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CIC Module 3 > Forensic Medicine > Flashcards

Forensic Medicine Flashcards

1
Q
  1. ______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),”
A
  1. fo·ren·sic

2. forensis

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2
Q

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.

A

Forensic medicine

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3
Q

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

A

China

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4
Q

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

A

Iraq

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5
Q

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

A

India

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6
Q

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

A

Roman Egypt

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7
Q

FUNCTIONS OF MEDICO-LEGAL DIVISION

A 
AUTOPSY
•PHYSICAL EXAMINATION
•ANTHROPOLOGY
•ODONTOLOGY
•HISTOPATHOLOGY
•SEROLOGY
•DNA
•SOCO
•COURT DUTY
•RESEARCH, LECTURES
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8
Q
  • 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
A

Medico-Legal Officer

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9
Q

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

A

Odontological Examination

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10
Q

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

A

Histopathological Examination

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11
Q
  • To determine presence of human blood,type and characteristics
  • To determine the presence of semen (4 working days)
A

Serological Examination

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12
Q
  • 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;
A

Medico-Legal Officer

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13
Q

MEDICO-LEGAL DEATHS

A 
•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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14
Q

Five categories of medico-legal cases

memorize

A
  1. Violent deaths
  2. Suspicious deaths
  3. Sudden and unexpected
  4. Unattended death
  5. Death in custody
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15
Q

Objectives of medico-legal examination of a body are:

A
  1. To determine the cause of death
  2. To determine the manner of death
  3. Estimate the time of death
  4. To document all findings
  5. To determine or to exclude other factors
  6. To collect trace evidence in criminal cases
  7. To positively identify a body
  8. To testify in court
  9. Interpret findings
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16
Q

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

A

Autopsies

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17
Q

Kinds of autopsies

ok

A
  • Hospital or non-official autopsy

* Medico-legal or official autopsy

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18
Q

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

A

A. HOSPITAL/ NON-OFFICIAL AUTOPSY

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19
Q

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

A

HOSPITAL/ NON-OFFICIAL AUTOPSY

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20
Q

–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

A

MEDICO-LEGAL or OFFICIAL AUTOPSY

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21
Q

–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

A

MEDICO-LEGAL or OFFICIAL AUTOPSY

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22
Q 
Starts in the morgue
Focuses on the internal findings
Determines cause of death
Determines prognosis
ok
A

Hospital Autopsy

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23
Q
  1. Starts in the crime scene
  2. Focuses on the external and internal findings
  3. Determines cause / manner/ mechanism of death
  4. Clothes included in the autopsy
  5. R.I.P. of evidence
  6. Determines identity
    ok
A

Forensic/Medico-legal Autopsy

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24
Q

When shall an autopsy be performed on a dead body

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

ok

A
  • 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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25
Q

Persons who are authorized to perform autopsies and dissections
repeat

A

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

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26
Q

Disease or injury that results in the individual dying.
ok

Cause, Manner, Mechanism

A

Cause of Death:

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27
Q

How the cause of death came about.

repeat

A

Manner of Death

a. Suicide
b. Homicide
c. Accident
d. Natural
e. Undetermined

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28
Q

physiological derangement.

ok

A
  1. Mechanism of Death:
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29
Q
  1. Circumstances
    - witnesses
    - investigators
    - history
    - the scene
    - medical records
  2. Examination of Body
    • search!
  3. Laboratory test
    • ballistics
    • toxicology
    • paraffin
A

3 steps in medico-legal investigation

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30
Q
  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

A

Handling of bodies

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31
Q

– 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

A

Autopsy Report

I. External Examination

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32
Q
  • external and internal injuries
    • GSW: assign number, location, characteristics, trajectory
    • pertinent negatives
    • entrance and exit
    • describe the slug, location
    • all bullets should be recovered
A

Autopsy Report

II. Evidence of Injuries

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33
Q

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

A 
Autopsy Report
III. Internal Examination
...
IV. Microscopic Examination
V. Toxicology
VI. Findings
VII. Opinion
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34
Q

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

A

physical Evidence

a. Biological evidence

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35
Q

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

A

physical Evidence

B. Non-biological evidence

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36
Q

Manner of death that must be autopsied

A

1, Death by violence

  1. accidental death
  2. Sudden death of person who are apparently in good health
  3. suicide
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37
Q

Cause, Manner, Mechanism

Gunshot wound?
Stab wound?
blunt force?
ok

A

Cause of death

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38
Q

Cause, Manner, Mechanism

Massive hemorrhage?
peritonitis
septicemia
hemorrhage

A

mechanism of death

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39
Q

Physical Evidence

A

a. Biological evidence

B. Non-biological evidence

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40
Q

I. Factors used in estimating time of death

ok

A
  • livor mortis
  • rigor mortis
  • algor mortis
  • vitreous (eye) potassium
  • stomach contents
  • environmental factors
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41
Q

(post mortem lividity)

A

livor mortis

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42
Q

(muscle stiffening)

A

rigor mortis

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43
Q

(body temp)

A

algor mortis

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44
Q

(eye)

A

vitreous potassium

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45
Q

Philippine Criteria of Brain Death

ok

A

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

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46
Q 
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
A

LIVOR MORTIS

30 mins

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47
Q

LIVOR MORTIS

Up to 6 hpm
Complete shifting

6-12 hpm
Incomplete shifting

Over 12 hpm
No shifting

A

pale coloration

lividity

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48
Q

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

A

RIGOR MORTIS

2 hours

6-12 hours

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49
Q

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

A

24 hours rigor

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50
Q 
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

A

35.6°C - 38.2°C
Infants
Obese

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51
Q

warm and not stiff

A

less than < 3 HRS.

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52
Q

warm and stiff

A

BET. 3-8 HRS.

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53
Q

cold and stiff

A

BET. 8-36 HRS.

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54
Q

cold and not stiff

A

> 36 HRS.

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55
Q

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

A

Vitreous Potassium

potassium

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56
Q

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

A

4 hours

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57
Q 
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 \_\_\_\_\_
A

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

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58
Q

Insect activity- from egg stage to adult stage.

A

ENVIRONMENTAL FACTORS

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59
Q

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

A

DECOMPOSITION

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60
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS

12 hours

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61
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS

24 hours

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62
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS

48 hours

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63
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL REGIONS

72 hours

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64
Q

Identification of bodies

A

a. non-scientific methods

b. Scientific methods

65
Q

Identification of bodies

  • by relatives, friends
  • by documents, clothing, scar tattoo
  • jewelries
  • by exclusion
A

non-scientific methods

66
Q

Identification of bodies

  • fingerprints
  • dental identification
  • DNA testing
  • ante and postmortem x-rays
A

scientific methods

67
Q 
filing / prosecution of case
 filing of death certificate
Insurance claim
Repatriation
Peace of mind 
among relatives
A

Importance of ID

68
Q

Soft viscera putrefied

A

1 week

69
Q

Only more resistant viscera distinguishable

Soft tissues largely gone

A

2 weeks

70
Q

Bone skeletonized

A

one week

71
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER

4-5 days

72
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER

5-7 days

73
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER

1-2 weeks

74
Q

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

A

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY HAS BEEN SUBMERGED IN WATER

4 weeks; 6-8 weeks

75
Q 
Importance of ID
 filing / prosecution of case
 filing of death certificate
Insurance claim
Repatriation
Peace of mind 
among relatives
A

ID of Remains

76
Q

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

A

Dental

77
Q

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

A

NON-SCIENTIFIC METHODS OF ID

78
Q 
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
A

Decomposed, Charred, Non-skeletonized Human Remains

79
Q
  • 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.
A

Skeletal Remains

80
Q

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

A

NATURAL DISEASE

24

81
Q

Instant

  • W/in seconds Non-instant
    - W/in minutes
A

Sudden Deaths

82
Q

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

A

I. Causes of sudden natural death in adults

83
Q

Coronary artery spasm-prinzmetal angina
Coronary artery dissection
Congenital anomaly

A

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

84
Q

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

A

E. Valvular disease that may cause sudden death

85
Q

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

A

F. Myocarditis

86
Q

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

A

G. Abnormalities of aorta

87
Q

Causes of sudden natural death in adults

A

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

88
Q

II. Central Nervous System Disorder

A 
A. Epilepsy
B. Subarachnoid Hemorrhage
C. Intracerebral Hemorrhage (stroke)
D. Cerebral Infarct (stroke)
E. Meningitis
F. Hydrocephalus
G. Psychiatric D/O: schizophrenia
89
Q

III. Respiratory

A

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

90
Q

IV. Gastrointestinal – sudden death

A

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

91
Q

V. Liver Diseases-sudden death

A

a. Liver: Massive fatty change

b. non-traumatic abdominal hemorrhage

92
Q

VII. Spleen

A

Rupture

Absence of spleen

93
Q

VIII. Miscellaneous sudden causes of death

A

Rupture tubal pregnancy

Undiagnosed cancer

94
Q

Sudden Death in Children

A

Sudden infant death syndrome (SIDS)

95
Q

Sudden Infant Death Syndrome

A

Maternal risk factors:

Scene investigation:

96
Q

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

A

Wound

97
Q

Types:

Wound

A

Close wound

Open wound

98
Q

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

A

Blunt Force Injury

99
Q

Blunt Force Injury

Severity due to several factors

A 
Nature of weapon
Amount of body surface
Amount of force
Time
Region
100
Q

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

A

Close Wound

101
Q

Close Wound

typs

A

a. Superficial close wound

b. Deep close wound

102
Q

a. Superficial close wound

A
  1. Petechiae
  2. Contusion
  3. Hematoma
103
Q

b. Deep close wound

A
  1. Sprain
  2. Fracture
  3. Dislocation
  4. Concussion
  5. Internal Hemorrhage
104
Q

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

A
  1. Petechiae –
105
Q

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

A 
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
106
Q

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.

A
  1. Hematoma
107
Q

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

A
  1. Sprain
108
Q

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

A
  1. Fracture –
109
Q

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

A
  1. Dislocation
110
Q

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

A
  1. Concussion
111
Q

bleeding usually in the cavity or organs inside the body.

A
  1. Internal Hemorrhage
112
Q

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

A

Open Wound

113
Q

open wounds

A
  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
114
Q

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.

A
  1. Abrasion
115
Q

reddish brown appearance

Heal without scarring

A

Antemortem abrasion

116
Q

Yellow, translucent, parchment like appearance

A

Postmortem abrasion –

117
Q

Types of abrasions

A
  1. scrape abrasions
  2. Brush burn abrasion
  3. Impact (pressure) abrasions
  4. Patterned abrasion
118
Q

scraping type of injury. Ex. Dragging abrasion, scratches

A
  1. scrape abrasions-
119
Q

commonly use in large area of the body

A
  1. Brush burn abrasion-
120
Q

skin crushed by force.

A
  1. Impact (pressure) abrasions
121
Q

pattern of object imprinted on the skin.

A
  1. Patterned abrasion
122
Q

Stages of Healing

A

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

123
Q

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.

A
  1. Incised wound
124
Q

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

A
  1. Lacerated wound
125
Q

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

A
  1. Punctured wound
126
Q

produced by sharp-edged and sharp-pointed instrument.

A
  1. Stab wound
127
Q

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

A
  1. Avulsion
128
Q

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

A

Blunt Force Injury to the Chest

129
Q

Liver most frequently injured

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

A

Blunt Force to the Abdomen

130
Q

“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

A

Extremities Injury due to Blunt Force Trauma

131
Q

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

A

Head Injuries Caused by Blunt Force

132
Q

Scalp : will show the extent of injury

A

Blunt force injury to the head

133
Q 
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
A

Blunt Force to the Neck

134
Q

Sharp Wounds

A

Stab wounds
Incised wounds
Chop wounds

135
Q

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

A

Stab wounds

136
Q

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

A

Stab wounds

137
Q

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

A

Incised wounds

138
Q

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

A

Chop wounds

139
Q

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

A

Gun Shot Wounds

140
Q
  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
A

Entrance Wound

Gunshot Wound

141
Q
  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
A

Exit Wound

Gunshot Wound

142
Q

Categories of Gunshot Wounds

A

Contact
Near contact
Intermediate
Distant

143
Q

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)

A

Contact Wounds

  1. Hard-contact would
  2. Ironing effect
  3. Stellate wound
144
Q

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

A
  1. Loose Contact

2. teardrop

145
Q

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

A

Near Contact

146
Q

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

A

Intermediate Range/ Close-Range

147
Q

> 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

A

Distant Gunshot

148
Q

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

A

GSW

149
Q 
\_\_\_\_\_:  inadequate oxygenation of tissue
Asphyxial Deaths: 
Suffocation
Strangulation
Chemical asphyxia
A

Asphyxia

150
Q 
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
A

Suffocation

151
Q 
Blockage of internal airways
Most are accidental
Aspiration of food among stroke victims
25% agonal aspiration
Children: toys
A

Choking

152
Q

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

A

Mechanical asphyxia

153
Q

Occlusion of blood vessels in the neck 2nd to external pressure
TYPES
-hanging
-ligature
-manual
Mechanism of Death: pressure on the neck artery &raquo_space;> 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

A

STRANGULATION

154
Q 
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
A

Hanging

155
Q 
Most are homicide
Victim: Woman in relation to rape
Ligature mark is horizontal
Below the larynx
Face congested with scleral, conjunctival h’ge
A

Ligature Strangulation

156
Q

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

A

Manual Strangulation

157
Q

Carbon monoxide
Hydrogen cyanide
Hydrogen sulfide

A

Chemical Asphyxiant

158
Q
  • killing of newborn
  • born alive or dead?
  • hydrostatic test
A

Neo-naticide

159
Q

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

A

Shaken Baby Syndrome

CIC Module 3 (13 decks)

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