48,702
edits
m (→Natural deaths: w) |
m (→Death categorization: fix word 'lightning') |
||
(39 intermediate revisions by 2 users not shown) | |||
Line 12: | Line 12: | ||
!Scenario | !Scenario | ||
|- | |- | ||
|[[Electrocution]] | | [[Electrocution]] | ||
|accident | | accident | ||
|cardiac arrhythmia | | [[cardiac arrhythmia]] | ||
|man struck by | | man struck by lightning | ||
|- | |- | ||
|Hyperthermia | | Hyperthermia | ||
|accident | | 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> | | 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 | | man lost on hiking trip in desert | ||
|- | |- | ||
|[[Epidural hemorrhage]] due to [[blunt force trauma]] to the head | | [[Epidural hemorrhage]] due to [[blunt force trauma]] to the head | ||
|homicide | | homicide | ||
|brain stem compression or cerebral vascular spasm leading to autonomic dysregulation | | brain stem compression or cerebral vascular spasm leading to autonomic dysregulation | ||
|man hit with a hammer in the head | | man hit with a hammer in the head | ||
|- | |- | ||
|[[Carbon monoxide toxicity]] | | [[Carbon monoxide toxicity]] | ||
|suicide | | suicide | ||
|cerebral hypoxia (CO binds to hemoglobin impairing oxygen transport) | | cerebral hypoxia (CO binds to hemoglobin impairing oxygen transport) | ||
|woman found in car with suicide note, long history of depression | | woman found in car with suicide note, long history of depression, previous suicide attempts | ||
|- | |- | ||
|[[Atherosclerotic heart disease]] | | [[Atherosclerotic heart disease]] | ||
|natural | | natural | ||
|cardiac arrhythmia due to ischemia | | cardiac arrhythmia due to ischemia | ||
|man | | 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== | ==Manner of death== | ||
The manner of death is a legislatively defined classification. It varies slightly between jurisdictions. | |||
<!-- | <!-- | ||
MANNER OF DEATH | MANNER OF DEATH | ||
Line 66: | Line 77: | ||
*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> | ||
Line 75: | Line 86: | ||
*''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 of death|mechanism]] is irrelevant. | *The [[mechanism of death|mechanism]] is irrelevant. | ||
Line 130: | Line 141: | ||
**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. | ||
Line 240: | Line 251: | ||
=Wounds= | =Wounds= | ||
==General== | ==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: | Special types of wounds: | ||
Line 246: | Line 257: | ||
*Incised wounds - see [[sharp force trauma]]. | *Incised wounds - see [[sharp force trauma]]. | ||
===Gross pathologic classification of | ===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> | ||
Line 260: | Line 271: | ||
*#"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> | *#"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: | ||
Line 319: | Line 335: | ||
Features: | Features: | ||
*Fragmentation of bone. | *Fragmentation of bone. | ||
*+/-Dead bone = lacunae have no osteocytes. | *+/-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. | *+/-Inflammatory cells. | ||
*+/-Hemosiderin-laden macrophages. | *+/-Hemosiderin-laden macrophages. | ||
Line 430: | Line 447: | ||
==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= | ||
Line 520: | Line 491: | ||
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. | ||
Line 529: | Line 500: | ||
==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. | |||
===Descent from height=== | ===Descent from height=== | ||
Line 561: | Line 533: | ||
*Bite marks, as evidence, have a limited value for identification purposes. | *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> | **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=== | ===Aortic trauma=== | ||
*Classic location of | *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. | ||
==Trauma with delayed death== | ==Trauma with delayed death== | ||
Line 586: | Line 563: | ||
**"Clean" edge (no contusion, no abrasion). | **"Clean" edge (no contusion, no abrasion). | ||
**Well-demarcated edges. | **Well-demarcated edges. | ||
*+/-Hilt mark. | |||
**Due to contact of hilt. | |||
Subclassified into - see ''[[Wounds|classification of wounds]]'': | Subclassified into - see ''[[Wounds|classification of wounds]]'': | ||
Line 591: | Line 570: | ||
*''Stab''. | *''Stab''. | ||
*''Chop'' - a mixed injury, sharp force and blunt force. | *''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= | ||
Line 649: | Line 633: | ||
===Stains=== | ===Stains=== | ||
*[[ | *[[Bielschowsky stain]] to highlight axonal swellings - appear 12-18 hours after injury.<ref name=Ref_Shkrum_562>{{Ref Shkrum|562}}</ref> | ||
===IHC=== | ===IHC=== | ||
*Beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref><ref name=pmid17368446>{{Cite journal | last1 = Mac Donald | first1 = CL. | last2 = Dikranian | first2 = K. | last3 = Song | first3 = SK. | last4 = Bayly | first4 = PV. | last5 = Holtzman | first5 = DM. | last6 = Brody | first6 = DL. | title = Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. | journal = Exp Neurol | volume = 205 | issue = 1 | pages = 116-31 | month = May | year = 2007 | doi = 10.1016/j.expneurol.2007.01.035 | PMID = 17368446 | PMC = 1995439 }}</ref> | *Beta-amyloid precursor protein (beta-APP ''or'' APP).<ref name=pmid10050789>{{cite journal |author=Gleckman AM, Bell MD, Evans RJ, Smith TW |title=Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining |journal=Arch. Pathol. Lab. Med. |volume=123 |issue=2 |pages=146–51 |year=1999 |month=February |pmid=10050789 |doi= |url=}}</ref><ref name=pmid17368446>{{Cite journal | last1 = Mac Donald | first1 = CL. | last2 = Dikranian | first2 = K. | last3 = Song | first3 = SK. | last4 = Bayly | first4 = PV. | last5 = Holtzman | first5 = DM. | last6 = Brody | first6 = DL. | title = Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. | journal = Exp Neurol | volume = 205 | issue = 1 | pages = 116-31 | month = May | year = 2007 | doi = 10.1016/j.expneurol.2007.01.035 | PMID = 17368446 | PMC = 1995439 }}</ref> | ||
Line 780: | Line 765: | ||
===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> | ||
Line 849: | Line 835: | ||
: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==== | ||
Line 864: | Line 850: | ||
Generally, these things are: | Generally, these things are: | ||
*Cardiovascular: | *Cardiovascular: | ||
**Arrhythmia. | **[[Cardiac arrhythmia|Arrhythmia]]. | ||
**Myocardial infarction. | **[[Myocardial infarction]]. | ||
**Haemorrhage. | **Haemorrhage. | ||
***Ruptured aneurysm. | ***Ruptured aneurysm. | ||
Line 874: | Line 860: | ||
*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= |
edits