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'''Forensic pathology''' is figuring-out why, when, where and how people died, if the manner of death is ''not'' obviously natural. | '''Forensic pathology''' is figuring-out why, when, where and how people died, if the manner of death is ''not'' obviously natural. | ||
=Manner of death= | =Death categorization= | ||
Deaths are categorized foremost by the '''manner of death'''. The manner is the single most important legal categorization for a death. | |||
The '''cause of death''' is important for understanding what happened. The '''mechanism of death''' is the pathophysiologic reason for death and can be inferred from the cause. | |||
Examples: | |||
{| class="wikitable sortable" | |||
!Cause of death | |||
!Manner of death | |||
!Mechanism of death | |||
!Scenario | |||
|- | |||
| [[Electrocution]] | |||
| accident | |||
| [[cardiac arrhythmia]] | |||
| man struck by lightning | |||
|- | |||
| Hyperthermia | |||
| accident | |||
| arrhythmias, seizures<ref name=fmuk>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 19 April 2012.</ref> | |||
| man lost on hiking trip in desert | |||
|- | |||
| [[Epidural hemorrhage]] due to [[blunt force trauma]] to the head | |||
| homicide | |||
| brain stem compression or cerebral vascular spasm leading to autonomic dysregulation | |||
| man hit with a hammer in the head | |||
|- | |||
| [[Carbon monoxide toxicity]] | |||
| suicide | |||
| cerebral hypoxia (CO binds to hemoglobin impairing oxygen transport) | |||
| woman found in car with suicide note, long history of depression, previous suicide attempts | |||
|- | |||
| [[Atherosclerotic heart disease]] | |||
| natural | |||
| cardiac arrhythmia due to ischemia | |||
| man found dead in bed, apartment locked, 95% stenosis of LMCA at autopsy, no other significant autopsy findings | |||
|- <!-- | |||
| [[Peritonitis]] due to duodenal perforation as a consequence of [[peptic ulcer disease]] | |||
| natural | |||
| cerebral hypoxia secondary to hypotension | |||
| man found in locked apartment, complained of abdominal pain before dead | |||
|- | |||
| Coronary artery stent thrombosis complicating the treatment of a [[myocardial infarction]] due to atherosclerotic heart disease | |||
| natural | |||
| cardiac arrhythmia due to ischemia | |||
| woman found dead following hospital stay for a myocardial infarction, post-angioplasty and coronary stenting --> | |||
|} | |||
==Manner of death== | |||
The manner of death is a legislatively defined classification. It varies slightly between jurisdictions. | |||
<!-- | <!-- | ||
MANNER OF DEATH | MANNER OF DEATH | ||
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*#Undetermined. | *#Undetermined. | ||
=Cause of death= | ==Mechanism of death== | ||
This is occasionally of interest. It is usually based on physiology. | |||
The mechanism is often asked for [[asphyxial death]]s. The short answer it is: brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref> | |||
==Cause of death== | |||
*Abbreviated ''COD''. | |||
===General=== | ===General=== | ||
*The cause of death should be what started the sequence of events that lead to death. | *The cause of death should be what started the sequence of events that lead to death. | ||
==== | ====Word form for cause of death==== | ||
Examples: | |||
*''[[C. difficile colitis]] complicating antibiotic treatment for a dental abscess''.<ref>MSP. 8 September 2010.</ref> | *''[[C. difficile colitis]] complicating antibiotic treatment for a dental abscess''.<ref>MSP. 8 September 2010.</ref> | ||
*''Complications of laparoscopic cholecystectomy for ascending cholangitis with [[mesothelioma]] and atherosclerotic heart disease''.<ref>TR. 3 September 2010.</ref> | *''Complications of laparoscopic cholecystectomy for ascending cholangitis with [[mesothelioma]] and atherosclerotic heart disease''.<ref>TR. 3 September 2010.</ref> | ||
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*''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''. | *''A'' complicating ''B'' for the treatment of ''C'' with ''D'' and ''E''. | ||
==== | ====World Health Organization form for cause of death==== | ||
General form:<ref name=pmid15914304>{{cite journal |author=Pollanen MS |title=Deciding the cause of death after autopsy--revisited |journal=J Clin Forensic Med |volume=12 |issue=3 |pages=113–21 |year=2005 |month=June |pmid=15914304 |doi=10.1016/j.jcfm.2005.02.004 |url=}}</ref> | General form:<ref name=pmid15914304>{{cite journal |author=Pollanen MS |title=Deciding the cause of death after autopsy--revisited |journal=J Clin Forensic Med |volume=12 |issue=3 |pages=113–21 |year=2005 |month=June |pmid=15914304 |doi=10.1016/j.jcfm.2005.02.004 |url=}}</ref> | ||
*1a = immediate cause of death. | *1a = ''immediate cause of death''. | ||
*1b = what lead to the immediate cause of death. | *1b = what lead to the ''immediate cause of death''. | ||
*1c... 1[x] -- where 'x' is the last letter used; 1x = What started the sequence of events. | *1c... 1[x] -- where 'x' is the last letter used; 1x = What started the sequence of events. This is known as the ''underlying cause of death''. | ||
*2 = contributing factors. | *2 = contributing factors. | ||
Example 1: | Example 1: | ||
*1a. Ketoacidosis. | *1a. [[Ketoacidosis]]. | ||
*1b. Diabetes mellitus. | *1b. [[Diabetes mellitus]]. | ||
* | *2. [[Alcoholism]] and acute [[bronchopneumonia]]. | ||
Example 2: | Example 2: | ||
*1a. Hemoperitoneum. | *1a. Hemoperitoneum. | ||
*1b. Splenic laceration. | *1b. [[Splenic laceration]]. | ||
*1c. Blunt force trauma. | *1c. Blunt force trauma. | ||
*2. Liver [[cirrhosis]]. | *2. Liver [[cirrhosis]]. | ||
===Natural deaths=== | ===Natural deaths=== | ||
{{Main|Natural death}} | |||
*The cause should be a medical diagnosis, '''not''' the mechanism (e.g. ''cardiac arrest'', ''cachexia'', ''kidney failure''). | *The cause should be a medical diagnosis, '''not''' the mechanism (e.g. ''cardiac arrest'', ''cachexia'', ''kidney failure''). | ||
*The mechanism is irrelevant. | *The [[mechanism of death|mechanism]] is irrelevant. | ||
Notes: | Notes: | ||
*Unnatural causes trump natural ones. If a guy with (nothing more than) a 70% proximal LAD stenosis and an old [[myocardial infarct]] is found in the water, they are usually called drowning. | *Unnatural causes trump natural ones. If a guy with (nothing more than) a 70% proximal LAD stenosis and an old [[myocardial infarct]] is found in the water, they are usually called [[drowning]]. | ||
*Cancer is rarely the immediate cause of death - it is usually something else.<ref> | *[[Cancer]] is rarely the immediate cause of death - it is usually something else.<ref>Shannon, P. 2009.</ref> | ||
*Things (mechanisms) that shouldn't be used: [http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html] | *Things (mechanisms) that shouldn't be used: [http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html http://www.pallimed.org/2008/03/unacceptable-causes-of-death-other-web.html] | ||
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====General==== | ====General==== | ||
*In Ontario, the ''manner'' is determined by the coroner. | *In Ontario, the ''manner'' is determined by the coroner. | ||
*Coroners, in Ontario, are MDs -- usually family docs. | *Coroners, in Ontario, are MDs -- usually [[family docs]]. | ||
*The cause (e.g. "gunshot wound to the head") is determined by the pathologist. | *The cause (e.g. "gunshot wound to the head") is determined by the pathologist. | ||
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**Haemorrhage (e.g. cerebral bleed, gastrointestinal bleed, aortic aneurysm). | **Haemorrhage (e.g. cerebral bleed, gastrointestinal bleed, aortic aneurysm). | ||
**Infection (e.g. [[pneumonia]]). | **Infection (e.g. [[pneumonia]]). | ||
** | **[[Coronary artery atherosclerosis]] ([[cardiac arrhythmia]]s - more common in the forensic context than [[myocardial infarction]] (MI); individuals with MIs don't usu. drop dead-- they go to the ER). | ||
***Post [[myocardial infarction]] (free wall rupture). | ***Post [[myocardial infarction]] (free wall rupture). | ||
***Ruptured (atherosclerotic) plaque. | ***Ruptured (atherosclerotic) plaque. | ||
*Toxic (memory device: ''PAIRO''): | *Toxic (memory device: ''PAIRO''): | ||
**Poisons. | **Poisons. | ||
**Alcohol (EtOH). | **[[Alcohol]] (EtOH). | ||
**Illicit (e.g. [[cocaine]], heroin, LSD). | **Illicit (e.g. [[cocaine]], heroin, LSD). | ||
**Rx. | **Rx. | ||
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=Wounds= | =Wounds= | ||
=== | ==General== | ||
*''Wound'' - definition: defect in skin or mucous membrane<ref>URL: [http://dictionary.reference.com/browse/wound http://dictionary.reference.com/browse/wound]. Accessed on: 20 April 2012.</ref> - usually due to trauma. | |||
Special types of wounds: | |||
*[[Gunshot wounds]]. | |||
*Incised wounds - see [[sharp force trauma]]. | |||
===Gross pathologic classification of injuries=== | |||
Mnemonic ''CALI'': | Mnemonic ''CALI'': | ||
*'''C'''ontusion - "bruise", | *'''C'''ontusion - "bruise", [[hematoma]]. | ||
**Age (usual colour change sequence): red, blue, green, yellow, brown.<ref name=Ref_HospAuto108>{{Ref HospAuto|108}}</ref> | **Age (usual colour change sequence): red, blue, green, yellow, brown.<ref name=Ref_HospAuto108>{{Ref HospAuto|108}}</ref> | ||
**Etiology: bleeding from arterioles or venules (not capillaries).<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref> | **Etiology: bleeding from arterioles or venules (not capillaries).<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref> | ||
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***Skin tags suggest directionality; they are found at the distal point / point of last contact.<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref> | ***Skin tags suggest directionality; they are found at the distal point / point of last contact.<ref name=Ref_HospAuto105>{{Ref HospAuto|105}}</ref> | ||
*'''L'''aceration - "tear", indicates blunt force trauma; contact point may be distant from where skin splits. | *'''L'''aceration - "tear", indicates blunt force trauma; contact point may be distant from where skin splits. | ||
*'''I'''ncised - "cut", e.g. caused by a knife | *'''I'''ncised - "cut", e.g. caused by a knife,<ref name=Ref_HoFP154>{{Ref_HoFP|154}}</ref> subdivided as follows: | ||
*#"Cut" or "slash" = length > depth. | *#"Cut" or "slash" = length > depth. | ||
*#"Stab" = depth > length. | *#"Stab" = depth > length. | ||
*#"Chop" = typically have a contusion at the margin of the wound, classically caused by an axe. May be caused by a propeller.<ref name=pmid19733336>{{Cite journal | last1 = Ihama | first1 = Y. | last2 = Ninomiya | first2 = K. | last3 = Noguchi | first3 = M. | last4 = Fuke | first4 = C. | last5 = Miyazaki | first5 = T. | title = Fatal propeller injuries: three autopsy case reports. | journal = J Forensic Leg Med | volume = 16 | issue = 7 | pages = 420-3 | month = Oct | year = 2009 | doi = 10.1016/j.jflm.2009.04.006 | PMID = 19733336 }}</ref> | |||
====Images==== | |||
<gallery> | |||
Image:Hand_Abrasion_-_32_minutes_after_injury.JPG | Abrasion. (WC) | |||
Image:Black_eye_2.jpg | Contusion ("black eye"). (WC) | |||
</gallery> | |||
====DDx==== | ====DDx==== | ||
How to decide what you're looking at: | How to decide what you're looking at: | ||
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**Lacerations are classically on the skull and face. They are rarely on the abdomen. | **Lacerations are classically on the skull and face. They are rarely on the abdomen. | ||
=== | ===Wound dating=== | ||
*Colour is somewhat useful for bruises. | *Colour is somewhat useful for contusions (bruises). | ||
*Post-mortem injuries tend to be orange-yellow.<ref name=pmid19237864>{{Cite journal | last1 = Campobasso | first1 = CP. | last2 = Marchetti | first2 = D. | last3 = Introna | first3 = F. | last4 = Colonna | first4 = MF. | title = Postmortem artifacts made by ants and the effect of ant activity on decompositional rates. | journal = Am J Forensic Med Pathol | volume = 30 | issue = 1 | pages = 84-7 | month = Mar | year = 2009 | doi = 10.1097/PAF.0b013e318187371f | PMID = 19237864 }}</ref> | *Post-mortem injuries tend to be orange-yellow.<ref name=pmid19237864>{{Cite journal | last1 = Campobasso | first1 = CP. | last2 = Marchetti | first2 = D. | last3 = Introna | first3 = F. | last4 = Colonna | first4 = MF. | title = Postmortem artifacts made by ants and the effect of ant activity on decompositional rates. | journal = Am J Forensic Med Pathol | volume = 30 | issue = 1 | pages = 84-7 | month = Mar | year = 2009 | doi = 10.1097/PAF.0b013e318187371f | PMID = 19237864 }}</ref> | ||
*Wounds age is difficult to determine as [[wound healing]] is affected by a large number of variables. | |||
*Old wounds (scars), generally, cannot be dated - one can only say they are ''old''. | |||
===Microscopic=== | ===Microscopic=== | ||
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**[[PMN]]s 6-24 hours after injury. | **[[PMN]]s 6-24 hours after injury. | ||
**PMNs replaced monocytes in 24-48 hours. | **PMNs replaced monocytes in 24-48 hours. | ||
===Stains=== | |||
*[[Iron stain]] for siderophages (hemosiderin-laden macrophages) -- presence suggests 2-3 days or older.<ref name=pmid7529545>{{Cite journal | last1 = Betz | first1 = P. | title = Histological and enzyme histochemical parameters for the age estimation of human skin wounds. | journal = Int J Legal Med | volume = 107 | issue = 2 | pages = 60-8 | month = | year = 1994 | doi = | PMID = 7529545 }}</ref> | |||
=Bone fractures= | =Bone fractures= | ||
*[[AKA]] ''fractures''. | *[[AKA]] ''fractures''. | ||
*[[AKA]] ''fracture of bone''. | |||
==Artefactual fractures== | |||
*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref> | *"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref> | ||
*Basal skull fracture due to opening of skull.<ref>MSP. 29 September 2010.</ref> | *Basal skull fracture due to opening of skull.<ref>MSP. 29 September 2010.</ref> | ||
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**Mechanism to explain trauma not present in history; a fall/tripping not sufficient. | **Mechanism to explain trauma not present in history; a fall/tripping not sufficient. | ||
== | ==Healing of fractures== | ||
===Simplified classification=== | |||
=== | |||
*Primary callus (cartilaginous) - early. | *Primary callus (cartilaginous) - early. | ||
*Secondary callus (bone) - late. | *Secondary callus (bone) - late. | ||
===Microscopic=== | |||
Features: | |||
*Fragmentation of bone. | |||
*+/-Dead bone = lacunae have no osteocytes.<ref name=pmid22460748>{{Cite journal | last1 = Fondi | first1 = C. | last2 = Franchi | first2 = A. | title = Definition of bone necrosis by the pathologist. | journal = Clin Cases Miner Bone Metab | volume = 4 | issue = 1 | pages = 21-6 | month = Jan | year = 2007 | doi = | PMID = 22460748 }}</ref> | |||
**Takes days for osteocyte loss. | |||
*+/-Inflammatory cells. | |||
*+/-Hemosiderin-laden macrophages. | |||
*+/-Osteoblastic rimming. | |||
DDx: | |||
*Fracture secondary to a tumour: | |||
**Metastatic carcinoma. | |||
**[[Osteosarcoma]] - typically does '''not''' have osteoblastic rimming. | |||
Notes: | Notes: | ||
*Radiology is not good at dating fratures | *Radiology is not good at dating fratures;<ref name=pmid15788611>{{Cite journal | last1 = Prosser | first1 = I. | last2 = Maguire | first2 = S. | last3 = Harrison | first3 = SK. | last4 = Mann | first4 = M. | last5 = Sibert | first5 = JR. | last6 = Kemp | first6 = AM. | title = How old is this fracture? Radiologic dating of fractures in children: a systematic review. | journal = AJR Am J Roentgenol | volume = 184 | issue = 4 | pages = 1282-6 | month = Apr | year = 2005 | doi = | PMID = 15788611 | url=http://www.ajronline.org/cgi/content/full/184/4/1282 }} | ||
</ref> | </ref> however, it is good at finding 'em. | ||
==Pattern and cause== | |||
===Child abuse-related=== | |||
*Paravertebral (bony) nodules = classic location for rib fractures in child abuse. | |||
*Metaphyseal fractures - "classical metaphyseal lesions".<ref name=pmid8615271>{{Cite journal | last1 = Kleinman | first1 = PK. | last2 = Marks | first2 = SC. | title = A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. | journal = AJR Am J Roentgenol | volume = 166 | issue = 5 | pages = 1207-12 | month = May | year = 1996 | doi = | PMID = 8615271 }}</ref> | |||
===Motor vehicle | ===Motor vehicle versus pedestrian=== | ||
If the pedestrian is standing during the initial impact one classically finds, at bumper level, a lower limb fracture with a ''Messerer wedge'' (German: ''Messerer-Kiel'');<ref name=pmid11376986>{{Cite journal | last1 = Karger | first1 = B. | last2 = Teige | first2 = K. | last3 = Fuchs | first3 = M. | last4 = Brinkmann | first4 = B. | title = Was the pedestrian hit in an erect position before being run over? | journal = Forensic Sci Int | volume = 119 | issue = 2 | pages = 217-20 | month = Jun | year = 2001 | doi = | PMID = 11376986 }} | If the pedestrian is standing during the initial impact one classically finds, at bumper level, a lower limb fracture with a ''Messerer wedge'' (German: ''Messerer-Kiel'');<ref name=pmid11376986>{{Cite journal | last1 = Karger | first1 = B. | last2 = Teige | first2 = K. | last3 = Fuchs | first3 = M. | last4 = Brinkmann | first4 = B. | title = Was the pedestrian hit in an erect position before being run over? | journal = Forensic Sci Int | volume = 119 | issue = 2 | pages = 217-20 | month = Jun | year = 2001 | doi = | PMID = 11376986 }} | ||
</ref> the wedge points in the direction of the (impact) force. | </ref> the wedge points in the direction of the (impact) force. | ||
==Location or type== | |||
===Orbital floor fractures=== | |||
*[[AKA]] ''blow-out fractures''.<ref name=pmid17333039>{{Cite journal | last1 = Punke | first1 = C. | last2 = Fritsche | first2 = A. | last3 = Martin | first3 = H. | last4 = Schmitz | first4 = KP. | last5 = Pau | first5 = HW. | last6 = Kramp | first6 = B. | title = [Investigation of the mechanisms involved in isolated orbital floor fracture. Simulation using a finite element model of the human skull]. | journal = HNO | volume = 55 | issue = 12 | pages = 938-44 | month = Dec | year = 2007 | doi = 10.1007/s00106-007-1545-5 | PMID = 17333039 }}</ref> | |||
====General==== | |||
*Classically due to fights, followed by traffic accidents.<ref name=pmid20165966>{{Cite journal | last1 = Gosau | first1 = M. | last2 = Schöneich | first2 = M. | last3 = Draenert | first3 = FG. | last4 = Ettl | first4 = T. | last5 = Driemel | first5 = O. | last6 = Reichert | first6 = TE. | title = Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. | journal = Clin Oral Investig | volume = 15 | issue = 3 | pages = 305-13 | month = Jun | year = 2011 | doi = 10.1007/s00784-010-0385-y | PMID = 20165966 }}</ref> | |||
*Thought to result from loading on the orbital rim directly or the orbit - both are transmitted to the orbital floor.<ref name=pmid17333039/> | |||
Note: | |||
*The orbital floor tends to the be weaker than other components of the orbital cavity wall; thus, it is the most common site of fracture in the orbital cavity wall. | |||
===Basal skull fracture=== | |||
====General==== | |||
Etiology: | |||
*Blunt force trauma - high energy & velocity. | |||
**Seen in ''motor vehicle collisions'', ''descent from height''. | |||
Clinical/external findings: | |||
*Raccoon eyes = periorbital ecchymosis. | |||
*Battle sign = mastoid ecchymosis. | |||
**Associated with orbital roof fractures.<ref>URL: [http://emedicine.medscape.com/article/1680107-overview#showall http://emedicine.medscape.com/article/1680107-overview#showall]. Accessed on: 28 March 2012.</ref> | |||
*Cerebrospinal fluid rhinorrhea. | |||
*Hemorrhage from nose and ears. | |||
*Hemotympanum. | |||
Note: | |||
*There is a dictum that states ''bilateral petrous bone fractures are due to impact to the side of the head'' - it isn't true.<ref name=pmid7391790>{{Cite journal | last1 = Harvey | first1 = FH. | last2 = Jones | first2 = AM. | title = Typical basal skull fracture of both petrous bones: an unreliable indicator of head impact site. | journal = J Forensic Sci | volume = 25 | issue = 2 | pages = 280-6 | month = Apr | year = 1980 | doi = | PMID = 7391790 }}</ref> | |||
===Hinge fracture of the skull=== | |||
*A special type of [[basal skull fracture]]. | |||
*Complete hinge fractures are considered severe; they are a 4 on the ''abbreviated injury scale'' (AIS).<ref>{{Cite journal | last1 = Adams | first1 = VI. | last2 = Carrubba | first2 = C. | title = The Abbreviated Injury Scale: application to autopsy data. | journal = Am J Forensic Med Pathol | volume = 19 | issue = 3 | pages = 246-51 | month = Sep | year = 1998 | doi = | PMID = 9760090 }}</ref> | |||
*Classically due to a blow to the chin - resulting in a fracture across the medial fossa and sella turcica.<ref>URL: [http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving http://wiki.answers.com/Q/Hinge_fracture_of_skull_is_seen_in_accidents_involving]. Accessed on: 28 March 2012.</ref> | |||
===Pathologic fracture=== | |||
{{Main|Pathologic fracture}} | |||
*A fracture due to an underlying pathology. | |||
===Hip fractures=== | |||
*[[Traumatic fracture of the femoral neck]]. | |||
=Autopsy= | =Autopsy= | ||
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===External exam findings=== | ===External exam findings=== | ||
Colour of the corpse:<ref name=Ref_Shkrum33>{{Ref Shkrum|33}}</ref> | Colour of the corpse:<ref name=Ref_Shkrum33>{{Ref Shkrum|33}}</ref> | ||
*Red (Pink) = [[carbon monoxide toxicity|carbon monoxide]], cyanide, fluoroacetate | *Red (Pink) = [[carbon monoxide toxicity|carbon monoxide]], cyanide, fluoroacetate,<ref name=pmid17288493>{{cite journal |author=Proudfoot AT, Bradberry SM, Vale JA |title=Sodium fluoroacetate poisoning |journal=Toxicol Rev |volume=25 |issue=4 |pages=213–9 |year=2006 |pmid=17288493 |doi= |url=}}</ref> [[hypothermia]]. | ||
*Purple (intense) = propane. | *Purple (intense) = propane. | ||
*Green = hydrogen sulfide. | *Green = [[hydrogen sulfide]]. | ||
*Brown = nitrites (methemoglobinemia). | *Brown = nitrites (methemoglobinemia). | ||
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===Autopsy on decomposed remains=== | ===Autopsy on decomposed remains=== | ||
*[[AKA]] "decomp autopsy" or simply "decomp". | |||
====General==== | ====General==== | ||
*Histology usually very limited ''or'' useless. | *Histology usually very limited ''or'' useless. | ||
*Often done to exclude trauma. | *Often done to exclude trauma. | ||
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==Environmental== | ==Environmental== | ||
{{Main|Environmental causes of death}} | |||
*Hypothermia. | They include: | ||
*Hyperthermia. | *[[Hypothermia]]. | ||
*[[Hyperthermia]]. | |||
*Drowning - see [[asphyxial deaths]]. | *Drowning - see [[asphyxial deaths]]. | ||
*Lack of oxygen - see [[asphyxial deaths]]. | *Lack of oxygen - see [[asphyxial deaths]]. | ||
* | *[[Electrocution]]. | ||
=Gunshot wounds= | =Gunshot wounds= | ||
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**Includes: carbon monoxide poisoning. | **Includes: carbon monoxide poisoning. | ||
*''Suffocation'' - usually no signs of neck compression. | *''Suffocation'' - usually no signs of neck compression. | ||
**Includes: | **Includes: smothering, [[choking]], positional asphyxia, [[drowning]]. | ||
=Blunt force injury= | |||
*[[AKA]] ''blunt force trauma''. | |||
==General== | |||
Classification: | |||
*Contusions. | |||
*Laceration. | |||
*Acceleration/deceleration injury, e.g. [[diffuse axonal injury]]. | |||
Weapons: | |||
*Fist. | |||
* | *Foot. | ||
*Baseball bat... pretty much anything. | |||
*Beer bottles are common... and strong enought to fracture a skull. | *Beer bottles are common... and strong enought to fracture a skull. | ||
**Empty bottles have a higher fracture energy than full ones.<ref name=pmid19239964>{{cite journal |author=Bolliger SA, Ross S, Oesterhelweg L, Thali MJ, Kneubuehl BP |title=Are full or empty beer bottles sturdier and does their fracture-threshold suffice to break the human skull? |journal=J Forensic Leg Med |volume=16 |issue=3 |pages=138–42 |year=2009 |month=April |pmid=19239964 |doi=10.1016/j.jflm.2008.07.013 |url=}}</ref> | **Empty bottles have a higher fracture energy than full ones.<ref name=pmid19239964>{{cite journal |author=Bolliger SA, Ross S, Oesterhelweg L, Thali MJ, Kneubuehl BP |title=Are full or empty beer bottles sturdier and does their fracture-threshold suffice to break the human skull? |journal=J Forensic Leg Med |volume=16 |issue=3 |pages=138–42 |year=2009 |month=April |pmid=19239964 |doi=10.1016/j.jflm.2008.07.013 |url=}}</ref> | ||
==Cause of death== | |||
===Commotio cordis=== | ===Commotio cordis=== | ||
Features:<ref name=pmid11334832>{{cite journal |author=Kohl P, Nesbitt AD, Cooper PJ, Lei M |title=Sudden cardiac death by Commotio cordis: role of mechano-electric feedback |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=280–9 |year=2001 |month=May |pmid=11334832 |doi= |url=}}</ref><ref>{{cite journal |author=Maron BJ, Estes NA |title=Commotio cordis |journal=N. Engl. J. Med. |volume=362 |issue=10 |pages=917–27 |year=2010 |month=March |pmid=20220186 |doi=10.1056/NEJMra0910111 |url=http://www.nejm.org/doi/full/10.1056/NEJMra0910111}}</ref> | Features:<ref name=pmid11334832>{{cite journal |author=Kohl P, Nesbitt AD, Cooper PJ, Lei M |title=Sudden cardiac death by Commotio cordis: role of mechano-electric feedback |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=280–9 |year=2001 |month=May |pmid=11334832 |doi= |url=}}</ref><ref>{{cite journal |author=Maron BJ, Estes NA |title=Commotio cordis |journal=N. Engl. J. Med. |volume=362 |issue=10 |pages=917–27 |year=2010 |month=March |pmid=20220186 |doi=10.1056/NEJMra0910111 |url=http://www.nejm.org/doi/full/10.1056/NEJMra0910111}}</ref> | ||
*Often negative autopsy; no cardiac pathology. | *Often negative autopsy; no cardiac pathology. | ||
*Etiology: arrhythmia. | *Etiology: [[cardiac arrhythmia|arrhythmia]]. | ||
*History: trauma to chest. | *History: trauma to chest. | ||
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*Analogous to ''[[commotio medullaris]]''. | *Analogous to ''[[commotio medullaris]]''. | ||
==Scenarios== | |||
===Motor vehicle collisions=== | ===Motor vehicle collisions=== | ||
*Pedestrian vs. motor vehicle: heel to injury measurement.<ref>{{Ref OPMfP|18}}</ref> | *Pedestrian vs. motor vehicle: heel to injury measurement, remember to include the thickness of the heel/sole of shoe.<ref>{{Ref OPMfP|18}}</ref> | ||
*Dicing injuries: tempered glass used in side window construction fragments into cubes when fractured causing L-shaped wounds. | |||
* | |||
===Descent from height=== | ===Descent from height=== | ||
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*+/-Haemoaspiration (due to facial trauma) - presence suggest that decendent was alive shortly after landing/impact and thus likely very alive during the descent. | *+/-Haemoaspiration (due to facial trauma) - presence suggest that decendent was alive shortly after landing/impact and thus likely very alive during the descent. | ||
**Patchy red centrilobular spots on gross examination. | **Patchy red centrilobular spots on gross examination. | ||
==Injury patterns== | |||
===Seromuscular tear=== | |||
* [[AKA]] ''seatbeat syndrome''. | |||
* Intestinal injury associated with motor vehicle collisions and more specifically seatbelts. | |||
Features: | |||
* Def'n: separation of (inner) muscularis propria from submucosa.<ref name=pmid12198344>{{Cite journal | last1 = Slavin | first1 = RE. | last2 = Borzotta | first2 = AP. | title = The seromuscular tear and other intestinal lesions in the seatbelt syndrome: a clinical and pathologic study of 29 cases. | journal = Am J Forensic Med Pathol | volume = 23 | issue = 3 | pages = 214-22 | month = Sep | year = 2002 | doi = 10.1097/01.PAF.0000023001.32202.2D | PMID = 12198344 }}</ref> | |||
===Bite injury=== | ===Bite injury=== | ||
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In the context of a suspicious case: | In the context of a suspicious case: | ||
*Human vs. animal. | *Human vs. animal. | ||
*Bite marks, as evidence, | *Bite marks, as evidence, have a limited value for identification purposes. | ||
**In the context of identifying a potential perpetrator, it is essential to swab the bite mark for saliva, which is rich in DNA.<ref>{{Cite journal | last1 = Pretty | first1 = IA. | title = Forensic dentistry: 2. Bitemarks and bite injuries. | journal = Dent Update | volume = 35 | issue = 1 | pages = 48-50, 53-4, 57-8 passim | month = | year = | doi = | PMID = 18277695 }}</ref> | |||
====Images==== | |||
<gallery> | |||
Image: Dog_bite.JPG | Bite injury. (WC) | |||
</gallery> | |||
===Aortic trauma=== | |||
*Classic location of transection of the aorta is distal the the left subclavian branch point near the insertion of the ligamentum arteriosum (e.g. peri-isthmus).<ref name=pmid1934437>{{cite journal |author=Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF |title=Traumatic rupture of the thoracic aorta. A 20-year review: 1969-1989 |journal=Circulation |volume=84 |issue=5 Suppl |pages=III40–6 |year=1991 |month=November |pmid=1934437 |doi= |url=}}</ref> | |||
*[[Aortic dissection]] due to trauma is often catastrophic. Several mechanisms have been proposed and there is a body of trauma biomechanics research that explores this. | |||
==Trauma with delayed death== | ==Trauma with delayed death== | ||
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*[[Aortic dissection]] with subsequent rupture. | *[[Aortic dissection]] with subsequent rupture. | ||
=Sharp force | =Sharp force injury= | ||
*[[AKA]] ''sharp force trauma''. | |||
* | ===General=== | ||
Injuries caused by:<ref name=Ref_HospAuto111-2>{{Ref HospAuto|111-2}}</ref> | |||
=== | |||
*Knife. | *Knife. | ||
*Scissors - classic "Z" shape. | *Scissors - classic "Z" shape. | ||
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*Glass. | *Glass. | ||
= | ===Gross=== | ||
== | Features:<ref name=Ref_HospAuto111-2>{{Ref HospAuto|111-2}}</ref> | ||
*Incised wound (see: ''[[Wounds|Classification of wounds]]''). | |||
**"Clean" edge (no contusion, no abrasion). | |||
**Well-demarcated edges. | |||
*+/-Hilt mark. | |||
**Due to contact of hilt. | |||
Subclassified into - see ''[[Wounds|classification of wounds]]'': | |||
*''Cut/slash''. | |||
*''Stab''. | |||
*''Chop'' - a mixed injury, sharp force and blunt force. | |||
====Images==== | |||
<gallery> | |||
Image: Thorax-Messerstichwunden.jpg | Sharp force trauma - thorax. (WC) | |||
</gallery> | |||
=Head injuries= | =Head injuries= | ||
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**Location: | **Location: | ||
***Above hat brim line (HBL). | ***Above hat brim line (HBL). | ||
***Ear. | ***[[Ear]]. | ||
***Left-sided. | ***Left-sided. | ||
*Fractures: | *Fractures: | ||
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*Tears - corpus callosum. | *Tears - corpus callosum. | ||
*Haemorrhage. | *Haemorrhage. | ||
Other (chronic) changes:<ref name=Ref_AoGP639>{{Ref AoGP|639}}</ref>{{fact}} | |||
*Thalamus - shrinkage. | |||
*Enlargement of third ventricle. | |||
DDx (medical imaging):<ref name=pmid22406792>{{Cite journal | last1 = Kumar | first1 = S. | last2 = Gupta | first2 = V. | last3 = Aggarwal | first3 = S. | last4 = Singh | first4 = P. | last5 = Khandelwal | first5 = N. | title = Fat embolism syndrome mimicker of diffuse axonal injury on magnetic resonance imaging. | journal = Neurol India | volume = 60 | issue = 1 | pages = 100-2 | month = | year = | doi = 10.4103/0028-3886.93597 | PMID = 22406792 }}</ref> | |||
*[[Cerebral fat embolism]]. | |||
===Microscopic=== | ===Microscopic=== | ||
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*Grade 2: macroscopic corpus callosum injury + microscopic findings of DAI. | *Grade 2: macroscopic corpus callosum injury + microscopic findings of DAI. | ||
*Grade 3: macroscopic corpus callosum and midbrain injuries + microscopic findings of DAI. | *Grade 3: macroscopic corpus callosum and midbrain injuries + microscopic findings of DAI. | ||
===Stains=== | |||
*[[Bielschowsky stain]] to highlight axonal swellings - appear 12-18 hours after injury.<ref name=Ref_Shkrum_562>{{Ref Shkrum|562}}</ref> | |||
===IHC=== | ===IHC=== | ||
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==Intracranial hemorrhage== | ==Intracranial hemorrhage== | ||
{{main|Intracranial hematoma}} | {{main|Intracranial hematoma}} | ||
Intracranial hemorrhage may be a consequence of blunt force trauma. | |||
Classification: | Classification: | ||
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*[[Subarachnoid hematoma]]. | *[[Subarachnoid hematoma]]. | ||
*[[Intracerebral hematoma]]. | *[[Intracerebral hematoma]]. | ||
==Cerebral contusion== | |||
===General=== | |||
*Due to blunt force trauma. | |||
===Gross=== | |||
Features: | |||
*Focal superficial hemorrhage. | |||
*Location, usually, ''frontal lobe'' and ''temporal lobe''.<ref name=Ref_HoFP_102>{{Ref HoFP|102}}</ref> | |||
Notes: | |||
*Classically, come in pairs:<ref name=Ref_HoFP_102>{{Ref HoFP|102}}</ref> | |||
*#''Coup contusion'' - at the site of the (primary) impact | |||
*#''Contrecoup contusion'' - secondary internal impact. | |||
**Example - fall on back of head: | |||
***Occipital lobe contusion = coup contusion. | |||
***Frontal lobe contusion = contrecoup contusion. | |||
*May be associated with contusions of the:<ref name=Ref_HoFP_103>{{Ref HoFP|103}}</ref> | |||
**Deep brain structures, known as an "intermediary coup". | |||
**Dorsal surface of the cerebral hemispheres, known as "gliding contusions". | |||
*Resolve as a yellow lesion (like at other sites), known as a ''[[plaque]] jaune'' in the brain. | |||
**Classically, inferior aspect of the frontal lobe. | |||
DDx: | |||
*Hemorrhagic [[stroke]] - usually temporal lobe and/or parietal lobe. | |||
==Traumatic brain injury in infants== | ==Traumatic brain injury in infants== | ||
{{main|Traumatic brain injury in infants}} | {{main|Traumatic brain injury in infants}} | ||
*Shaken-impact syndrome | *Shaken-impact syndrome, [[AKA]] shaken baby syndrome. | ||
==Commotio medullaris== | ==Commotio medullaris== | ||
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Excited delirium - hypothesis: | Excited delirium - hypothesis: | ||
*Thought to arise in the context of severe chronic mental disorders (e.g. schizophrenia) and protracted cocaine binges.<ref name=pmid9645173>{{Cite journal | last1 = Pollanen | first1 = MS. | last2 = Chiasson | first2 = DA. | last3 = Cairns | first3 = JT. | last4 = Young | first4 = JG. | title = Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. | journal = CMAJ | volume = 158 | issue = 12 | pages = 1603-7 | month = Jun | year = 1998 | doi = | PMID = 9645173 | PMC = 1229410 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1229410}}</ref> | *Thought to arise in the context of severe chronic mental disorders (e.g. schizophrenia) and protracted [[cocaine]] binges.<ref name=pmid9645173>{{Cite journal | last1 = Pollanen | first1 = MS. | last2 = Chiasson | first2 = DA. | last3 = Cairns | first3 = JT. | last4 = Young | first4 = JG. | title = Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. | journal = CMAJ | volume = 158 | issue = 12 | pages = 1603-7 | month = Jun | year = 1998 | doi = | PMID = 9645173 | PMC = 1229410 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1229410}}</ref> | ||
*Thought to result from alteration of dopamine receptor density. The D2 receptor in particular, which is thought to be important in temperature regulation, is decreased in psychotic cocaine abusers.<ref name=pmid8768172/> | *Thought to result from alteration of dopamine receptor density. The D2 receptor in particular, which is thought to be important in temperature regulation, is decreased in psychotic cocaine abusers.<ref name=pmid8768172/> | ||
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===Vitreous=== | ===Vitreous=== | ||
*Creatinine and urea - approximate those at time of death.<ref name=Ref_HospAuto222>{{Ref HospAuto|222}}</ref> | *Creatinine and urea - approximate those at time of death.<ref name=Ref_HospAuto222>{{Ref HospAuto|222}}</ref> | ||
*Glucose - used to assess for hyperglycemia (due to [[diabetes mellitus|diabetic coma]]) in life.<ref name=pmid19167848>{{Cite journal | last1 = Zilg | first1 = B. | last2 = Alkass | first2 = K. | last3 = Berg | first3 = S. | last4 = Druid | first4 = H. | title = Postmortem identification of hyperglycemia. | journal = Forensic Sci Int | volume = 185 | issue = 1-3 | pages = 89-95 | month = Mar | year = 2009 | doi = 10.1016/j.forsciint.2008.12.017 | PMID = 19167848 }}</ref> | |||
===Toxicology=== | ===Toxicology=== | ||
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#Suspected toxicologic death - need details on drugs. | #Suspected toxicologic death - need details on drugs. | ||
====Mandated by case<ref>{{Ref OPMfP|14}}</ref> | ====Mandated by case==== | ||
*Sudden death | In Ontario, the following are mandated by the case:<ref>{{Ref OPMfP|14}}</ref> | ||
*Workplace | *Sudden death of child under five years old. | ||
*Fatal motor vehicle collision. | *Workplace death. | ||
*Aviation | *Fatal motor vehicle collision - esp. driver. | ||
*Fire-related | *Aviation death - esp. pilot & co-pilot. | ||
*Fire-related death (carboxyhemoglobin). | |||
===Toxins=== | ===Toxins=== | ||
====Ethanol toxicity==== | ====Ethanol toxicity==== | ||
{{Main|Ethanol abuse}} | |||
*Usually measured (in Canada) as: ''mass of EtOH (mg)/volume of blood (mL)''. | *Usually measured (in Canada) as: ''mass of EtOH (mg)/volume of blood (mL)''. | ||
**Limit (Ontario): 80 milligrams of alcohol in 100 millilitres of blood (0.08 gm/100 mL).<ref>URL: [http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml]. Accessed on: 28 September 2010.</ref> | **Limit (Ontario): 80 milligrams of alcohol in 100 millilitres of blood (0.08 gm/100 mL).<ref>URL: [http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml http://www.mto.gov.on.ca/english/safety/impaired/fact-sheet.shtml]. Accessed on: 28 September 2010.</ref> | ||
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*Typically an accidental death; person consumes methanol as an ethanol substitute. | *Typically an accidental death; person consumes methanol as an ethanol substitute. | ||
*Blindness. | *Blindness. | ||
*Putamen necrosis (bilateral).<ref name=pmid16484428>{{Cite journal | last1 = Blanco | first1 = M. | last2 = Casado | first2 = R. | last3 = Vázquez | first3 = F. | last4 = Pumar | first4 = JM. | title = CT and MR imaging findings in methanol intoxication. | journal = AJNR Am J Neuroradiol | volume = 27 | issue = 2 | pages = 452-4 | month = Feb | year = 2006 | doi = | PMID = 16484428 }}</ref> | *[[Putamen]] [[necrosis]] (bilateral).<ref name=pmid16484428>{{Cite journal | last1 = Blanco | first1 = M. | last2 = Casado | first2 = R. | last3 = Vázquez | first3 = F. | last4 = Pumar | first4 = JM. | title = CT and MR imaging findings in methanol intoxication. | journal = AJNR Am J Neuroradiol | volume = 27 | issue = 2 | pages = 452-4 | month = Feb | year = 2006 | doi = | PMID = 16484428 }}</ref> | ||
*+/-Pancreatic injury.<ref name=pmid10866330>{{Cite journal | last1 = Hantson | first1 = P. | last2 = Mahieu | first2 = P. | title = Pancreatic injury following acute methanol poisoning. | journal = J Toxicol Clin Toxicol | volume = 38 | issue = 3 | pages = 297-303 | month = | year = 2000 | doi = | PMID = 10866330 }}</ref> | *+/-Pancreatic injury.<ref name=pmid10866330>{{Cite journal | last1 = Hantson | first1 = P. | last2 = Mahieu | first2 = P. | title = Pancreatic injury following acute methanol poisoning. | journal = J Toxicol Clin Toxicol | volume = 38 | issue = 3 | pages = 297-303 | month = | year = 2000 | doi = | PMID = 10866330 }}</ref> | ||
====Cocaine toxicity==== | ====Cocaine toxicity==== | ||
*No agreed upon toxic dose<ref name=pmid15075681>{{cite journal |author=Stephens BG, Jentzen JM, Karch S, Wetli CV, Mash DC |title=National Association of Medical Examiners position paper on the certification of cocaine-related deaths |journal=Am J Forensic Med Pathol |volume=25 |issue=1 |pages=11–3 |year=2004 |month=March |pmid=15075681 |doi= |url=}}</ref> - due to tolerance. | *No agreed upon toxic dose<ref name=pmid15075681>{{cite journal |author=Stephens BG, Jentzen JM, Karch S, Wetli CV, Mash DC |title=National Association of Medical Examiners position paper on the certification of cocaine-related deaths |journal=Am J Forensic Med Pathol |volume=25 |issue=1 |pages=11–3 |year=2004 |month=March |pmid=15075681 |doi= |url=}}</ref> - due to tolerance. | ||
*Usual mechanism ''cardiac failure''. | |||
Features | Features - heart: | ||
*Usually anatomically normal heart. | *Usually anatomically normal heart. | ||
*+/-Advanced atherosclerosis for age. | **+/-Advanced [[coronary artery atherosclerosis]] for age. | ||
*+/- | **+/-[[Myocardial infarction]]. | ||
*+/-Contraction band necrosis. | ***+/-Contraction band necrosis. | ||
*+/-Cardiac hypertrophy. | **+/-Cardiac hypertrophy. | ||
Other: | |||
*+/-Nasal septum perforation. | |||
*+/-Track marks (other drug use). | |||
*+/-Finger burns (during preparation of crack). | |||
*+/-Drug paraphernalia, e.g. crack pipe. | |||
====Ethylene glycol toxicity==== | ====Ethylene glycol toxicity==== | ||
:For a more general discussion see ''[[Crystals_in_body_fluids#Urine_crystals|urine crystals]]'' | :For a more general discussion see ''[[Crystals_in_body_fluids#Urine_crystals|urine crystals]]'' | ||
*Not done in routine toxicology screening. | *Not done in routine toxicology screening. | ||
*Birefringent calcium oxalate crystals found in kidney (with polarized light).<ref name=Ref_KFP589>{{Ref KFP|589}}</ref> | *Birefringent calcium oxalate crystals found in kidney (with [[polarized light]]).<ref name=Ref_KFP589>{{Ref KFP|589}}</ref> | ||
====Anaphylaxis==== | ====Anaphylaxis==== | ||
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Generally, these things are: | Generally, these things are: | ||
*Cardiovascular: | *Cardiovascular: | ||
**Arrhythmia. | **[[Cardiac arrhythmia|Arrhythmia]]. | ||
**Myocardial infarction. | **[[Myocardial infarction]]. | ||
**Haemorrhage. | **Haemorrhage. | ||
***Ruptured aneurysm. | ***Ruptured aneurysm. | ||
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*GI: | *GI: | ||
**Haemorrhage. | **Haemorrhage. | ||
***Esophageal varices. | ***[[Esophageal varices]]. | ||
***Gastric varices. | ***Gastric varices. | ||
*Neurologic: | *Neurologic: | ||
**Intracranial haemorrhage. | **Intracranial haemorrhage. | ||
***Ruptured aneurysm. | ***Ruptured aneurysm. | ||
***Spontaneous subdural | ***Spontaneous [[subdural hemorrhage]]. | ||
**Stroke: | **[[Stroke]]: | ||
***Haemorrhagic. | ***Haemorrhagic. | ||
***Thrombotic (more common than | ***Thrombotic (more common than hemorrhagic). | ||
=Forensic entomology= | =Forensic entomology= | ||
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*[http://cap-acp.org/forensic.cfm Forensic pathology (cap-acp.org)]. | *[http://cap-acp.org/forensic.cfm Forensic pathology (cap-acp.org)]. | ||
*[http://neurobio.drexelmed.edu/goldmanweb/forensicanthro/trauma.pdf Fractures (drexelmed.edu)]. | *[http://neurobio.drexelmed.edu/goldmanweb/forensicanthro/trauma.pdf Fractures (drexelmed.edu)]. | ||
*[http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ Mechanisms of death (forensicmed.co.uk)]. | |||
==Post-mortem changes== | ==Post-mortem changes== | ||
*[http://emedicine.medscape.com/article/1680032-overview Post-mortem changes (emedicine.medscape.com)]. | *[http://emedicine.medscape.com/article/1680032-overview#showall Post-mortem changes (emedicine.medscape.com)]. | ||
*[http://emedicine.medscape.com/article/1680107-overview#showall Autopsy of blunt force trauma (emedicine.medscape.com)]. | |||
*[http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html Post-mortem changes (the-crankshaft.info)]. | *[http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html Post-mortem changes (the-crankshaft.info)]. | ||
[[Category:Autopsy]] | [[Category:Autopsy]] | ||
[[Category:Forensic pathology]] | [[Category:Forensic pathology]] |
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