Post Mortem Changes and Bodies from Water

Question 1

How long does it take for irreversible brain damage?

Answer 1

3-9 minutes

Question 2

In the hospital, what four things are death determined by?q

Answer 2

1. Cessation of breathing
2. No response to pain or voice
3. No pupillary response to light
4. Cessation of pulse and heart beat

Question 3

How many doctors establish brainstem death?

Answer 3

Two

Question 4

What two organs show the most cellular resilience to hypoxia?

Answer 4

Bone and corneas (48 hours)

Question 5

What two organs show the least cellular resilience to hypoxia?

Answer 5

Brain and spinal cord (4 minutes)

Question 6

What do post mortem changes do to confirmation?

Answer 6

They confirm death. Resuscitation is futile.

Question 7

What is Post Mortem Interval

Answer 7

Post-mortem interval (PMI) is the time that has elapsed since a person has died.

Question 8

What colour will abrasions which occur in life be?

Answer 8

Red

Question 9

What colour will abrasions that occur in death be?

Answer 9

Orange and parchmented

Question 10

What sort of sites do animal artefacts occur in?

Answer 10

Exposed

Question 11

What are these artefacts of:

Entry impact
Washerwoman change
Gooseflesh (Cutis anserina)

Answer 11

Artefacts of immersion

Question 12

What is skin splitting an artefact of?

Answer 12

Fire and heat

Question 13

What can extradural haematoma be an artefact of?

Answer 13

Fire and heat

Question 14

What post mortem changres occur in hours?

Answer 14

Algor mortis
Livor mortis
Rigor mortis

Question 15

What post mertem changes occur in days to weeks?

Answer 15

Putrefaction

Question 16

What two post mortem changes occur after months?

Answer 16

Skeletonisatin

Mummification

Question 17

Chill of death?

Answer 17

Algor mortis

Question 18

Darkening of death?

Answer 18

Livor mortis

Question 19

Stiffening of death?

Answer 19

Rigor mortis

Question 20

What can be a useful indicator of PMI in the first 24 hours of death, only in temperate and cool climates?

Answer 20

Algor mortis

Question 21

When assessing for algor mortis what method of determining core body temperature must you avoid in sexual cases?

Answer 21

Anal

Question 22

When assessing for algor mortis what method of determining core body temperature could you use instead of anal?

Answer 22

Liver by subcostal stab- creates a wound

Question 23

Loss of heat from the body due to conduction, convection and radiation. Little heat lost by evaporation

Answer 23

Algor mortis

Question 24

Who will cool quicker- an obese individual or a thin person?

Answer 24

obese- larger surface area

Question 25

What can there be a slight rise of temperature in after deatgh?

Answer 25

Decomposition

Question 26

What is Henssge's Normogram based on?

Answer 26

a mathematical cooling model

Question 27

What does Henssge's Normogram allow for correction of?

Answer 27

Body weight Clothing Drafts Immersion in water

Question 28

What does Henssge's Normogram assume?

Answer 28

Normal body temp at death | No ariation in ambient temperature during cooling period

Question 29

What are some exclusions to using Henssge's Normogram?

Answer 29

1. Near strong heat source 2. Near cooling source 3. Floor tiles 4. Abnormal body temperature at death 5. Body moved between death andtemperature reading i.e. fridge

Question 30

How much faster does body cool in still water than air?

Answer 30

Twice as fast

Question 31

How much faster does body cool in flowing water than air?

Answer 31

Three times as afast

Question 32

Gravitational pooling of blood in blood vessels due to cessation of circulation in death

Answer 32

Livor mortis

Question 33

Can you see livor mortis in internal organs too?

Answer 33

Yes

Question 34

What is development of livor mortis delayed by?

Answer 34

Blood loss e.g. AAA, gastric ulcers and haemorrhage and poisoning

Question 35

What happens to livor mortis at under 6 hours?

Answer 35

Incompletely formed, blanching, unfixed. | Primary pattern fades and secondary pattern develops according to new position.

Question 36

What happens to livor mortis at 10-24 hours?

Answer 36

Well established, partially fixed- if moved from front to back will exhibit two patterns. Primary pattern fixed enough to remain, secondary pattern develops giving dual distribution.

Question 37

What happens to livor mortis >24 hours?

Answer 37

Fully fixed, Primary pattern persists. No secondary patter ndevelops.

Question 38

What does early lividity look like?

Answer 38

bLOTCHY SPOTS

Question 39

Give two causes of bright pink lividity?

Answer 39

Refrigeration | Hypothermia (oxyhaemoglobin)

Question 40

Give one cause of cherry pink lividity?

Answer 40

Carbon monoxide

Question 41

Give one cause of scarlet lividity/

Answer 41

Cyanide

Question 42

Give one cause of chocolate brown lividity?

Answer 42

Aniline dye

Question 43

What causes vibices?

Answer 43

Rupturing of small blood vessels: Intravascular hydrostatic pressure PM weakening/breakdown of vessel wall

Question 44

Where are vibices typically limited to?

Answer 44

Livid tissues

Question 45

What causes rigor morits?

Answer 45

Muscle relaxation requires ATP to break actin-myosin bonds. ATP requires oxygen. Decrease in ATP post mortem means bonds cannot be broken causing rigor mortis. Also calcium build PM promotoes actin myosin cross bridging.

Question 46

What is rigor superseded by?

Answer 46

Decomposition

Question 47

Does rigor mortis involve smaller or larger muslces first?

Answer 47

Smaller- eye lids, jaw and neck

Question 48

Hyperthermia at death does what to onset of rigor mortis?

Answer 48

Increases it

Question 49

In what other situation does rigor mortis come on quickyl?

Answer 49

Muscle activity immediatley prior to death

Question 50

Forenisc value of rigor mortis?

Answer 50

May indicate if body has been moved

Question 51

pugilistic atitude?

Answer 51

Kneeling position PM when exposed to high temperatuer

Question 52

What is the PM interval when: warm and without rigor?

Answer 52

less than 3 hours

Question 53

What is the PM interval when: warm with rigor?

Answer 53

3 - 8 hours

Question 54

What is the PM interval when: cold with rigor?

Answer 54

8-36 hours

Question 55

What is the PM interval when: cold and without rigor?

Answer 55

>36 hours

Question 56

enzymatic breakdown of cells/tissues

Answer 56

Autolysis

Question 57

Bacterial breakdown of cells/tissues

Answer 57

Putrefaction

Question 58

What is maceration?

Answer 58

Type of decomp. Sterile autolysis of foetus in uterus.

Question 59

What conditions does adipocere need?

Answer 59

Wet

Question 60

What conditions does mummification need?

Answer 60

Cool and dry

Question 61

What happens within two days of putrefaction?

Answer 61

Green discoloration of lower abdomen due to overgrowth of colonic bacteria

Question 62

What happens within 3-4 days of putrefaction?

Answer 62

Greenish black discoloration and swelling of face and neck due to gas production from bacteria

Question 63

During putrefaction what might extrude from the mouth?

Answer 63

Reddish brown purge fluid

Question 64

How does marbelling occur during putrefaction?

Answer 64

Due to breakdown of haemoglobin within blood vessels- prominence of blood vessels on skin (days to a week)

Question 65

Name four gases found in gaseous bloating during putrefaction?

Answer 65

Methane Hydrogen Hydrogen sulphide Carbon dioxide

Question 66

Who is mummication more common in?

Answer 66

Infants

Question 67

What term is given to the transformation of body fat to oleic, palmitic and stearic acids by hydrolysis?

Answer 67

Adipocere- saponification

Question 68

What are the causative bacteria for saponification?

Answer 68

Clostridium welchii

Question 69

What prolongs gastric emptying?

Answer 69

Alcohol. Stress delays it.

Question 70

State Casper's Rule of decomposition.

Answer 70

At similar average temperatures, the degree of putrefaction in a body in open air for 1 week corresponds to that of a body immersed after 2 weeks or a body burried for 8 weeks.

Question 71

Estimation of duration of immersion if wrinkled fingers, palsm and feetS?

Answer 71

12-30 HOURS

Question 72

Estimation of duration of immersion if early decomp in head, neck, abdo and thighs?

Answer 72

4-10 days

Question 73

Estimation of duration of immersion if Bloating of face and abdomen, venous marbling & peeling of epidermis on hands and feet, scalp slippage:

Answer 73

2-4 weeks

Question 74

Duration of immerstion if gross skin shedding, muscle loss and exposure of skeleton?

Answer 74

1-2 months

Question 75

If body temp is at 34 what happens?

Answer 75

Loss of consciousness and aspiration of water

Question 76

If body temp is at 28 what happens?

Answer 76

Ventricular fibrillation

Question 77

If body temp is at 24 what haPPENS?

Answer 77

Asystole

Question 78

What exacerbates circum-rescue collapse?

Answer 78

Cold water and vertical rescue

Question 79

Explain 3 steps in drowning in fresh (hypotonic water). Death in 4-5 minutes

Answer 79

1. Water absorbed from airways into circulation- hypervolaemia 2. Na diffuses from circulation into lung fluid- hyponatraemia 3. RBC swell and burst (haemolysis)- raised blood K leading to VF

Question 80

Explain the two steps of drowning in salt (hypertonic) water. Death 8-10 minutes

Answer 80

1. Water diffuses from cirulation into lung fluid- reduced blood volume nad increase blood concentration 2. Na and Cl diffuse from lung fluid in to circulation - raised blood Na

Question 81

What is the mechanism of instantaneous drowning?

Answer 81

Reflex cardiac arrest (vagal inhibition)- triggered by cold water in nasal passages, sensation of myocardium by adrenaline and/or alcohol

Question 82

Skin maceration or washerwoman change occurs after how long in warm and cold water?

Answer 82

wARM- minutes | Cold- 4-5 hours

Question 83

Are there diagnostic features of drowning?

Answer 83

There are none.

Question 84

What are these signs suggestive of: Foam in airways Emphysema aqueosum Foreign material in airways and stomach Middle ear haemorrhage

Answer 84

Drowning

Question 85

Champignon de mousse

Answer 85

Foam in airways suggesting pulmonary oedema. Only found in freshly drowned bodies.

Question 86

In drowning id the lungs are voluminousl hyperinflated, overlapping and doughy?

Answer 86

Emphysema aqueosum

Question 87

In drowning what is the term for blue disclolouartion in bony roof of middle ear (tube)?

Answer 87

Middle ear haemorrhage

Question 88

What bruising is common in drowning?

Answer 88

Shoulder muscle bruising

Question 89

Name 4 lab tests for drowning.

Answer 89

Specific gravity of blood in left ventricle. Plasma chloride Plasma magnesium Diatoms