Environmental causes of death
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This article deals with environmental causes of death.
They include:
- Hypothermia.
- Hyperthermia.
- Drowning - see asphyxial deaths.
- Lack of oxygen - see asphyxial deaths.
- Electrocution.
Hypothermia
Features:[1]
- Reddening of exposed skin areas "frost erythema" - classic feature.
- Wischnewski spots (AKA Leopard spots) - classic feature.
- Brown/black spots of the gastric mucosa ~ 0.1-0.4 cm; thought to represent pre-mortem/perimortem hemorrhage.[2]
- Paradoxical undressing; decedent has removed clothes due to perception of being too hot.[3]
Notes:
- Findings are often non-specific.[4]
- Non-specific findings seen in hypothermia:[4]
- Pulmonary edema.
- Hemorrhagic pancreatitis.
- Hemorrhage of the iliopsoas muscle.
- DDx of reddening of skin includes carbon monoxide poisoning.
Image:
Hyperthermia
Features:
- Findings are non-specific.[4]
- Short survival:
- +/-Petechiae - serosal (pleural, epicardial, pericardial) and cerebral periventricular.
- +/-Cerebral edema.
- Long survival:
- Findings consistent with hypovolemic shock (hepatic necrosis, cerebral edema, DAD in lung, acute pancreatitis).
- Clinical/biochemical: rhabdomyolysis, DIC, ATN.
Electrocution
General
- May be missed - as can be subtle.
- Usually causes death by cardiac arrhythmia.
- Typically accidents.[5]
- Occasionally used to suicide.[6]
Gross features
- Usually burns on the hands - brown.
- Typically absent if it happened in a wet environment.[7]
- Focal injury suggestive of high voltage (> 1000 V).
- Lichtenberg figure = fern-like figure.
Image
Lichtenberg figure. (WC)
Microscopic
Features:
- Palisading of basal cells (like cautery artefact).
See also
References
- ↑ E. E. Türk, J. P. Sperhake, K. Pueschel and Michael Tsokos (2005). "An approach to the evaluation of fatal hypothermia". Forensic Science, Medicine, and Pathology 1 (1): 31–35. http://www.springerlink.com/content/n785314u75m71j8h/fulltext.pdf.
- ↑ Tsokos M, Rothschild MA, Madea B, Rie M, Sperhake JP (March 2006). "Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia". Am J Forensic Med Pathol 27 (1): 70–4. doi:10.1097/01.paf.0000202716.06378.91. PMID 16501354. http://journals.lww.com/amjforensicmedicine/Abstract/2006/03000/Histological_and_Immunohistochemical_Study_of.14.aspx.
- ↑ Turk EE (June 2010). "Hypothermia". Forensic Sci Med Pathol 6 (2): 106–15. doi:10.1007/s12024-010-9142-4. PMID 20151230.
- ↑ 4.0 4.1 4.2 Nixdorf-Miller A, Hunsaker DM, Hunsaker JC (September 2006). "Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes". Arch. Pathol. Lab. Med. 130 (9): 1297–304. PMID 16948514. http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B1297%3AHAHMIO%5D2.0.CO%3B2.
- ↑ Wick, R.; Gilbert, JD.; Simpson, E.; Byard, RW. (Apr 2006). "Fatal electrocution in adults--a 30-year study.". Med Sci Law 46 (2): 166-72. PMID 16683472.
- ↑ Dokov, W. (May 2009). "Forensic characteristics of suicide by electrocution in Bulgaria.". J Forensic Sci 54 (3): 669-71. doi:10.1111/j.1556-4029.2009.01002.x. PMID 19298463.
- ↑ Karger, B.; Süggeler, O.; Brinkmann, B. (May 2002). "Electrocution--autopsy study with emphasis on electrical petechiae.". Forensic Sci Int 126 (3): 210-3. PMID 12062943.