estimate the time of death
To document all findings
To determine or to exclude other factors
To collect trace evidence in criminal cases
To positively identify a body
To testify in court
Interpret findings

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•Comprehensive study of a dead body, performed by a trained physician employing recognized dissection procedure and techniques.
•Removal of tissues for further examination
read!

Autopsies

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Kinds of autopsies

Hospital or non-official autopsy

* Medico-legal or official autopsy

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Kinds of autopsies
–Consent from relatives
•Spouse, descendants of the nearest degree, ascendants of nearest degree, brothers and sisters (decreasing order)

A. HOSPITAL/ NON-OFFICIAL AUTOPSY

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Purpose:
•Determine cause of death
•Provide clinical correlation of diagnosis and clinical symptoms
•Determine the effectiveness of therapy
•Study natural course of the disease process
•Educating students and physicians

HOSPITAL/ NON-OFFICIAL AUTOPSY

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–Dead body belongs to the state for protection of public interest
•All that needs to be turned over to the next of kin would be burial of the deceased

MEDICO-LEGAL or OFFICIAL AUTOPSY

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–Purpose:
•Determine cause, manner and time of death
•Recovering, identifying and preserving evidentiary material
•Providing interpretation and correlation of facts and circumstances related to death
•Providing a factual, objective medical report for law enforcement, prosecution and defense agencies
•Separating death due to disease and death due to external cause

MEDICO-LEGAL or OFFICIAL AUTOPSY

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Starts in the morgue
Focuses on the internal findings
Determines cause of death
Determines prognosis
ok

Hospital Autopsy

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Starts in the crime scene
Focuses on the external and internal findings
Determines cause / manner/ mechanism of death
Clothes included in the autopsy
R.I.P. of evidence
Determines identity
ok

Forensic/Medico-legal Autopsy

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When shall an autopsy be performed on a dead body

SEC 98 (B) P.D. 856, Code of Sanitation

Whenever required by special laws
Upon order of a competent court, a mayor and a provincial or city fiscal
Upon written request of police authorities
Whenever the solicitor general, provincial or city fiscal as authorized by existing laws shall deem it necessary to take possession of the remains and determine cause of death

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Persons who are authorized to perform autopsies and dissections repeat

Health officers •Medical officers of the law enforcement agencies •Members of the medical staff of accredited hospitals

Disease or injury that results in the individual dying. ok Cause, Manner, Mechanism

Cause of Death:

How the cause of death came about. | repeat

Manner of Death a. Suicide b. Homicide c. Accident d. Natural e. Undetermined

physiological derangement. | ok

3. Mechanism of Death:

1. Circumstances - witnesses - investigators - history - the scene - medical records 2. Examination of Body - search! 3. Laboratory test - ballistics - toxicology - paraffin

3 steps in medico-legal investigation

1. Document first- photos, sketches 2. Minimal handling of the body 3. Protect the hands- use paper bag 4. Wrap the body in white clean sheet/ cadaver bag 5. Encircle the injection sites 6. In the hospital, don’t remove tubes 7. Document the location, number of injuries 8. Medical records/ procedures done must accompany the body Con’t 9. In the morgue, must log the case, include Who brought the body, what time, who received it 10. Don’t wash the body! Examining the clothing is an important part of autopsy. 11. Photo before and after cleaning the body. Re-examine after cleaning. 12. X-ray: GSW and child abuse 13. Photo with ruler each injury. 14. Internal examination-autopsy proper 15. Lab test: toxicology, histology, neuropathology, microbiology, serology, ballistics 16. Lastly, fingerprint and palm print ok

Handling of bodies

– age/sex, race, physique, height, nourishment –Congenital malformations –Brief description of clothing –General description of body state •Degree of rigor/livor mortis •Hair (length and color), facial hair, alopecia •Eye appearance, eye color, teeth, dental plates, scars , tattoos, old injuries unrelated to death, evidence of recent medical intervention

Autopsy Report | I. External Examination

- external and internal injuries - GSW: assign number, location, characteristics, trajectory - pertinent negatives - entrance and exit - describe the slug, location - all bullets should be recovered

Autopsy Report | II. Evidence of Injuries

-weight of organ is important, dimensions of organs not needed.

``` Autopsy Report III. Internal Examination ... IV. Microscopic Examination V. Toxicology VI. Findings VII. Opinion ```

-Blood -Semen -Hair -Tissue -Fingernails -Bite marks -Saliva ok

physical Evidence | a. Biological evidence

-clothing -bullets -fibers -paint -glass -soil ok

physical Evidence | B. Non-biological evidence

Manner of death that must be autopsied

1, Death by violence 2. accidental death 3. Sudden death of person who are apparently in good health 4. suicide

Cause, Manner, Mechanism Gunshot wound? Stab wound? blunt force? ok

Cause of death

Cause, Manner, Mechanism Massive hemorrhage? peritonitis septicemia hemorrhage

mechanism of death

Physical Evidence

a. Biological evidence | B. Non-biological evidence

I. Factors used in estimating time of death | ok

- livor mortis - rigor mortis - algor mortis - vitreous (eye) potassium - stomach contents - environmental factors

(post mortem lividity)

livor mortis

(muscle stiffening)

rigor mortis

(body temp)

algor mortis

(eye)

vitreous potassium

Philippine Criteria of Brain Death | ok

I. An individual who has sustained: A. Irreversible cessation of circulatory and respiratory functions; or B. Irreversible cessation of all functions of the entire brain, including the brain stem

``` postmortem lividity Due to settling of blood by gravity on dependent areas of body If pressed against hard surface - pale coloration is seen Reddish, purplish blue color Begins in ___mins Intensifies over time May result in post mortem petechiae Its not a contusion Livor vs contusion? ok ```

LIVOR MORTIS 30 mins

LIVOR MORTIS Up to 6 hpm Complete shifting 6-12 hpm Incomplete shifting Over 12 hpm No shifting

pale coloration | lividity

Stiffening of the body after death Due to postmortem muscle contraction Depletion of ATP > stable complex of actin and myosin begins within ___ hours after death jaw>face>upper ext > lower ext _______ – full rigor mortis

RIGOR MORTIS 2 hours 6-12 hours

RIGOR MORTIS Lost due to decomposition Temperate climates – persists for 36-48 hours Warm climates – persists less than ____hours Cold weather – persists for several days Cadaveric spasm-rare

24 hours rigor

``` Algor mortis ______degrees Not accurate if used solely Body cooling is not uniform Does not follow a linear pattern Fastest during first 2 hours Body habitus may influence rate of cooling ``` ____ cool faster due to body mass/surface area ratio Higher in girls ____ cools at lower rate

35.6°C - 38.2°C Infants Obese

warm and not stiff

less than < 3 HRS.

warm and stiff

BET. 3-8 HRS.

cold and stiff

BET. 8-36 HRS.

cold and not stiff

> 36 HRS.

Determined by degree and rapidity of decomposition Accelerated decomposition raises ____ level Time is only one factor so unreliable solely

Vitreous Potassium | potassium

STOMACH CONTENTS Gastric emptying varies from person to person, amount of meal and time of the day Half gastric emptying time: ___ hrs Stress will delay digestion

4 hours

``` Size of the last meal The stomach usually starts to empty within 10 minutes after the first mouthful has entered. light meal - ____hrs medium sized meal - _____ heavy meal _____ ```

1 1/2 to 2 hrs 3 to 4 hrs 4 to 6 hrs

Insect activity- from egg stage to adult stage.

ENVIRONMENTAL FACTORS

Autolysis: - aseptic breakdown - pancreas Putrefaction: breakdown due to bacteria - 1st sign is greenish color of LQ abdomen - greenish-black color of face/neck - swelling - protruded eyes and tongue - purge fluid Gas formation- slippage of skin with blister and marbling ( rxn of hgb and hydrogen sulfide). Skin from green to black. Hair will slip from the scalp brain: liquefied Decomposition: after 24hrs in hot weather while slower process in a wk or 2 in temperate climates Skeletonization: a week to years Adipocere: fats will undergo fatty acid transformation

DECOMPOSITION

Rigor mortis present all over. Hypostasis well-developed and fixed. Greenish discoloration showing over the caecum.

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS 12 hours

Rigor mortis absent all over. Green discoloration over whole abdomen and spreading to the chest. Abdomen distended with gases.

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS 24 hours

Ova of flies seen. Trunk bloated. Face discolored and swollen. Blisters present. Moving maggots seen. ok

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS 48 hours

Whole body grossly swollen and disfigured. Hair and nails loose. Tissues soft and discolored.

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS 72 hours

Identification of bodies

a. non-scientific methods | b. Scientific methods

Identification of bodies - by relatives, friends - by documents, clothing, scar tattoo - jewelries - by exclusion

non-scientific methods

Identification of bodies - fingerprints - dental identification - DNA testing - ante and postmortem x-rays

scientific methods

``` filing / prosecution of case filing of death certificate Insurance claim Repatriation Peace of mind among relatives ```

Importance of ID

Soft viscera putrefied

1 week

Only more resistant viscera distinguishable | Soft tissues largely gone

2 weeks

Bone skeletonized

one week

Very little change is water is cold. Rigor mortis may persist The skin on the hands and feet became sodden and bleached. The face appears softened and has a faded white color

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER 4-5 days

Face swollen and red. Greenish discoloration on the eyelids, lips, neck and sternum. Skin of the hands and feet wrinkled. Upper surface of brain greenish in color

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER 5-7 days

Skin wrinkled. Scrotum and penis distended with gas. Nails and hair still intact. Lungs, emphysematous and covered the heart.

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER 1-2 weeks

Abdomen distended, skin of hands and feet come off with nails like glove

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER 4 weeks; 6-8 weeks

``` Importance of ID filing / prosecution of case filing of death certificate Insurance claim Repatriation Peace of mind among relatives ```

ID of Remains

Humans have 20 deciduous (baby) teeth 4 maxillary incisors , 4 mandibular incisors 2 maxillary cuspids, 2 mandibular cuspids 4 maxillary molars, 4 mandibular molars EXAMPLE: (dental eruption) Mandibular incisor: usually at 6-7 months 3rd molar: 17-24 years old Humans usually develop 32 permanent teeth -4 maxillary, 4 mandibular incisors -2 maxillary cuspids, 2 mandibular cuspids -4 maxillary premolar, 4 mandibular premolar - 6 maxillary molars, 6 mandibular molars

Dental

Comparison of physical attributes Distinctive marks- tattoo, scar, jewelry Visual ID Circumstancial evidence- dentures, wallet, clothes, eyeglass

NON-SCIENTIFIC METHODS OF ID

``` Scientific Fingerprint : remove the skin Dental x-ray Total body radiographs- bullet DNA: muscle, marrow, molar-dental pulp Non-Scientific 1. Hydrogen peroxide (Agua oxinada) - to clean the skin to see tattoo 2. Carefully observing the jewelries 3. UV or infrared light may show tattoo ```

Decomposed, Charred, Non-skeletonized Human Remains

- 1st determine if it is human! - Then get DNA- bone with marrow - Collect the clothing, jewelry, personal effects - Forensic anthropologist – may determine the sex, race, age, height.

Skeletal Remains

Causes of sudden natural death in adults “ sudden, unexpected death due to natural disease is relatively uncommon between ages of 1 and 30.” Sudden death: died within __ HRS

NATURAL DISEASE | 24

Instant - W/in seconds Non-instant - W/in minutes

Sudden Deaths

A. Coronary Artery Disease - 75% of all sudden deaths - mechanism of death: fatal cardiac arrhythmia. 80% from ventricular Arryh. 20% from asystole - most common autopsy findings: coronary artery atherosclerosis. - for death to occur 75% of coronaries must be blocked CAD - 2nd most frequent findings: ischemic fibrosis Infarcts <24Hrs, “wavy fibers.” Arrhythmia, no gross findings. Cause of Death: Arteriosclerotic Cardiovascular Disease (ASCVD) B. Hypertensive Cardiovascular Disease - heart >350 gm - associated with renal findings and coronary atherosclerosis. C. Cardiomyopathies - congestive (CHF) dilated cardiomyopathy -asso. with chronic alcohol abuse -peri / post partum cardiomyopathy -Hypertrophic Cardiomyopathy: enlarged but not dilated. Thickened septum -50% is autosomal dominant -history of dropping dead during exercise -Restrictive Cardiomyopathy-least common -amyloidosis -sarcoidosis -glycogen storage disease -hemochromatosis

I. Causes of sudden natural death in adults

Coronary artery spasm-prinzmetal angina Coronary artery dissection Congenital anomaly

D. Other coronary artery abnormalities w/c may cause sudden death

Floppy mitral valve- myxoid degeneration Calcific aortic stenosis-RHF endocarditis

E. Valvular disease that may cause sudden death

Infectious- multiple sections of the heart for histopath Hypersensitivity Giant cell myocarditis

F. Myocarditis

Acute aortic dissection- asso. with atherosclerosis and hypertension Syphilytic aortic aneurysm

G. Abnormalities of aorta

Causes of sudden natural death in adults

A. Coronary Artery Disease B. Hypertensive Cardiovascular Disease C. Cardiomyopathies D. Other coronary artery abnormalities w/c may cause sudden death E. Valvular disease that may cause sudden death F. Myocarditis G. Abnormalities of aorta

II. Central Nervous System Disorder

``` A. Epilepsy B. Subarachnoid Hemorrhage C. Intracerebral Hemorrhage (stroke) D. Cerebral Infarct (stroke) E. Meningitis F. Hydrocephalus G. Psychiatric D/O: schizophrenia ```

III. Respiratory

a. Pulmonary thromboembolism b. Amniotic fluid embolism c. Asthma d. Pneumonia e. Acute epiglottitis: edema of epiglottis f. Massive hemoptysis g. Spontaneous pnemothorax

IV. Gastrointestinal – sudden death

a. Massive hematemesis b. massive stomach bleeding c. Strangulated hernia d. Diabetes mellitus e. Pancreatitis

V. Liver Diseases-sudden death

a. Liver: Massive fatty change | b. non-traumatic abdominal hemorrhage

VII. Spleen

Rupture | Absence of spleen

VIII. Miscellaneous sudden causes of death

Rupture tubal pregnancy | Undiagnosed cancer

Sudden Death in Children

Sudden infant death syndrome (SIDS)

Sudden Infant Death Syndrome

Maternal risk factors: | Scene investigation:

A break or solution in the continuity of the skin or tissues of the body.

Wound

Types: | Wound

Close wound | Open wound

injury produced by blunt object striking the body or impact of the body against a blunt surface.

Blunt Force Injury

Blunt Force Injury | Severity due to several factors

``` Nature of weapon Amount of body surface Amount of force Time Region ```

wound where there is no break in the overlying skin or tissue.

Close Wound

Close Wound | typs

a. Superficial close wound | b. Deep close wound

a. Superficial close wound

1. Petechiae 2. Contusion 3. Hematoma

b. Deep close wound

1. Sprain 2. Fracture 3. Dislocation 4. Concussion 5. Internal Hemorrhage

minute, pin-point, circumscribed extravasation of blood in the subcutaneous tissues or underneath the mucuos membrane.

1. Petechiae –

– discolorations of the skin caused by bleeding into the tissues from ruptured blood vessels.

``` 2. Contusion (Bruise) Color is not always reliable Red, violaceous, purple, dark blue Hemoglobin: broken down to color green, dark yellow, pale yellow Resolve from days to weeks ```

large extravasation of blood in a newly formed cavity secondary to trauma characterized by swelling, discoloration of tissues, and extravasation of blood underneath the tissues.

3. Hematoma

straining or tearing of the articular tendons, ligaments and muscles characterized by swelling, discoloration of tissues involved and extreme pain.

1. Sprain

it is a break solution in the continuity of the bone tissue resulting from violence or from some existing pathology.

2. Fracture –

displacement of the articular surfaces of the bones forming the joints usually secondary to trauma.

3. Dislocation

resulting from a sudden jarring or stunning of the brain which follows a head injury.

4. Concussion

bleeding usually in the cavity or organs inside the body.

5. Internal Hemorrhage

– wound where there is break in the overlying skin or tissue.

Open Wound

open wounds

1. Abrasion 2. Incised wound 3. Lacerated wound 4. Punctured wound 5. Stab wound 6. wound produced by explosion of explosive material 7. Avulsion 8. Gushot & Shotgun wound

An injury to skin in which there is removal of the epidermis by friction against a rough surface or destruction of the superficial layers by compression.

1. Abrasion

reddish brown appearance | Heal without scarring

Antemortem abrasion

Yellow, translucent, parchment like appearance

Postmortem abrasion –

Types of abrasions

1. scrape abrasions 2. Brush burn abrasion 3. Impact (pressure) abrasions 4. Patterned abrasion

scraping type of injury. Ex. Dragging abrasion, scratches

1. scrape abrasions-

commonly use in large area of the body

2. Brush burn abrasion-

skin crushed by force.

3. Impact (pressure) abrasions

pattern of object imprinted on the skin.

4. Patterned abrasion

Stages of Healing

1st stage: Scab Formation. within 24 Hrs 2nd stage: Epithelial Regeneration. visible in 3rd day post injury 3rd stage: Sub epidermal Granulation. 5-8 days 4th stage: Regression. Dec. vascularity 12 days post injury

produced by forcible contact with a sharp-edged instrument characterized by gaping smooth edges of the wound; sharp extremities; shelving and profuse bleeding of the wound.

2. Incised wound

produced by blunt instrument and is characterized by irregular edges of the wound.

3. Lacerated wound

produced by sharp-pointed instrument and is characterized by small opening of the wound.

4. Punctured wound

produced by sharp-edged and sharp-pointed instrument.

5. Stab wound

A form of laceration ripping the skin and soft tissue off the underlying fascia or bone.

6. Avulsion

May have severe internal injuries sans external evidence. Rib / sternal fractures: maybe due to CPR Cardiac rupture due to steering wheel

Blunt Force Injury to the Chest

Liver most frequently injured Spleen: minimal force may cause rupture in typhoid, malaria, IM, hemophilia, leukemia Kidney: most common is contusion

Blunt Force to the Abdomen

“Bumper fracture” -must measure the location from the heel Complication of fractures: -fat embolization: seen in histopath sections of the lungs Defense and Offensive wounds

Extremities Injury due to Blunt Force Trauma

Epidural Hematoma Subdural Hematoma Subarachnoid H’ge Intracerebral H’ge

Head Injuries Caused by Blunt Force

Scalp : will show the extent of injury

Blunt force injury to the head

``` Alteration in the normal alignment of the cervical vertebral column Hyperflexion (chin to chest) Hyperextension (head backwards) Compressive (head landing) Torsion Elongation (Hanging) Axis or C2, most commonly injured ```

Blunt Force to the Neck

Sharp Wounds

Stab wounds Incised wounds Chop wounds

Produced by pointed instrument like knife or ice pick Skin markings may tell the type of weapon used Homicidal, suicidal or accidental Defensive stab wounds

Stab wounds

It is common for stab wounds to be altered by surgeons. MELO must determine if px was brought to hospital Don’t remove the knife from the body unless fingerprint was taken. Examine the clothes Post-mortem SW- yellow to tan in color

Stab wounds

Wound produced by sharp weapon. Wound is longer than the depth. Lacking bridging tissue Usually not fatal Defensive incised wound

Incised wounds

Caused by heavy instrument or weapon Ex. Axes, machete, meat cleaver Incised wound with bone cut/groove Soft tissue h’ge means px is still alive when injury was inflicted

Chop wounds

Whenever a gun is fired, the exiting bullet is accompanied by: A jet of flame, 1-2 inches in length (3 inches Pistol, 6 inches Rifle)- Solis A cloud of gas Unburnt gunpowder Carbon or soot from burnt gunpowder Vaporized metal from the bullet

Gun Shot Wounds

1. Usually smaller than the missile owing to the elasticity of tissue. 2. Edges are inverted. 3. Usually oval or round depending upon the angle of approach of the bullet. 4. Contusion collar or contact ring/ abrasion ring is present due to invagination of the skin and spinning of the missile. 5. Tattooing or smudging may be present when firing is near 6. Always present after fire. 7. GSR/ Paraffin test may be positive. 8. Bright to redness due to COHg is present. 9. Bursting effect is present

Entrance Wound | Gunshot Wound

1. Usually bigger than the missile. 2. Edges are everted. 3. It does not manifest any definite shape. 4. Contusion collar is usually absent. 5. Absent. 6. Maybe absent if missile is lodge in the body. 7. GSR/ Paraffin test is always absent. 8. Absent 9. Absent

Exit Wound | Gunshot Wound

Categories of Gunshot Wounds

Contact Near contact Intermediate Distant

A. _________1 The muzzle of the gun is pressed against the skin All the materials exiting the muzzle goes beneath the skin _______2 - detailed imprint of the heated muzzle to the skin _______3 – tears that radiate from the edge of the wound caused by the blast effect that follows the sudden release of gases between the skin and underlying bone (skull)

Contact Wounds 1. Hard-contact would 2. Ironing effect 3. Stellate wound

B. ___________1 Ironing effect Soot and small amount of gunpowder is deposited on the wound edges If the gap between the skin and muzzle is angled, products escape in one direction – _____2 pattern

1. Loose Contact | 2. teardrop

2-3 inches to 6-7inches Scorching of the skin, but no ironing effect large amount of soot/ smudge is deposited Little amount of gunpowder may be scattered on the surface

Near Contact

6-7 inches to 12- 18 inches (Spitz) The principal indicator of close range fire is stippling or powder tattooing. Tattooing or Stippling is caused by unburned particles of gunpowder striking the skin resulting in punctuate abrasions in the skin surrounding the entrance wound May be distributed circumferentially or more densely scattered on one side. Powder tattooing cannot be wiped away

Intermediate Range/ Close-Range

>12-18 inches (Spitz) > 2 feet (24 inches), >36 inches (long firearm) Round to oval with sharp punched out margin Absence of ironing, smudging or tattooing Abrasion ring – scraping the raw edges of the skin Irregular abrasion ring – impact at an angle

Distant Gunshot

One cannot determine the caliber of bullet by examining the GSW. However 9mm, usually produces 9mm holes Suicide: most use hand gun, most are contact, most are on the head, single shot. Temple, mouth, under the chin, between the eyes 25% w/ suicide note; gun still on hand

GSW

``` _____: inadequate oxygenation of tissue Asphyxial Deaths: Suffocation Strangulation Chemical asphyxia ```

Asphyxia

``` Failure of oxygen to reach the blood A. environmental suffocation: “no air” -negative autopsy B. smothering: obstruction of nose and mouth accidental, homicidal, suicidal -may show bruising on the mouth ```

Suffocation

``` Blockage of internal airways Most are accidental Aspiration of food among stroke victims 25% agonal aspiration Children: toys ```

Choking

Pressure on the chest and abdomen Accidental Ex. Parent rolled over the baby during sleep Autopsy: congested face, neck, scleral h’ge

Mechanical asphyxia

Occlusion of blood vessels in the neck 2nd to external pressure TYPES -hanging -ligature -manual Mechanism of Death: pressure on the neck artery >>> no oxygen to the brain Blood to the brain, 2/3 supplied by carotid artery 11 lbs necessary to occlude the carotid 15 sec of occlusion>>> loss of consciousness

STRANGULATION

``` Weight of the head is 10-12 lbs Complete suspension is not necessary All hanging are suicide Inverted “V” at the side of the neck Above the larynx Furrow is yellow then brown on drying 1/4 of cases with conjunctival h’ge 10% with fractured hyoid Marking on the neck may suggest the type of cord used Linen, no marking ```

Hanging

``` Most are homicide Victim: Woman in relation to rape Ligature mark is horizontal Below the larynx Face congested with scleral, conjunctival h’ge ```

Ligature Strangulation

Always homicide Death is not due to vaso-vagal stimulation Death is due to occlusion of blood vessels Victims: Woman Marks on the neck H’ge on the soft tissue of the neck Hyoid fracture is valid when surrounded by h’ge

Manual Strangulation

Carbon monoxide Hydrogen cyanide Hydrogen sulfide

Chemical Asphyxiant

- killing of newborn - born alive or dead? - hydrostatic test

Neo-naticide

No external head trauma Positive h’ge in the brain Due to violent shaking of the head

Shaken Baby Syndrome