Forensic Pathology Monograph - Puttoff Flashcards
proximal cause of death
actual true cause of death
* found from the “due to” question
EX: Atherosclerotic Cardiovascular Disease
mechanism of death
also called immediate COD
= final pathologic event
EX: cardiopulmonary arrest (heart and lung stopped), MI, CHF, Vfib
what determines the proximal COD
the history of pt, circumstance around death, autopsy = manner or death
manner of death acronym
NASHU N : natural (due to disease or disorder) A : accident S : suicide H: Homicide U : undetermined (SIDS)
Homicide vs suicide
Homicide is murder
reason death certificate is important
so see most prevalent diseases causing death in US for guiding research
who can certify a death certificate in natural
physician
who can certify a death certificate if not natural
legally appointed medical examiner physicians, coroners, justice of peace
= needs jurisdictions of ME
Rigor Mortis
muscles stiffen after death (hrs) however time depends on temp
Algor mortis
body cooling after death, need steady ambient temp to calculate
Livor Mortis
blood circulating to dependent areas after death, becomes fixed after a time, (useful when looking at death scene)
3 types of body decomposition
Putrefactive
Mummification
Adipocere formation
Putrefactive
most temps, discoloration, tissue softening, liquefaction, gas production, body bloating
Mummification
very dry and arid climate
Adipocere formation
death and immersion of body into water, saponification of epidermal surface
how to get true time of death
at beginning of crime scene forensic experts don’t have any definitive conclusion (as seen on TV)
TOD is usually an approximation
forensic autopsy
find proximal COD, by medicolegal investigation by justice inservice of the public,
= usually death by foul play or trauma
(highly consider outside appearnece of dead person and things around them)
hospital autopsy
usually deal with natural cause death evaluation,
= look for disease of extent of natural death that was undiagnosed before
how many pt that die in hospital are autopsied
it continuous to decline
misconception of forensic specialists
they are physicians and pathologists, not detectives or police officers
ME
medical examiners
training for ME
- 4yrs (medical school)
- 4yr (AP/CP pathology)
- 1yr (Forensic Pathology Fellowship)
common problem in US jurisdiction
staffed by unqualified due to no ME system
should be an ME signing the death certificate
forensic specialists can be
a wide range or credentials and degrees depending on forensic subspecialty and size of ME offices
ME cant be part of what case
when it involves a family member or next-to-kin person
forensic features of mechanical force
- Abrasion = damage to skin (epidermis)
- Laceration = splitting of skin with hemorrhagic
- Contusions = intact skin, hemorrhage of dermis and below
- Incise wounds
- Gunshot wounds
Lacerations are caused by
blunt force, usually leasions are more wide then deep + hemorrhagic bridges
Contusions are caused by
blunt force (bruise) *if yellow it has been over 18hrs
bruises that are not contusions
Battle’s Sign (Raccoon eyes) due to skull fractures and periorbital injury
Abrasion causes by
scrapes, disrupted epidermis,
due to blunt force
what are incise wounds
due to eged instrument (like in ER) , razor, knife
= more deep then wide +NO bridging in depths
what can cause more then normal bleeding for a patient
- chronic renal failure (from DM or HTN)
- liver failure (usually from alcohol)
- coagulative disorder, autoimmune, hematologic neoplastic disorders
which organs are more susceptible to bleeding
- intracranial and intracerebral from blunt force trauma (esp in elderly)
use of drugs and finding cause of death
makes the whole process more complicated
mass and velocity of handguns
revolvers and semiautoomatics
= low V, small caliber bullets
= have hollow point, muchroom over base, round thing making it not go through tissue, however causes more damage
modern handguns have
rifling (grooves that make for more accurate shooting)
marginal abrasions
machine pistols
civilian use is semiautomatic, fire handgun ammunition
Long guns (rifles) mass and velocity of
HIGH V, fully jacked bullets, marginal abrasions,
EXIT is larger then the entry
also have rifling grooves
shotguns
shells with pellets or varying size, gunpowder, plastic or felt
= sprays the pellets (controlled by chock structure for dispersal)
short shotgun barrel means
no chock so pellets disperse all over
what is the classification of a Handgun
Revolver (rotating cylinder bullets)
Semiautomatic (must be inserted) = Magazine type
what is the classification of Long Gun
Rifles:
- Bolt action
- Magazine type
smoothbore weapons
shotguns with slugs (large projectiles)
Range
distance from end of barrel to external skin
close or contact range
- marginal abrasion
- gunpowder in wound
- muzzle or slight burn on skin if contact
Intermediate range
- gunpowder around the entry (embedded in skin) = powder tattooing, stippling
- distance determined by accuracy
Distant range
- Marginal Abrasion
2. no gunpowder in skin, wound, or surrounding area
entry and exit of gunshot to head
head has outer and inner table separated by spongy, cancellous bone = dipole
ENTRY WOUND : outer table sharply circumscribed, inner beveled
EXIT WOUND: Outer table beveled, inner table sharply circumscribed
as a bullet hits the tissue or skull
V slows and energy is transferred
