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Forensic Pathology

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Title: Forensic Pathology


1
Forensic Pathology
  • This is the place where death rejoices to teach
    those who live.

2
Introduction
  • A death that is unexpected or is thought to have
    been caused by injury or trauma is always
    investigated.
  • Coroner
  • Medical Examiner

3
Coroner vs. Medical Examiner
  • Coroner a public official, appointed or
    elected, who makes inquires into deaths and
    completes death certificates.
  • Determines cause/manner of death
  • Decides if foul play
  • May or may not have medical training

4
Coroner vs. Medical Examiner
  • Medical Examiner a physician, evaluates medical
    history and physical exam of deceased to
    determine cause and manner of death.
  • Must receive special training to become a
    forensic pathologist
  • Forensic Pathology unnatural or suspicious
    disease or injury
  • In most large US cities, the medical examiner is
    required to be a forensic pathologist.

5
Forensic Pathologist
  • Education and Training
  • Medical school 4 years
  • Post medical training
  • 3 to 5 year residency in general pathology
  • Additional year of training
  • In medical examiners office (forensic pathology)
  • American Board of Pathology Exam
  • Training / Knowledge in other areas of Forensics

6
  • In US 500 Forensic Pathologists
  • About 25 of the 500 also have LAW DEGREES

7
Deaths Investigated
  • Two Main Categories
  • 1. Persons who die suddenly when in apparent good
    health, those who are unexpected to die, or
    those who are without medical treatment for
    fatal diseases.
  • Public Health Threat (bacterial meningitus)
  • Death in public places (electrocution in public
    place)
  • Maternal Death
  • Death outside of medical facility

8
Deaths Investigated
  • 2. Deaths caused by unnatural causes
  • Examples
  • Acts of violence
  • Drug related
  • Trauma / Asphyxiation
  • Weather
  • Vehicular accident

9
Deaths Investigated
  • Special Categories
  • Under 18
  • Death of an individual under legally dependent
    care.
  • Death in correctional facility
  • On aircraft or ship
  • MURDERS ARE THE SMALLEST NUMBER OF DEATHS
    INVESTIGATED!

10
Three facets of guilt
  • Motive
  • Means
  • Opportunity

11
Medical Examiners Duties
  • Review eyewitness statements
  • Examine crime scene
  • Autopsy
  • Photography
  • Report
  • Testimony

12
Duties and Responsibilities
  • Establish the cause of death
  • Establish the time of death
  • Infer the type of weapon used
  • Determine the manner of death
  • Identify the deceased
  • Determine the effects of trauma or pre-existing
    conditions.

13
Postmortem Lividity(Livor Mortis)
  • The Settling of blood that causes the skin to
    change color

14
30 Minutes
  • Changes in skin color first appear
  • on fair-skinned persons

15
4 to 8 hours
  • The blood in capillaries settles
  • PERMANENTLY

16
Between 1 and 8 hours
  • (1) Blanching

Light-colored marks made by finger pressure
17
(2)
  • Where a trained investigator will begin..

18
Why livor mortis is important
  • Has
    the body been moved?

19
Rigor Mortis
  • The period of time that a body goes through a
    state of Rigidity
  • Caused by lactic acid build-up in the body.

20
Rigor Mortis Progression
  • Shorter muscles face, fingers, toes

21
  • Neck

22
  • Then moves down and out the long muscles of the
    legs and forearms

23
  • Legs stiffen last

24
Rigor MortisTime-line
  • 1-4 hours Jaw and neck rigid, rest of body
    limp
  • Up to 8 hours everything down to the legs is
    rigid
  • For 12 hours everything remains rigid
  • 24 hours Jaw is limp, everything else is rigid
  • 30-32 hours everything but the legs are limp
  • 36 hours entire body is limp (no rigidity)
    decomposition has begun

25
Circumstances affecting Rigor Mortis
  • Starvation

26
  • Extreme temperatures

27
  • Physical exertion

28
  • Effects of fire

29
  • or water (in the case of drowning)

30
Decomposition
  • Bacteria Co2 is produced, abdominal swelling

31
  • Blood vessels
  • discoloration of skin in upper abdomen
  • marbling effect
  • Red ? darker red ? purple ? green

32
  • Putracine foul- smelling, nauseating odors

33
Algor Mortis
  • Either Liver temperature (LT)
  • or Rectal Temperature (RT)
  • Drop of about
  • 2 degrees
  • per hour

34
  • Factors affecting temperature loss
  • Size (mass) of body
  • Body Temperature at death
  • Temperature of crime scene

35
The Autopsy Examination
  • You've got to be the type of person who can
    emotionally disconnect from it. I mean, if you
    went into a case looking at it as, 'Geez, this is
    somebody's little girl or somebody's little boy,'
    you'd never be able to do the case. You can't
    personalize it in any way... When you walk in,
    you never forget that this is somebody's loved
    one. You never forget that, but when you walk in
    to do the job, you kinda put that information
    aside. You look at them more as a puzzle, and
    your job is to sort out this puzzle.
  • I've got to find out what happened. Who, what,
    why, when, where. I mean, that's what my job is,
    to sort out and get those answers. And, do it in
    a respectful way.
  • A lot of people can't do this type of job. A
    lot of people don't want to do this type of job.
    There are a lot of jobs I wouldn't want to do
    either.
  • Eric Kiesel
  • Atlanta's Fulton County Deputy Chief Medical
    Examiner

36
HISTORY OF AUTOPSY
  • EGYPTIONS
  • 1600 BCE
  • HIPPOCRATES
  • 5TH 4TH CENTURY BCE

37
  • AUTOPSIES TO DETERMINE THE CAUSE OF DEATH

38
The Autopsy Examination
  • Legality
  • Permission required family can request an
    autopsy be performed (usually free)
  • Next of kin must sign autopsy permit.
  • Religious considerations
  • Mandatory when death is suspicious of foul play
    or if public health concern (in most states)

39
The Autopsy Examination
  • Attending Personnel
  • Diener autopsy assistant
  • Prosector - pathologist
  • Pathologist Assistant
  • Precautions protective
  • clothing

40
The Autopsy Examination
  • The External Exam done first when body is
    examined.
  • Looking for
  • Wounds
  • Contusions (Bruises)
  • Unusual marks on the body
  • Overall impression of the body

41
Forensic Autopsy
An intensive search for information To locate
PHYSICAL EVIDENCE to determine the cause of death
42
The Autopsy Examination
  • At this point, a general description of the body
    is made. All identifying features are noted
    including
  • Race
  • Sex
  • Hair color and length
  • Eye color
  • Approximate age
  • Any identifying features (scars,tattoos, etc.)

43
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44
The Autopsy Examination
  • Opening the Body
  • Y-incision incision made from left and right
    shoulders to mid-chest and straight down to pubic
    region.

45
  • No bleeding (usually) because there is no blood
    pressure.
  • If head is to be opened, an incision is made
    across the head from one ear to the other.

-----------------------------------------
46
The Autopsy Examination
  • Rib cage is cut at the cartilage that joins the
    ribs to the breastbone with a scalpel, saw or
    knife to enter the chest cavity. Soft tissue
    peeled back to look for abnormalities.

47
  • Chest plate (ribs and breastbone) are removed and
    examined. Often fractured during CPR.

48
Skull is cut in front and back for removal.
49
The Autopsy Examination
  • Removing and Examination of the Organs
  • Each organ is removed, photographed and weighed.
    Organs are usually dissected and slides prepared
    to look for disease or irregularities.

50
THE HEART
Checked for TRAUMA
51
Pulmonary artery
52
  • The pulmonary arteries carry blood from the heart
    to the lungs.

They are the only arteries (other than umbilical
arteries in the fetus) that carry deoxygenated
blood.
53
  • Looking for a blood clot that has dislodged from
    a vein traveling through the heart
  • To the pulmonary artery SUDDEN DEATH

54
Blood samples are taken from the AORTA
  • Blood-typing and Blood/Alcohol test

55
Larynx and Trachea
Food lodged in trachea
Checked for food bolus (choking)
56
Lungs
57
Drowning
58
Diatoms
lungs
stomach
Blood stream
Bone marrow
59
Heroin Use
Carbonate crystals
Used to mix heroin
Will be found in the lungs
60
Death in fires
If alive During Fire there Will be soot and
ash in the Trachea Bronchi And Lungs
61
  • If CO2 levels in blood are greater than
    2
  • The victim was alive at the onset of the fire

62
Samples taken
  • CO2 and other
  • gases in lungs
  • Microscopic slides

63
Liver
64
Liver
  • A healthy liver
  • Soft, pliable, vulnerable to blunt-force trauma

65
Cirrhotic Liver
  • Caused by hepatitus, malnutrition, drug alcohol
    use

66
Jaundiced Liver
67
Kidneys filter blood
68
The Kidney Punch
  • A World Boxing Association foul

69
Drug use
  • Drug addicts who have a cirrhotic liver
  • cannot metabolize proteins
  • Toxins pass out of the liver and
  • Damage kidneys

70
Diseased Kidneys
Jaundiced kidneys
Polycystic liver
71
Stomach
  • Important in drug-overdose cases
  • Helps establish activities prior to death

72
  • POISONS
  • CYANIDE
  • -red color of organs
  • -almond-like odor
  • (only 50 of pop can detect the odor)
  • -KCN used for executions

73
Estimated time of death
  • If TIME OF MEAL and MENU are known

74
Intestines
Location of food can help determine time of death
75
Pair swallows 850 g cocaine..
  • Katriya Connor, 23, a chef from Waterloo in
    Liverpool, became violently ill on a flight from
    Cancun in Mexico to Birmingham on February 6,
    after scores of packets of cocaine that she had
    swallowed burst in her stomach. She died within
    hours on an airport runway in the Azores, where
    the flight had been diverted, while paramedics
    desperately tried to save her life. A 21-year-old
    man, apparently travelling with Ms Connor, also
    fell into a coma on the flight and remains
    seriously ill on the island.
  • (from The Guardian)

76
Stomach of drug mule
Drug packets in rectum area
77
Bladder
URINE SAMPLE
78
Reproductive Organs
Inspected for pregnancy
(Teenage suicide)
79
The Brain
80
Removal of Brain
81
A blood clot caused by a blow to the head can
be fatal
82
Formaldehyde fixes the brain for better
dissection
83
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84
Autopsy Conclusion
85
  • Samples are obtained of bodily fluids and sent to
    toxicology for examination.
  • Blood
  • Urine
  • Bile

86
Manner and Cause of Death
  • Mechanism biochemical or physiological
    abnormality produced by the cause of death that
    is incompatible with life.
  • Manner of Death homicide, suicide, natural
    causes, accidental or undetermined.
  • Cause disease or injury that initiated the
    lethal chain of events that lead to death

87
Manner of Death
  • homicide
  • Suicide
  • accidental trauma occurring from acts
  • NO REASONABLE person
  • would have felt have a high probability
  • of injury or death
  • natural cause
  • undetermined

88
Determination of Cause of Death
  • One can die of a massive hemorrhage (the
    mechanism of death) due to a gunshot wound
    through the head (the cause of death) as a result
    of being shot (homicide), shooting yourself
    (suicide), dropping the gun and it discharging
    (accidental), or not being able to tell how it
    occurred (undetermined). All of which are manners
    of death.

89
Causes of Death
  • Brain Damage
  • Subdural hematoma

90
  • Brain Damage Subarachnoid hematoma

91
Brain Damage
  • Intracerebral hematoma

92
Suffocation
93
Positional Asphyxiation
94
Positional Asphyxiation
95
SADS
96
Choking
97
Drowning
  • Vomitos amigos Drug/alcohol

  • Intoxication

98
Neck Injuries
  • Strangulation
  • accidental

  • suicide
  • homicide

99
Petechial hemorrhage
  • Ruptures in the tiny capillaries

100
Hyoid Bone
101
Hanging
  • Nature of rope and knots

102
Suicide by hanging
Female suicide
Male suicide
103
Jugular vein
  • On average, blood accounts for 8 of total body
    weight 5 to 6 liters of blood for males
  • 4 to 5 liters of blood for females A 40
    percent blood loss results in death.
  • The loss of 1.5 L can
  • cause incapacitation.

Jugular vein
104
Stab Wounds Sharp Force Trauma
  • Type of knife used (width, length, single or
    double-edged)
  • Stabbing wounds
  • Slicing wounds

105
Blunt Force Trauma
  • Caused by being struck by a flat surface

106
Gunshot Wounds
107
International Gun Statistics
108
Classification of Traumatic Death
  • Four Categories
  • Thermal
  • Chemical
  • Electrical
  • Mechanical
  • Asphyxiation interference of oxygen to brain
  • Can be caused by all mechanisms

109
Mechanical Trauma
  • Blunt or Sharp
  • Penetrating or Non-penetrating
  • Mechanical Trauma occurs when the applied
    physical force exceeds tensile strength of the
    tissue, causing lacerations (blunt force) or
    incised wounds (sharp)

110
Mechanical Trauma
  • Sharp Force Trauma
  • Most common cause of death exsanguination
  • Major arteries or the heart are damaged
  • Blunt Force Trauma
  • Cause contusions or lacerations
  • Most common cause of death significant damage
    to brain or internal bleeding

111
Mechanical Trauma
  • Firearm Injury
  • Contact wound blackening of skin around wound
    (gas burns skin), small in size
  • Distant wound circular skin defect and rim of
    abraded skin around the edges
  • Exit wound is larger and more irregular than
    entry wound.

112
Chemical Trauma
  • Death that results from drugs or poisons
  • Alcohol most common drug that causes death
  • Rarely kills directly, but contributes to about
    50 of traumatic deaths.
  • Other chemicals
  • Drugs
  • Carbon Monoxide
  • Cyanide / Arsenic (poisons)

113
Thermal Trauma
  • Exposure to excessive heat or cold
  • Hypothermia excessive cold
  • Hyperthermia excessive heat
  • Causes death via a breakdown in the normal
    mechanisms that maintain body temperature.
  • Thermal Burns death usually occurs as a result
    of complications (shock mechanism multiple
    organ failure)
  • Cause of death in fires inhalation of CO, not
    burns

114
Electrical Trauma
  • Passage of electricity through a person
  • Low Voltage heart experiences ventricular
    fibrillation (quivering of the heart beats
    faster than the body can handle)
  • High Voltage forces heart into tetany, a
    contraction that is broken when the circuit is
    broken. Heart generally starts again with a
    normal rhythm
  • Loss of limbs or electrical burns are possible
    within seconds of shock.
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