|
|
Definition |
Examples |
|
Cause of death |
Disease or injury that
produces the physiological changes that result in death |
MI due to ASCVD |
|
Manner of death |
How the cause of death
occurred |
natural, homicide, suicide,
accident, undetermined |
|
Mechanism of death |
physiological event set in
motion by the cause of death |
cardiorespiratory arrest |
|
abrasion |
superficial scrape |
|
|
laceration |
tearing injuries (occur over
bony prominences) |
|
|
contusion |
bruising; tearing of blood
vessels and bleeding into tissues |
|
|
ferning |
red, dendritic mark on skin
(electrical injury) |
|
Major considerations for time
of death: livor, rigor, body temperature, vitreous analysis, stomach contents,
surrounding environment
Livor Mortis
- settling of blood in
dependent areas due to gravity
- areas
with pressure do not develop livor
- noticeable
within 30 minutes of death
- mimics bruising
Rigor Mortis
- stiffening
of muscles
- after
2 hours (peaks at 12h, ends at 24h)
- develops more quickly in hot
environment, lasts longer in cold environments
- small
muscles affected first
Putrefaction
·
result of skin
necrosis
·
green
discoloration in lower abdomen (intestine closest to skin)
·
marbling
(bacterial growth along vessels)
·
bloating of face
and head (slipping skin – hand comes off in glove - , blister formation)
·
gas production ŕ rectal prolapse, eyes bulging, tongue protruding
Who gets referred to the
medical examiner
1.
Death under
suspicious, unusual, or unnatural circumstances
a.
Sudden violence (car accident, murder, etc.)
b.
Suicide
c.
Casualty
d.
Suddenly when in
apparent health
e.
Found dead (death
unattended by physician)
f.
In prison
g.
Cremation
h.
Lack of 24 hour
rule (hospitals may have, state does not require)
i.
SIDS (happens most
commonly 2-4 months of age) Defined as:
i.
diagnose ONLY if under 1 year and
unexplained after:
1.
complete autopsy
2.
examination of
death scene
3.
review of clinical
history
ii.
SIDS mimics
1.
positional
asphyxia
2.
down in bed with mother, father, pets, comforters etc.
3.
dies in presence of non-biological relative (boyfriend,
etc.)
4.
shaken baby,
damage head (no external marks)
A number of manners of death were discussed (blunt
force, asphyxia, thermal injuries, etc.); most of these are “common-sense” with
a few notes listed below:
Best estimate of time of
death: time last seen alive
CO toxicity: liver is red
Cardiac tamponade: fatal if
rapid; tolerated to a certain extent if slow
SIDS: diagnosis of exclusion
(2-4 months old)
Burns: 1st degree:
epidermis (sun-burn); 2nd degree: epidermis and dermis (blisters); 3rd
degree: full-thickness (no sensation, scarring); 4th degree:
charring
Drowning: salt vs. fresh water
(water flow differs in alveoli)
Methanol toxicity: acidosis,
headache, blindness (treatment = ethanol)
Gun wounds: Entrance and exit
wounds can be difficult to determine (exit wounds tend to be more irregular and
larger)