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1
Q

SIDS: definition

A
  • under 1

- remains unexplained after autopsy, death scene and clinical history

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2
Q

SIDS: characteristics

A
  • Low ses
  • male
  • premature
  • winter months
  • most common in 1-2 months old
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3
Q

SIDS: mother characteristics

A
  • single
  • smoker
  • high parity
  • infection in pregnancy
  • short inter-pregnancy interval
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4
Q

SIDS: mechanisms

A
  • many diff causes, often multifactorial

- Act via a final common pathway of cardioresp failure

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5
Q

SIDS: risk factors

A
  • prone sleeping
  • cigarette smoke exposure
  • covering the head
  • overheating
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6
Q

SIDS: triple risk model

A
  • predisposed infant
  • vulnerable period
  • external stresses
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7
Q

Bruising

A
  • can’t be used for age estimation
  • although, yellow bruise may be more than 18 hours old
  • bruising can occur after death
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8
Q

Incised Wound

A
  • longer than it is deep
  • less likely to effect organs
  • usually bleeding is serious complication
  • if sharp, no bruising or abrasion around wound
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9
Q

Knife Injuries

A
  • single edged blade said to give a V at one end of the wound and a blunt end at the other
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10
Q

Self Inflicted Wounds

A
  • usually multiple
  • No of premil trial or hesitance cuts
  • throat, wrists, front of chest and abdomen, thighs
  • uniform depth
  • superficial or minor
  • similar appearance, style and orientation
  • injuries are grouped on the contralateral side to the patients handedness
  • old healed scars in similar sites
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11
Q

FSSA Departments

A
  1. chem
  2. biology
  3. forensic pathology
  4. toxicology
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12
Q

forensic anthropology

A
  • missing people
  • recently deceased
  • incomplete or partial remains
  • DVI
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13
Q

Haemastix

A
  • detection of blood

- strip used by doctors to test for blood in urine

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14
Q

Polilight

A
  • can locate semen, saliva and blood
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15
Q

Sexual Assault

A
  • 17% of women and 5% of men experience sexual assault

- 19% of adult women report to police

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16
Q

Process

A
  1. assessment
  2. control
  3. preservation
  4. examination
  5. interpretation
  6. recording
  7. collection
  8. case management
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17
Q

Factors that may influence the condition of the body

A
  • fresh vs salt water
  • tidal or non-tidal water
  • presence of predators
  • water temp
  • clothing
  • type of surface at the base of the water
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18
Q

Postmortem findings of drowning

A
  • Washer womans hand
  • Skin degloving
  • Loss of pigment in skin
  • bloating of the body
  • Froth around nose and mouth***
  • haemolytic staining of the aorta (fresh water)
  • water in the stomach
  • Haemorrhage in middle ears
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19
Q

Diatoms

A
  • Microscopic algae

- Found in brain, kidneys and bone marrow

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20
Q

Burns: who is most effected?

A
  • young children
  • males (largely occupational)
  • Older people
  • aboriginal and torres strait island people
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21
Q

Key Chemicals in Drug Manufacturing

A
  • Iodine
  • Hypophosporous acid
  • red phosphorus
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22
Q

Fresh water drowning

A
  • absorbed in circulation (through osmosis): results in dilution of blood -> swelling and rupture of rbcs -> liberation of potassium -> death from hyprekalamemia
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23
Q

Salt water drowning

A
  • water from blood into lungs -> thickening of blood -> failure of circulation
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24
Q

Immediate death due to burn injury

A
  • direct thermal injury: fluid loss, hypovolemia, shock, acute renal failure
  • thermal injury to airways
  • inhalation of toxic gases
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25
Delayed death due to burn injury
- ongoing fluid loss with shock and renal failure - resp failure due to damaged resp epithelium - sepsis - pulmonary embolism
26
Hyperthermia: Predisposing factors
- extremes of age - co existing illnesses - drugs - obesity
27
Hyperthermia: autopsy findings
- non-specific - vitreous electrolytes can confirm renal failure and dehydration - if the deceased is found shortly after death, a core bosy temp (along with environment temp) can assist the diagnosis
28
Fire: Postmortem findings
- presence of soot below the level of the vocal cords - thermal injury of the epithelial lining of the vocal cords - blood samples to detect levels of carboxyhaemaglobin (although can be effecting by other factors eg. smoking)
29
Mechanism of death during fire
- not usually due to burns - usually exposure to products of combustion - and/or inhalation of hot air/gases
30
Hypothermia: Predisposing Factors
- extremes of age - sex: males more susceptible - thin - immersion of water - alcohol: vasodilation -> increase heat radiation
31
Effect of Hypothermia
- ability to shiver lost - cerebral function impaired - ECG changes - Pulse slows - Cardiac arrhythmia - Death
32
Hypothermia: autopsy findings
- cherry red lividity - Pinkish discolouration over large joints - Wischnewsky spots: gastric erosions of the lining of the stomach (not specific to hypothermia) - Paradoxical undressing - Haemorrhagic pancreatitis - Pneumonia - Acute tubular necrosis - Myofibre degeneration/necrosis
33
Electrocution: effect depends on
- voltage - available current - alternating or direct current - resistance - path through body
34
Electrical lesion
- collapsed blister surrounded by a pale area then a red rim - although if immersed in water, there may by no signs - internally there are no characteristics findings in fatal electrocution - 'streaming of nuclei' was thought to be characteristic but has been seen in other injuries too
35
causes of death: electrocution
- primary: cardiac (at least 40Amps), resp arrest, CNS effects - Secondary: trauma, burns
36
SIDS autopsy findings
- 70% of cases: intrathoracic petechiae on the pleura, epicardium and thymus
37
SIDS: conclusions
- not 'A' disease with 'A' cause - end point of a number of diff factors - external and internal - these may be different for different babies
38
Laceration
- bruised and crushed margins | - tissue strands or bridges in depths of wound
39
Semi-automatic
- single bullet when trigger is pulled
40
Automatic
- fires bullets as long as its trigger is squeezed eg/ machine guns
41
Rifle
- long-barrelled with grove to give bullets spin - more accurate and powerful than handuns - can be single action, semi-automatic or fully automatic
42
Shotguns
- Smooth bore - Similar appearance to rifle but doesn't have rifling inside the barrel - Shell contains one large projectile (slug) and pellets
43
Gunshot Injuries
- Discharging a firearm will result in formation of smoke, flame and gases of combustion
44
Forensic Odontology: services summary
- identification - oro-facial trauma - opinion on dental issues - training
45
Dental Identification
- highly individual - resist destruction - existence of dental data - rapid - although, shouldn't compare to photos of teeth
46
Coroner
- investigates deaths - +/- an inquest - determines cause and manner of death
47
Reportable Deaths
- Unexpected, unnatural, unusual, violent or known - Death within 24 hrs of a surgical procedure or having an anaesthetic - Death within 24 hours after being discharged from hospital or seeking emergency medical treatment
48
Causes of Asphyxia
1. reduced oxygen in environment 2. reduced air/oxygen intake 3. reduced oxygen transport 4. reduced oxygen utilisation by tissues
49
Reduced Oxygen in environment
- Displacement of oxygen: sewers and pits, suicide by inert gas - Consumption of oxygen: sealed space and flash fires - Altitude
50
Reduced air/oxygen intake
Obstruction/covering of mouth Blockage of internal airways: choking, disease (acute epiglottis), compression of the neck (about 15kgs to collapse trachea) Restriction of chest wall movement: crush, disease of muscles/nerves, drugs Impaired lung function: pneumonia
51
Reduced oxygen transport
Cardiac failure Anaemia Poisoning of haemoglobin (CO)
52
Diagnosis of Asphyxia
- Special tests: O2 levels drop and CO2 builds up, poisons: CO, cyanide - Post mortem examination: 'quintet of features' petechiae, cyanosis, facial congestion, fluid heart blood, right heart congestion - although not specific to asphyxia - Diagnosis requires integration of scene, post-mortem findings and other tests (tox)
53
Throttling
- Manual strangulation - compression of veins in the neck results in petechiae and congestion - External: bruises on neck, fingernail abrasions, petechiae - Internal: bruising in muscles and tissues of neck, fractures of hyoid bone (greater wings), thyroid cartilage (superior horns)
54
Hanging Features
- Complete suspension: if sufficient compressive force to compress arteries of neck there is no congestion - petechiae absent - Low/partial suspension: if incomplete/less compressive force - petechiae may be present
55
Possible mechanisms of death in hanging
- Compression of veins causing congestion of head stagnating flow - Compression of carotid arteries depriving brain of blood - Compression of airway - considered less likely - Displacement of larynx upwards, causing epiglottis ot be closed over larynx - Carotid reflex
56
Carotid Reflex
- at point of bifurcation of carotid artery there is a receptor for BP - External pressure may 'fool' sensor into thinking BP is high - Pressure on the bifurcation can cause the heart to slow and BP to fall - Some individuals have a very sensitive receptor area and pressure on both sides can stop heart
57
Crush Asphyxia
- Intense congestion upper chest, into neck and head with petechiae - Disruption of superior vena cava - Delineation line of crushing object may be seen - Weight on body: prevents movement of chest - prevents breathing, compresses chest - impairs blood return to the heart
58
Smothering
- May see blanching of skin under area of object used to perform smothering - May have injuries on mouth - Typically no findings
59
Asphyxia: Key Points
- There are no specific signs of 'asphyxia' - Petechiae occur due to increased capillary pressure (congestion), not hypoxia - 'Asphyxial death' covers a range of conditions, in some (eg. hanging) airway obstruction may not be the main factor - Diagnostic tests exist for only a small no of specific conditions eg. CO poisoning - Diagnosis often requires integration of scene, autopsy, other findings (eg. toxicology) - A high degree of suspicion should be maintained in vulnerable groups
60
DVI: Phase 1 - The scene
- scene photographed - positioning of bodies recorded - human remains are labelled, recovered and transported
61
DVI: Phase 2 - post mortem
- body is photographed - jewellery, clothes removed and photographed - Examinations: pathology, dental, xray, DNA samples, fingerprints
62
DVI: Phase 3
- Antemortem Info retrieval
63
DVI: Phase 4
- Reconciliation - Ante and post mortem info is matched for identification - Primary identifiers: dental, fingerprints, DNA - Secondary identifiers: physical evidence, property
64
Forensic Toxicology
- Detection: presence or absence of drug or poison - Quantification: how much is there? - Interpretation: what's the significance?
65
Drug Metabolism
- ADME - Phase I: adds a polar handle or removes a group - Phase II: attaches a more water soluble polar group to the handle
66
Somatic Death
- Irreversible loss of sentient personality (unconscious) | - Reflex and other autonomic nervous systems still function
67
Cellular Death
- Tissues and cells are dead - no longer function or have metabolic activity - Follow cardio-resp failure
68
Body Cooling after death
- Algor Mortis - Loss of metabolic function -> temp drop - except when temp is over 37 - children lose heat more quickly - oedema and dehydration can effect cooling
69
Post Mortem Lividity
- Cherry red - CO poisoning - Brown lividity- nitrate poisoning - Develops 30 mins to 2hrs after death - Fully developed 8 to 12 hrs - Fixed at 18 - 24 hrs (a finger pressed will not cause blanching)
70
Rigor Mortis
- 20 mins in jaw and eyelids - Usually 2 - 4 hours after death and is fully developed 6 - 12 hours - Temp and mode of death effect the development - high temp may speed up development - Cool temp may allow rigor to persist - wear off 24-50 hrs post mortem or when decomposition starts
71
Decomposition
- two processes: autolysis and putrefaction
72
Autolysis
- BD of cells and organs through an aspectic process by intracellular enzymes (lysosomes and hydrolases) - Accelerated by heat, slowed with cold, stopped with frozen - Organs rich in enzymes will autolyse quicker eg. pancreas, intestine and adrenal medulla (within hours)
73
Sequence of Putrefaction
- Due to bacteria and fermentation - GI flora travel throughout body - Green discolouration in right lower quadrant of abdomen (above caecum) - Organisms BD haemaglobin into sulph-haemaglobin (green colour) - Green spreads, body becomes distended - Bacteria tend to colonise in venous system -> venous marbling - Skin blisters and slippage - Gas builds up in abdomen - Pressure causes eyeball and tongue to protrude
74
Body Changes after Death
- body cooling - lividity - rigor mortis - decomposition - mummification
75
Insect Activity
- Maggots secrete proteolytic enzyme that speeds up tissue destruction - Diff insects at diff stages of decomposition - This can help determine time of death - Also can give info as to location of body and if it has been moved at any stage
76
Putrefaction of Internal Organs
- Diff rates - Even a body in advances stages of putrefaction can yield info on cause of death - Brian is one of the first organs
77
Adipocere
- Waxy substance derived from body fat | - requires water to form
78
Mummification
- Warm dry or frozen environment - caused by dehydration of the tissues - common in newborn infants (small and sterile)
79
Acceleration of Post Mortem Changes
- hot, moist environment - overweight, high fat content - infection or sepsis - illicit drugs eg. meth - insulated by warm clothing or coverings
80
Deceleration of Post Mortem Changes
- Cold environment - Scantily dressed/naked - Stored in cooling apparatus shortly after death
81
Determining Time of Death
- Three sources: - Corporal evidence (present in the body) - environment and associated evidence (present in the vicinity of the body) - Historical evidence (based on deceased habits, movements and daily activities)
82
Rate Method
- measuring a change produced by a process which take place at a known rate Examples: - amount and distribution of rigor mortis - change in body temp - degree of putrefaction
83
Concurrence method
- comparing the occurrence of events which took place at known times with the time of occurrence of the event under investigation Example: - wrist watch stopped by a blow during an assault - the extent of digestion of the last meal - reciepts
84
Nomogram Method
- most widely accepted method used to determine time of death based on body temp
85
Circumstances indication child abuse
- explanation not good enough - changes the explanation - low ses - seeks attention late - repeating injuries
86
Typical Injuries in Child Abuse
- Subdural haematoma - fractures of skull, ribs, arms and legs - Patterned skin lesions - Injuries to abdominal organs - Various ages on injuries
87
Shaken Baby Syndrome
- Subdural haematoma - retinal haemorrhage - no skull fractures - no scalp injuries - grip markings - rib fractures - vein injuries - diffuse axonal injuries
88
Why are children vulnerable to being shaken?
- large head compared to body - weak neck muscles - skull base flat - not completely myelinated - high water content - less supportive tissue - thin and soft skull
89
Child abuse: Burns/Scalds
- characteristic patterns: immersion, splash, contact - cigarette burns: multiple, small round lesions - contact burns: distinct patterns eg iron, stove, element
90
Child abuse: physical neglect
- Emaciation - loss of fat - hollow cheeks - sunken eyes - dry skin - 'little old man'
91
Autopsies in SA
- 1300 per year | - 53% natural causes
92
What can an Autopsy Achieve?
- Establish or confirm identity of the deceased - Determine cause of death - Determine the mechanism of death - Determine manner of death - Establish time/place of death
93
Prevalence SIDS
0.4-1/1000 live births
94
Tram track marking
Bruising along the edge of the weapon
95
Burns 1st - 3rd degree
1st: superficial blistering 2nd: full thickness 3rd: destruction of skin and underlying muscle, fat and bone
96
Forensic Assessment of Bites
- Swabbing for DNA is the most important
97
Suicide Stabbing
- Will usually take top off first | - If wearing clothes, could be a homicide
98
Contact Discharge of Gun
- Circular hole with abrasion collar +/- muzzle impression, no soot or burn
99
Close Discharge on Gun
- Burns of the skin and hairs, soot soiling, propellant tattooing and unburnt propellant flakes
100
Distant Discharge
- No soot or powder
101
Death from external causes
- accidents, homicides, suicides | - 6.1% of deaths in Aus
102
Males Death from external causes
1. suicide - hanging | 2. transport accidents
103
Female Death from external causes
1. falls | 2. suicide - self poisoning
104
Manslaughter
- Voluntary: diminished responsibility, loss of control, suicide pact - Involuntary: gross neglect, unlawful or dangerous act
105
Role of Pathologist at Blast Scene
- Not really identification - Description and prep of bodies - Assessment of victimes
106
Identification in DVI
1. Dental 2. Fingerprint 3. DNA (problem; 'comingling'/contamination) 4. Pathological 5. Circumstantial
107
CSI Examination
Aim is to identify potential physical evidence
108
Dead before entered water
- Natural disease IHD - Homicide - Accident: water skiing - Suicide: planned complex suicide
109
Hypothermia in Water
- Survival time at 6 degrees is estimated at .4-8.8hrs | - Water at 5 degrees will reduce body temp to 35 degrees (hypothermia) in around an hour
110
Drowning Mechanism
- When immersed in water breath holding - Then gasp and hyperventilation - results in inhalation of water -> drowning - Water disrupts surfactant -> collapse of alveoli -> hypoxia
111
Haemolytic Staining of Aorta
- Fresh water - Attributed to haemolysis of RBCs - Not always seen as when bodies not rapidly recovered postmortem changes lead to dark red colouration of the aorta
112
Drowning Tests
- Blood biochemistry: changes in potassium, sodium or chloride (unclear in literature) - Vitreous biochem: increased sodium in vitreous in salt water drowning has been reported - Diatoms
113
Poison Schedules
- Prescription: S4 - Dependence: S8- meth, morphine, cocaine - Prohibited: S9 - heroin, LSD, MDMA, cannabinoids
114
Fantasy
- GHB, GBL, NaGHB
115
Indoles
- LSD, magic mushrooms
116
NPS
- range of drugs generally not explicitly listed in the regulations - 'Designer drugs' - Chemical structure are similar to many controlled drugs - Limited data on dosage levels and the effect of abuse (both short and long term) - Users unaware of what they are consuming - Difficulty in treating overdoses
117
Types of Hyperthermia
1. Classic: prolonged or extreme environmental exposure eg. heat waves, saunas, children in cars 2. Exertional: extreme exertion eg. marathon runners, labourers, military
118
Hypothermia Definiton
Below 35 degrees
119
Hyperthermia Definition
Above 40.5 degrees
120
Investigation of Sudden Death
- History - Scene - Postmortem examination: internal, external, other eg. histology, tox
121
Haemopericardium
- Pericardial sac filled with blood -> heart can't beat | - Causes: ruptured MI or ruptured dissection of the aorta
122
Cardiomegaly
- Cardiac enlargement | - Hypertension
123
Myocarditis
- 'flu like illness' - Inflammation of the heart - Mainly viral

Forensics (3 decks)

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