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Difference between revisions of "Forensic pathology"
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==Forensic triangle== | ==Forensic triangle== | ||
Most general differential diagnosis: | Most general differential diagnosis: | ||
*Natural | *Natural: | ||
** | **Infection (e.g. pneumonia), | ||
** | **Infarction (e.g. MI), | ||
** | **Haemorrhage (e.g. cerebral, GI). | ||
*Toxic | *Toxic: | ||
**EtOH, | **EtOH, | ||
** | **Illicit (e.g. cocaine, heroin, LSD), | ||
**Rx, | **Rx, | ||
** | **Over-the-counter (OTC) (e.g. acetaminophen, warfarin), | ||
** | **Poisons. | ||
*Trauma | *Trauma: | ||
** | **Gunshot wound (GSW), | ||
** | **Blunt force trauma, | ||
** | **Sharp force trauma, | ||
** | **Asphyxial, | ||
** | **Environmental (e.g. hypothermia, hyperthermia, drowning, lack of oxygen). | ||
Difficulties arise when more than one point of the triangle is in play, i.e. the forensic pathologist has to earn their pay when an old man with a heart condition is known to be into erotic asphyxia, and dies after doing some drugs and whilst indulging in erotic asyphxiation with a friend... | Difficulties arise when more than one point of the triangle is in play, i.e. the forensic pathologist has to earn their pay when an old man with a heart condition is known to be into erotic asphyxia, and dies after doing some drugs and whilst indulging in erotic asyphxiation with a friend... | ||
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Its onset & presence is '''highly variable'''. Therefore, it is only marginally useful for determining the time of death. | Its onset & presence is '''highly variable'''. Therefore, it is only marginally useful for determining the time of death. | ||
A crude guess for time of death based on rigor:<ref> | A crude guess for time of death based on rigor:<ref>KFP 3rd Ed., P.61.</ref> | ||
* | *Warm & flaccid <3 h. | ||
* | *Warm & stiff 3-8 h. | ||
* | *Cold & stiff 8-36 h. | ||
* | *Cold & flaccid > 36 h. | ||
===Livor mortis=== | ===Livor mortis=== | ||
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*Lung emphysema. | *Lung emphysema. | ||
*Froth in the trachea. | *Froth in the trachea. | ||
*Patlauf spots<ref name=pmid12134758> | *Patlauf spots<ref name=pmid12134758>{{cite journal |author=Bohnert M, Ropohl D, Pollak S |title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] |language=German |journal=Arch Kriminol |volume=209 |issue=5-6 |pages=158–64 |year=2002 |pmid=12134758 |doi= |url=}}</ref> -- ??? | ||
===Micro/Lab=== | ===Micro/Lab=== | ||
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===Diffuse axonal injury=== | ===Diffuse axonal injury=== | ||
General: | General: | ||
*Hypothesized to arise from high shear loading of white mater tracts.<ref name=pmid2769276> | *Hypothesized to arise from high shear loading of white mater tracts.<ref name=pmid2769276>{{cite journal |author=Blumbergs PC, Jones NR, North JB |title=Diffuse axonal injury in head trauma |journal=J. Neurol. Neurosurg. Psychiatr. |volume=52 |issue=7 |pages=838–41 |year=1989 |month=July |pmid=2769276 |pmc=1031929 |doi= |url=}}</ref> | ||
Macroscopic findings:<ref name=pmid2769276/> | Macroscopic findings:<ref name=pmid2769276/> | ||
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==Excited delirium== | ==Excited delirium== | ||
General: | General: | ||
*Also known as "agitated delirium".<ref name=pmid8768172> | *Also known as "agitated delirium".<ref name=pmid8768172>{{cite journal |author=Wetli CV, Mash D, Karch SB |title=Cocaine-associated agitated delirium and the neuroleptic malignant syndrome |journal=Am J Emerg Med |volume=14 |issue=4 |pages=425–8 |year=1996 |month=July |pmid=8768172 |doi= |url=}}</ref> | ||
*Dx is considered controversial, especially outside of the forensic pathology community.<ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2374865 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2374865]</ref> | *Dx is considered controversial, especially outside of the forensic pathology community.<ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2374865 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2374865]</ref> | ||
*The diagnosis has garnered considerable attention in the context of electroshock weapon use, as ''Taser International'' (a manufacturer of electroshock weapons) has blamed all deaths involving its weapons on it. | *The diagnosis has garnered considerable attention in the context of electroshock weapon use, as ''Taser International'' (a manufacturer of electroshock weapons) has blamed all deaths involving its weapons on it. | ||
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==Toxicology== | ==Toxicology== | ||
===Cocaine=== | ===Cocaine=== | ||
*No agreed upon toxic dose.<ref name=pmid15075681> | *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) | ||
*Chronic use may lead to cardiac enlargement. | *Chronic use may lead to cardiac enlargement. | ||