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Forensic Pathology

Note: these are only topics that were mentioned as possible exam material. Boxes = highly emphasized material.
Her notes are pretty concise for the other (pretty interesting) stuff

Cause vs. Mechanism vs. Manner of Death


Cause of Death: that disease process or injury that brings about the cessation of life (immediate cause)
 ( i.e. multiple gunshot wounds, multiple injuries, hanging, narcotic intoxication, pulmonary embolism, etc.)

The proximate or original, initiating cause of death:


 underlying medical condition or injury that initiates the lethal chain of events culminating in death.
o (write on part 23 of the death certificate)

For example, a person might die of sepsis, but the initiating cause could be a stab wound of the chest. Therefore, part 23a would be:
Sepsis (immediate cause of death) and part 23b would be: Stab wound of the chest (proximate cause of death).

Mechanism of Death is the physiologic process that results from the cause of death
 i.e. cardiopulmonary arrest, asystole, respiratory arrest, etc.
 NEVER PUT A MECHANISM OF DEATH ON A DEATH CERTIFICATE!!

Manner of Death is the circumstance under which the cause of death occurs
 i.e. Homicide, Suicide, Accident, Natural, or Undetermined
 Only medical examiners can certify non-natural deaths.
 Another physician can fill out and sign a death certificate with approval of the medical examiner’s office. A medical examiner will
have to co-sign the death certificate. The funeral home usually brings the death certificate to our office for co-signature.
Remember if there is any type of trauma or injury listed in the Cause of death or Other significant condition sections and a
physician fills in a manner of natural, vital records will reject the death certificate and the case will be investigated by our office,
hopefully before the body is embalmed!!

Pulmonary embolism can be any manner of death (what if you were shot  broken leg  etc. – homicide!)
Quadriplegia too (if you tried to jump off a bridge, died years later – still suicide!)

Suicide / Homicide vs. Murder


Suicide: the act of taking one’s own life (no intent needed)
Homicide: a death caused by the act of another or the omission of an act (no intent needed)
Murder: a legal definition that implies INTENT

Laceration vs. Cut


Incisions or cuts are caused by sharp objects. They can be straight or jagged.
 There is no peripheral abrasion, tissue bridging, or undermining.
 Stab wounds are sharp force injuries that are deeper than they are long.
o The depth of a stab wound can be longer or shorter than the actual knife blade.

Lacerations or tears in the skin are caused by blunt objects.


 They usually have irregular contours, peripheral abrasion, the presence of uncut strands of tissue bridging
between the opposing edges of a linear defect, and often show undermining.
 The BRIDGING TISSUE IN A LACERATION is the most important criteria in distinguishing a cut from a laceration.

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Other types of blunt object injuries
Contusion: bruise which is the leakage of blood from torn vessels
Abrasion: scrape with damage to the surface of the skin and is produced by friction or pressure.

Automobile accidents: Blunt and sharp force injuries are common. Sharp force injuries include dicing and slicing.
 DICING INJURIES: small angulated cuts produced by the cube-like fragments of tempered glass
o from the side or rear windows.
 Slicing injuries: delicate, thin, long, straight cuts produced by laminated glass
o from the front windshield.
o Laminated glass consists of a layer of plastic between two layers of glass and in an accident it usually comes off in
one large dented and folded piece

Lividity (liver mortis) / Rigor Mortis / Algor Mortis


Lividity or Livor mortis: the postmortem pooling of blood in dependent areas of the body due to gravitational forces.
 After approximately 8-12 hours, the blood congeals in the capillaries or diffuses into the extravascular tissues and does not
permit blanching or displacement at this point it is determined to be “fixed”.

Rigor mortis: the postmortem stiffening of the muscles due to lack of ATP regeneration and acidity, which results in
the formation of locking chemical bridges between actin and myosin.
 Becomes apparent within 30 minutes to an hour, maximizes at 12 hours, remains for 12 hours, and progressively disappears
within the following 12 hours.

Algor mortis: postmortem cooling of the body.


 Average conditions: body cools at a rate of 1.5°F per hour during the first 12 hrs and 1°F per hour for the next twelve hours.

Close firing range / Stippling / Contact Gun Wounds

Know CONTACT and CLOSE RANGE

Entrance wound has a circumferential marginal abrasion collar and its edges are unopposable.
Exit wound: laceration or tear in the skin; usually larger than the entrance wound and the edges can be opposed.

Range of fire:
Soot: burnt particles of gunpowder which can be wiped from the skin around an entrance wound.
Gunpowder stippling are punctate abrasions on the skin caused by unburnt particles of gunpowder striking and
scraping the skin around an entrance wound. STIPPLING = CLOSE RANGE (18 inches)

Contact GSW – soot and gunpowder are within the wound track and there could be a muzzle imprint on the skin
surrounding the entrance wound.
 If on scalp, the scalp closely overlying the bone has a tendency to tear due to the loss of kinetic energy of the bullet.
o Star shaped tear; entrance beveled inward, exit beveled outward

Near or Loose contact – soot and gunpowder are within and partially around the entrance wound.
Close range – searing of the skin (w/in 2 to 3 in), soot deposition (w/in 6 in), and gunpowder stippling (w/in 18 inches)
Distant – no soot or gunpowder stippling is present on the skin surrounding the entrance wound.

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Definition of decomposition
Decomposition includes:
 autolysis, which is the enzymatic digestion of the body
 putrefaction, which is the action of bacteria on the body.

24-36 hrs: Early decomposition


 green discoloration of the skin
 gaseous bloating
 dark purple to green discoloration of the skin of the face
 purging of bloody decomposition fluid from the nose and mouth.

36-48 hrs: A marbling pattern


 from decomposition of blood; formation of sulfhemoglobin and hematin w/in dilated subQ blood vessels.

After 72 hrs: Vesicle formation with skin slippage and marked bloating of the entire body

If the body decomposes in a dry environment, mummification of the skin can occurs at about 4 days.
Skeletonization is dependent on environmental conditions
 in a hot, dry climate if may take 6 to 9 months
 hot, humid climate with marked insect activity: a week to ten days.

These postmortem changes are extremely variable.


They are basically chemical reactions; heat accelerates them and cold slows them down.