Autopsy: Forensics II

1. Ages 1-4

2. 80% male

3. Inexperienced swimmer

4. Seizure disorder

5. Environmental (slippery ground, very cold water)

6. Ethanol

Discuss the risk factors which contribute to an increased incidence of drowning (6)

cutis anserina

spasm of erector pili muscles that can be a sign of immersion in drowning deaths

1. cutis anserina (spasm of erector pili muscles)

2. washerwoman hands

3. white or hemorrhagic edema fluid present in the nostrils, mouth, airways

4. large, bulky hyperinflated lungs, completely occupying the pleural cavities

   1. brick-red, large edema fluid, white hemorrhagic foam in trachea, subpleural hemorrhages (paltauf’s spots)

5. water in stomach

6. conjunctival hemorrhage (drowning = asphyxia)

7. dilation of right ventricle

8. nonspecific brain swelling

9. hemorrhage of mastoid bones or petrous portion of temporal bone

10. condition of body: floating head down, butt up; animal activity could be present

11. dry drowning = lungs do not exhibit heavy, boggy, edematous appearance seen in drowning cases - laryngeal spasms ??

List the expected gross findings associated with drowning.

survival of 24 hours or more post immersion

define what constitutes a near drowning

1. pneumonia

2. pulmonary edema

3. diffuse alveolar damage/acute respiratory distress (hyaline membranes)

4. sepsis

5. DIC (disseminated intravascular coagulation)

6. brain death due to hypoxic encephalopathy (transtentorial herniation)

discuss the most common causes of death in near drownings

1. natural: cardiac, respiratory, metabolic, neurologic, unlikely at MEO unless sudden or unknown medical condition

2. accidental: drowning, asphyxia, MVA, firearms, fire/burn deaths/ electrocution

differentiate injuries from accidental and natural deaths in children as discussed in lecture

1. TEN4FACES

   1. Torso

   2. Ears

   3. Neck

   4. Bruising anywhere on a child 4 months or younger

   5. Frenulum

   6. Auricular area

   7. Cheek

   8. Eyelids

   9. Scleral hemorrhage

2. Contusions, abrasions

3. Radiographic: fractures along growth plate of long bones, periosteum shearing, spiral/transverse fractures, head trauma, rib fractures

4. Head injuries: subdural, arachnoid hemorrhages

5. Abdominal: liver lacerations

6. Neglect: appears skeletal, dehydration → subcu fat has tacky, sticky feeling, empty bowel, sunken eyes and soft globes

   1. Parent claims child a “poor eater”

describe injuries seen in battered child syndrome

1. Battered child syndrome = repeated and deliberate physical abuse

2. Impulse homicides = acute injury/minimal evidence of chronic abuse; symmetric, well-demarcated, patterns; typically a child “annoys” adult and child is punished

   1. Scalding burns, cigarette burns

   2. Accidental will be more irregular, on anterior portion of body, splash marks

3. Gentle = asphyxia, smothering

   1. external/internal findings absent

   2.  Can’t diagnose from autopsy alone - scene and toxicology report very important

   3. SIDS vs. smothering

      1. Usually not considered homicide unless multiple children have died

differentiate between the different types of homicides in children

soot in airways, ischemia or hemorrhagic necrosis in globus pallidus and perivascular foci of demyelination in deep white matter

autopsy findings from CM poisoning?

renal failure, shock, ARDs, pneumonia, pulmonary embolism

autopsy findings from delayed death after CM poisoning

1. Charred body

2. Pugilistic attitude = flexion of upper extremities

3. Complete absence of fingers, toes, portions of extremities

4. Heat fractures and no ST hemorrhage

5. Heat epidural = blood boiling out of venous sinuses; chocolate or brown in color, spongy or crumbly; frontal/temporal/parietal areas of brain

6. Black carbonaceous matter in upper and lower airway indicates if decedent was alive prior to the fire

autopsy findings from death due to burn injury

1. Cherry red lividity = accumulation of oxyhemoglobin in tissues due to under utilization - not specific!

2. Death not immediate = hemorrhagic pancreatitis, erosions/focal hemorrhages of GI mucosa, pneumonia, acute tubular necrosis in kidneys, myocardial fiber necrosis

   1. wischnewski spots = hemorrhage in gastric mucosa

3. paradoxical undressing (terminal hallucinations)

autopsy findings for death from hypothermia

1. Impairment of the driver

2. Human factors: speed, recklessness, falling asleep

3. Environmental factors: slick pavement, icy roads, construction, fog

Analyze the causes of common motor vehicle accident injuries according to lecture

1. Driver = rectangular or linear abrasion/contusion angling downwards from left neck or shoulder toward anterior midline of chest

2. Passenger = angle downwards from right neck or shoulder area

3. Lap belt may produce horizontal linear contusion or abrasion of the abdomen

Contrast the injuries that occur to passengers with and without using seatbelts, according to lecture.

1. No restraints = can be thrown from the vehicle

   1. Full ejection = numerous injuries result when victim lands on firm surface

      1. Could be crushed or trapped beneath vehicle = traumatic asphyxia

   2. Partial ejection = body may be crushed or amputated

Argue the utility of vehicular restraint devices according to lecture

epidural hematoma

• laceration of the middle meningeal artery

• breaking of temporal bone

• bleeding between dura and skull

subarachnoid hematoma

• rupture of AVM or aneurysm, head injury

• bleeding within the subarachnoid space

subdural hematoma

• typically from trauma

• tearing of the bridging veins, between brain and dura