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| | accident | | | accident |
| | [[cardiac arrhythmia]] | | | [[cardiac arrhythmia]] |
| | man struck by lightening | | | man struck by lightning |
| |- | | |- |
| | Hyperthermia | | | Hyperthermia |
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| ====Word form for cause of death==== | | ====Word form for cause of death==== |
| Example:
| | 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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| ==Environmental== | | ==Environmental== |
| Includes:
| | {{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. | | *[[Electrocution]]. |
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| ===Hypothermia===
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| Features:<ref name=>{{cite journal |author=E. E. Türk, J. P. Sperhake, K. Pueschel and Michael Tsokos |title=An approach to the evaluation of fatal hypothermia |journal=Forensic Science, Medicine, and Pathology |volume=1 |issue=1 |pages=31–35 |year=2005 |month= |pmid= |doi= |url=http://www.springerlink.com/content/n785314u75m71j8h/fulltext.pdf}}</ref>
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| *Reddening of exposed skin areas "frost erythema" - '''classic feature'''.
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| *Wischnewski spots ([[AKA]] Leopard spots) - '''classic feature'''.
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| **Brown/black spots of the gastric mucosa ~ 0.1-0.4 cm; thought to represent pre-mortem/perimortem hemorrhage.<ref>{{cite journal |author=Tsokos M, Rothschild MA, Madea B, Rie M, Sperhake JP |title=Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia |journal=Am J Forensic Med Pathol |volume=27 |issue=1 |pages=70–4 |year=2006 |month=March |pmid=16501354 |doi=10.1097/01.paf.0000202716.06378.91 |url=http://journals.lww.com/amjforensicmedicine/Abstract/2006/03000/Histological_and_Immunohistochemical_Study_of.14.aspx}}</ref>
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| *Paradoxical undressing; decedent has removed clothes due to perception of being too hot.<ref name=pmid20151230>{{cite journal |author=Turk EE |title=Hypothermia |journal=Forensic Sci Med Pathol |volume=6 |issue=2 |pages=106–15 |year=2010 |month=June |pmid=20151230 |doi=10.1007/s12024-010-9142-4 |url=}}</ref>
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| Notes:
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| *Findings are often non-specific.<ref name=pmid16948514>{{cite journal |author=Nixdorf-Miller A, Hunsaker DM, Hunsaker JC |title=Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=9 |pages=1297–304 |year=2006 |month=September |pmid=16948514 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B1297%3AHAHMIO%5D2.0.CO%3B2}}</ref>
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| *Non-specific findings seen in hypothermia:<ref name=pmid16948514/>
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| **[[Pulmonary edema]].
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| **Hemorrhagic pancreatitis.
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| **Hemorrhage of the iliopsoas muscle.
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| *DDx of reddening of skin includes [[Carbon_monoxide toxicity|carbon monoxide poisoning]].
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| Image:
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| *[http://www.springerlink.com/content/n785314u75m71j8h/fulltext.pdf Wischnewski spots (springerlink.com)].
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| ===Hyperthermia===
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| Features:
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| *Findings are non-specific.<ref name=pmid16948514>{{cite journal |author=Nixdorf-Miller A, Hunsaker DM, Hunsaker JC |title=Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=9 |pages=1297–304 |year=2006 |month=September |pmid=16948514 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B1297%3AHAHMIO%5D2.0.CO%3B2}}</ref>
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| *Short survival:
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| **+/-Petechiae - serosal (pleural, epicardial, pericardial) and cerebral periventricular.
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| **+/-Cerebral edema.
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| *Long survival:
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| **Findings consistent with hypovolemic shock (hepatic [[necrosis]], cerebral edema, [[DAD]] in lung, acute [[pancreatitis]]).
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| **Clinical/biochemical: [[rhabdomyolysis]], [[DIC]], [[ATN]].
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| ===Electrocution===
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| ====General====
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| *May be missed - as can be subtle.
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| *Usually causes death by [[cardiac arrhythmia]].
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| *Typically accidents.<ref>{{Cite journal | last1 = Wick | first1 = R. | last2 = Gilbert | first2 = JD. | last3 = Simpson | first3 = E. | last4 = Byard | first4 = RW. | title = Fatal electrocution in adults--a 30-year study. | journal = Med Sci Law | volume = 46 | issue = 2 | pages = 166-72 | month = Apr | year = 2006 | doi = | PMID = 16683472 }}</ref>
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| *Occasionally used to suicide.<ref name=pmid19298463>{{Cite journal | last1 = Dokov | first1 = W. | title = Forensic characteristics of suicide by electrocution in Bulgaria. | journal = J Forensic Sci | volume = 54 | issue = 3 | pages = 669-71 | month = May | year = 2009 | doi = 10.1111/j.1556-4029.2009.01002.x | PMID = 19298463 }}</ref>
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| ====Gross features====
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| *Usually burns on the hands - brown.
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| **Typically absent if it happened in a wet environment.<ref name=pmid12062943>{{Cite journal | last1 = Karger | first1 = B. | last2 = Süggeler | first2 = O. | last3 = Brinkmann | first3 = B. | title = Electrocution--autopsy study with emphasis on electrical petechiae. | journal = Forensic Sci Int | volume = 126 | issue = 3 | pages = 210-3 | month = May | year = 2002 | doi = | PMID = 12062943 }}</ref>
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| *Focal injury suggestive of high voltage (> 1000 V).
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| *Lichtenberg figure = fern-like figure.
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| =====Image=====
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| <gallery>
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| Image:Lightning_injury.jpg | Lichtenberg figure. (WC)
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| </gallery>
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| ====Microscopic====
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| Features:
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| *Palisading of basal cells (like [[cautery artefact]]).
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| =Gunshot wounds= | | =Gunshot wounds= |
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| ==Scenarios== | | ==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. |
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| ===Descent from height=== | | ===Descent from height=== |
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| ===Aortic trauma=== | | ===Aortic trauma=== |
| *Classic location of injury is subclavian branch point.<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> | | *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. | | *[[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. |
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| ==Trauma with delayed death== | | ==Trauma with delayed death== |
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| *''Stab''. | | *''Stab''. |
| *''Chop'' - a mixed injury, sharp force and blunt force. | | *''Chop'' - a mixed injury, sharp force and blunt force. |
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| | ====Images==== |
| | <gallery> |
| | Image: Thorax-Messerstichwunden.jpg | Sharp force trauma - thorax. (WC) |
| | </gallery> |
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| =Head injuries= | | =Head injuries= |
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| :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> |
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| ====Anaphylaxis==== | | ====Anaphylaxis==== |