Postmortem Examination

Somatic death

Irreversible loss of sentient personality

Unable to be aware of its environment

No sensory stimuli and voluntary movement

Cellular death

Tissue and their constituent cells are dead, following ischemia and anoxia upon cardiorespiratory failure

No metabolic activity

Process, not an event; different tissues die at different rates

Cortical death

Higher cerebral activities are lost

Brainstem is preserved; cardiopulmonary functions are maintained

Patient is in vegetative state, deep coma for indefinite time

Brainstem death

Loss of vital centers that control respiration, and RAAS system

Loss of spontaneous breathing and consciousness

Dead in a somatic sense, but not yet dead in a cellular snese

Signs of death

Unconsciousness

Loss of ALL reflexes (Pain stimuli, corneal reflex, gag reflex, light reflex)

Muscle flaccidity

Cessation of circulatory and respiratory functions

Immediate postmortem changes

Loss of voluntary power

Cessation of respiration and circulation

Early postmortem changes

Pallor and loss of skin elasticity

Tache noire

Primary flaccidity

Rigor mortis

Hypostasis

Algor mortis

Late postmortem changes

Putrefaction

Adipocere

Mummification

Tests to check respiratory function

Mirror test

Feather test

Winslow glass water test

Tests to check circulatory function

Magnus test

Fingernail test

Diaphanous test

Icard’s Fluorescein test

Heat test

Artery Incision

Flat ECG

5 mins

Length of flat ECG to be considered dead

Pallor and loss of skin elasticity

Skin becomes pale due to lack of circulation

Develops 15 mins after death

Tache noire

French for “black line/spot”

If the eyes remain open after death, the areas of the sclera exposed to the air dry out, which results in a first yellowish, then brownish-blackish band like discoloration zone

7 to 8 hours after death.

Primary flaccidity

All the muscles begin to relax

Extends 3-6 hours after death before stiffening occurs

Muscle response to electrical and mechanical stimuli still persists

Rigor mortis

Stiffening of muscles

Stiffness first apparent small joints (jaw, facial muscle, neck, wrist, ankles)

Happens simultaneously through all the muscles.

START: 6 to 12 hrs. and PERSIST: 18 to 36hrs

Affected by age, nature of death, muscular state, and atmospheric condition

Hypostasis (Livor mortis)

Bluish purple or purplish red discoloration of the skin of the dependent parts of the body

Cessation of the circulation and the relaxation of the muscular tone of the vascular bed

May be absent in young, old, anemic, severe blood loss

May be masked by dark skin color, jaundice and dermatological conditions.

Tardieu spots

Are petechiae and purpuric hemorrhages that develop in dependent areas secondary to the rupture or degenerating vessels

Algor mortis

Cooling of the body

Approaches the surrounding temp by 15-20 hours

Putrefaction

Caused by bacteria largely originating from intestines and lungs

3 days after death

Visually observed first at the abdomen

12-18 months → skeleton and tendons

3 yrs → skeleton

Adipocere

Waxy substance derived from body fat caused by hydrolysis and hydrogenation of adipose tissues

Seen in wet/moist environment

May preserve body for decades or centuries

Clostridium perfringens

Assists in the process for adipocere

Mummification

Drying of tissues instead of liquifying putrefaction

Seen in dry and hot environment

More likely to happen in thin individuals whose bodies will cool quickly

Autopsy

Aims to determine cause of death, manner of death, time since death, establish identity, and know the viability of infants and fetal death

Cause

The disease or injury responsible for the sequence of events

Specific

e.g., gunshot, blunt force trauma, heart attack, strangulation, drowning

Manner

Explains how the cause of death arose

e.g., Natural, accidental, suicidal, homicidal

Injury

Disruption of the anatomical continuity of any tissues of the body

May either be mechanical or defensive

Blunt force injuries

Abrasions, contusions, lacerations

Sharp force injuries

Incised wounds, stab wounds, chop wounds

Mechanical injuries

Caused by physical violence to the body

Blunt force injury, sharp force injury, fractures, firearm injuries

Defensive wound

Results from immediate and instinctive reaction of the victim to save himself, either by raising the arm to prevent the attack or by grasping the weapon

Asphyxia

It is a condition that if oxygen supply to the blood and tissues is reduced because of interference with respiration

Also called Anoxia / Hypoxia

Hanging

Caused by the suspension of the body by ligature which encircles the neck, the constricting force being the weight of the body

Ligature furrow elevates to the back and sides of the neck, behind the ears

Strangulation

Caused by the constriction of neck by ligature or by any means without suspending the body

Ligature furrow lower horizontal, completely encircles the neck; back of the neck has trauma

Suffocation

Mechanical obstruction to air passage due to causes other than constriction of the neck

Drowning

Due to aspiration of fluid into the air passage by submersion of the body in water or fluid medium

Complete hanging

Feet do not touch the ground

Weight of the body acts as a constricting force

Partial hanging

Weight of the head (not the whole body) as a constricting force

Typical hanging

Ligature is situated in the midline above the thyroid cartilage and runs symmetrical upwards on both sides of the neck to the occipital region

Atypical hanging

Any variation of the standard hanging position

Manual strangulation

Caused by the constriction of neck by ligature

Throttling

Compression of the neck by hands

Bruises produced by tips of fingers

Bansdola

Practiced in North India

Bamboo or sticks are used to strangle victim

Garroting

Strangulation, typically with an iron collar or length of wire or cord

Mugging

Strangulation by holding the neck in the bend of the elbow/knee

Accidental strangiulation

Children may get entangled during play

Infants are strangled in their cots, when the neck is caught in sidebars.

Smothering

Closure of external respiratory passage either by hand or other means or introduction of foreign materials like cloth or paper etc.

Gagging

It results from closure of mouth by a cloth or similar material causing obstruction to the larynx or force the base of the tongue

Overlaying

Compression of chest to prevent breathing

Mother infants

Forceful pressure over the chest

Burking

Method of homicidal smothering

Practiced by Burk and Hare

Choking

Caused by obstruction within air passage

Usually accidental

Typical drowning / Wet drowning

Obstruction of air passages and lungs by inhalation of fluid

Fresh water drowning → hypotonic → hypervolemia

Saltwater drowning → hypertonic → hypovolemia

Atypical drowning

Conditions in which there is very little or no inhalation of water or fluid in the air passages

- Dry drowning

- Immersion syndrome (vagal inhibition)

- Submersion of the unconscious

- Secondary drowning syndrome/near-drowning

Dry drowning

Intense laryngeal spasm due to entry of water into nasopharynx and larynx

Very little water enters into lungs

Best case for resucitation

Immersion syndrome (vagal inhibition)

Due to sudden impact with very cold water and causes death from cardiac arrest

Victims are young people with excess of alcohol

Also result from falling or diving with feet or duck diving by the inexperienced swimmers

Submersion of the unconscious

Commonly seen if the victim is suffering from disease like epilepsy, heart diseases and is drunk or head injury during fall

Secondary drowning syndrome / near-drowning

It is mainly due to infection from inhalation of contaminated water

Findings in drowned patients

Fine froth at the nose and mouth

Cutis anserina (Goose skin)

Hands and feet of a washer-woman

Emphysema aquosum

General identity

Race

Age

Sex

Stature

Specific identity

Facial features

Scars, tattoos, deformities

Finger / foot / lip prints

Forensic odontology

Forensic radiology

Blood grouping, DNA analysis

Maceration

Determines non-viability of the baby prior to expulsion from the womb

Lung flotation test

Unreliable

(+) floating - infant was alive prior to birth

(-) floating - infant was dead prior to birth

Presumptive evidence to sex

Face, dress hair, voice, inclination to opposite sex

Probable evidence to sex

Primary and secondary sex characteristics

Positive evidence to sex

Nuclear sexing: Barr bodies, Davidson’s bodies, Y-chromosomes

Bones

Antropometry-Bertillonage

Determines stature of the patient

Dactylography / dermatoglyphics

The process of taking impressions of the pulp of fingers and thumbs and examining them

Poroscopy

Study of pores of sweat glands and papillary ridges of epidermis

Cheiloscopy

Study of lip prints

Rugoscopy

Study of palatal rugae

Virchow

Individual organ removal

Rokitansky

Organ dissection in-situ

Letulle

En-masse dissection & organ separation

Ghon

Separate block dissection & organ separation

Civil Registry Law (Act No 3753)

All facts and acts concerning the civil status of persons from birth to death, including the changes in civil status taking place therein in appropriate civil registry books

The Philippine Statistical Act (RA 10625)

To carry out, enforce, and administer civil registration functions in the country

Code on Sanitation of the Philippines (PD 856)

No remains shall be buried without Certificate of Death

The death certificate shall be forwarded to the local civil registrar within 48 hours after death

Local Government Code (RA 7160)

Civil registration is a function of the local government through the city/municipal registrar but is under the technical supervision of the Civil Registrar General (CRG)

As a general rule, the place of registration is the city or municipality where the event occurs

Fetal death

Death of a product of conception prior to the expulsion or extraction from its mother, irrespective to the duration of pregnancy

Requires Certificate of Fetal Death

Not deemed born

Less than 7 months of gestation

Dies within 24 hours after its complete delivery from the maternal womb