forensic pathology “this is the place where death rejoices to teach those who live.”
TRANSCRIPT
Forensic Forensic PathologyPathology
““This is the place where This is the place where death rejoices to teach those death rejoices to teach those
who live.”who live.”
IntroductionIntroduction
A death that is unexpected or is A death that is unexpected or is thought to have been caused by thought to have been caused by injury or trauma is always injury or trauma is always investigated.investigated.
CoronerCoronerMedical ExaminerMedical Examiner
Coroner vs. Medical Coroner vs. Medical ExaminerExaminer
Coroner – a public official, appointed Coroner – a public official, appointed or elected, who makes inquires into or elected, who makes inquires into deaths and completes death deaths and completes death certificates.certificates. Determines cause/manner of deathDetermines cause/manner of death Decides if foul playDecides if foul play May or may not have medical trainingMay or may not have medical training
Coroner vs. Medical Coroner vs. Medical ExaminerExaminer
Medical Examiner – Medical Examiner – a physiciana physician, , evaluates medical history and physical evaluates medical history and physical exam of deceased to determine cause and exam of deceased to determine cause and manner of death.manner of death. Must receive special training to become a Must receive special training to become a
forensic pathologistforensic pathologist Forensic PathologyForensic Pathology – unnatural or suspicious – unnatural or suspicious
disease or injurydisease or injury In most large US cities, the medical In most large US cities, the medical
examiner is required to be a forensic examiner is required to be a forensic pathologist.pathologist.
Forensic PathologistForensic Pathologist
Education and TrainingEducation and Training Medical school – 4 yearsMedical school – 4 years
Post – medical training Post – medical training 3 to 5 year residency in general pathology3 to 5 year residency in general pathology
Additional year of trainingAdditional year of training In medical examiners office (forensic In medical examiners office (forensic
pathology)pathology) American Board of Pathology ExamAmerican Board of Pathology Exam Training / Knowledge in other areas of Training / Knowledge in other areas of
ForensicsForensics
In US 500 Forensic PathologistsIn US 500 Forensic Pathologists
About 25 of the 500 also have LAW About 25 of the 500 also have LAW DEGREESDEGREES
Deaths InvestigatedDeaths Investigated
Two Main CategoriesTwo Main Categories 1. Persons who die suddenly when in 1. Persons who die suddenly when in
apparent good apparent good health, those who are health, those who are unexpected to die, or those unexpected to die, or those who are who are without medical treatment for fatal without medical treatment for fatal diseases. diseases.
Public Health Threat (bacterial meningitus)Public Health Threat (bacterial meningitus) Death in public places (electrocution in public Death in public places (electrocution in public
place)place) Maternal DeathMaternal Death Death outside of medical facilityDeath outside of medical facility
Deaths InvestigatedDeaths Investigated
2. Deaths caused by unnatural causes2. Deaths caused by unnatural causes
Examples:Examples: Acts of violenceActs of violence Drug relatedDrug related Trauma / AsphyxiationTrauma / Asphyxiation WeatherWeather Vehicular accidentVehicular accident
Deaths InvestigatedDeaths Investigated
Special Categories:Special Categories: Under 18Under 18 Death of an individual under legally Death of an individual under legally
dependent care.dependent care. Death in correctional facilityDeath in correctional facility On aircraft or shipOn aircraft or ship
MURDERS ARE THE SMALLEST MURDERS ARE THE SMALLEST NUMBER OF DEATHS NUMBER OF DEATHS INVESTIGATED!INVESTIGATED!
Three facets of guilt:Three facets of guilt:
MotiveMotive MeansMeans OpportunityOpportunity
Medical Examiner’s Duties:Medical Examiner’s Duties:
Review eyewitness statementsReview eyewitness statements Examine crime sceneExamine crime scene AutopsyAutopsy PhotographyPhotography ReportReport TestimonyTestimony
Duties and Duties and ResponsibilitiesResponsibilities
Establish the cause of deathEstablish the cause of death Establish the time of deathEstablish the time of death Infer the type of weapon used Infer the type of weapon used Determine the manner of deathDetermine the manner of death Identify the deceasedIdentify the deceased Determine the effects of trauma or Determine the effects of trauma or
pre-existing conditions.pre-existing conditions.
Postmortem LividityPostmortem Lividity(Livor Mortis)(Livor Mortis)
The Settling of blood that causes the The Settling of blood that causes the skin to change colorskin to change color
30 Minutes:30 Minutes:
Changes in skin color first appear Changes in skin color first appear
on fair-skinned persons on fair-skinned persons
4 to 8 hours:4 to 8 hours:
The blood in capillaries settles The blood in capillaries settles
PERMANENTLYPERMANENTLY
Between 1 and 8 hours:Between 1 and 8 hours:
(1) Blanching (1) Blanching Light-colored marks made by finger pressure
(2)(2)
Where a trained investigator will Where a trained investigator will begin..begin..
Why livor mortis is Why livor mortis is importantimportant
Has the Has the body been body been moved? moved?
Rigor MortisRigor Mortis The period of time that a body goes The period of time that a body goes
through a state of Rigidity through a state of Rigidity Caused by lactic acid build-up in the Caused by lactic acid build-up in the
body.body.
Rigor Mortis Rigor Mortis ProgressionProgression
Shorter muscles – face, fingers, toesShorter muscles – face, fingers, toes
NeckNeck
Then moves down and out the long Then moves down and out the long muscles of the legs and forearmsmuscles of the legs and forearms
Legs stiffen lastLegs stiffen last
Rigor MortisTime-lineRigor MortisTime-line
1-4 hours: Jaw and neck rigid, rest of body 1-4 hours: Jaw and neck rigid, rest of body limplimp
Up to 8 hours: everything down to the legs is Up to 8 hours: everything down to the legs is rigidrigid
For 12 hours: everything remains rigidFor 12 hours: everything remains rigid 24 hours: Jaw is limp, everything else is rigid24 hours: Jaw is limp, everything else is rigid 30-32 hours: everything but the legs are limp30-32 hours: everything but the legs are limp 36 hours: entire body is limp (no rigidity) 36 hours: entire body is limp (no rigidity)
decomposition has begundecomposition has begun
Circumstances affecting Circumstances affecting Rigor MortisRigor Mortis
StarvationStarvation
Extreme temperaturesExtreme temperatures
Physical exertionPhysical exertion
Effects of fireEffects of fire
or water (in the case of drowning)or water (in the case of drowning)
DecompositionDecomposition
Bacteria: CoBacteria: Co22 is produced, is produced, abdominal swellingabdominal swelling
Blood vessels: Blood vessels: discoloration of skin in upper abdomendiscoloration of skin in upper abdomen marbling effectmarbling effect Red → darker red → purple → greenRed → darker red → purple → green
Putracine – foul- smelling, Putracine – foul- smelling, nauseating odors nauseating odors
Algor MortisAlgor Mortis Either Liver temperature (LT) Either Liver temperature (LT)
or Rectal Temperature (RT)or Rectal Temperature (RT) Drop of about Drop of about
2 degrees 2 degrees
per hourper hour
Factors affecting temperature loss:Factors affecting temperature loss: Size (mass) of bodySize (mass) of body Body Temperature at deathBody Temperature at death Temperature of crime scene Temperature of crime scene
The Autopsy ExaminationThe Autopsy Examination““You've got to be the type of person who can You've got to be the type of person who can
emotionally disconnect [from] it. I mean, if you went emotionally disconnect [from] it. I mean, if you went into a case looking at it as, 'Geez, this is somebody's into a case looking at it as, 'Geez, this is somebody's little girl or somebody's little boy,' you'd never be able little girl or somebody's little boy,' you'd never be able to do the case. You can't personalize it in any way... to do the case. You can't personalize it in any way... When you walk in, you never forget that this is When you walk in, you never forget that this is somebody's loved one. You never forget that, but when somebody's loved one. You never forget that, but when you walk in to do the job, you kinda put that you walk in to do the job, you kinda put that information aside. You look at them more as a puzzle, information aside. You look at them more as a puzzle, and your job is to sort out this puzzle. and your job is to sort out this puzzle.
I've got to find out what happened. Who, what, I've got to find out what happened. Who, what, why, when, where. I mean, that's what my job is, to sort why, when, where. I mean, that's what my job is, to sort out and get those answers. And, do it in a respectful out and get those answers. And, do it in a respectful way. way.
A lot of people can't do this type of job. A lot of 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 people don't want to do this type of job. There are a lot of jobs I wouldn't want to do either.”of jobs I wouldn't want to do either.”
Eric KieselEric Kiesel Atlanta's Fulton County Deputy Chief Medical Atlanta's Fulton County Deputy Chief Medical
ExaminerExaminer
HISTORY OF HISTORY OF AUTOPSYAUTOPSY
EGYPTIONSEGYPTIONS 1600 BCE1600 BCE
HIPPOCRATES HIPPOCRATES – – 55THTH + 4 + 4THTH CENTURY BCE CENTURY BCE
AUTOPSIES TO DETERMINE THE CAUSE AUTOPSIES TO DETERMINE THE CAUSE OF DEATH:OF DEATH:
The Autopsy ExaminationThe Autopsy Examination
LegalityLegality Permission required – family can Permission required – family can
request an autopsy be performed request an autopsy be performed (usually free)(usually free)
Next of kin must sign autopsy permit.Next of kin must sign autopsy permit. Religious considerationsReligious considerations Mandatory when death is suspicious of Mandatory when death is suspicious of
foul play or if public health concern (in foul play or if public health concern (in most states)most states)
The Autopsy The Autopsy ExaminationExamination
Attending PersonnelAttending Personnel Diener – autopsy assistantDiener – autopsy assistant Prosector - pathologistProsector - pathologist Pathologist AssistantPathologist Assistant Precautions – protective Precautions – protective
clothingclothing
The Autopsy ExaminationThe Autopsy Examination
The External Exam = done first The External Exam = done first when body is examined.when body is examined. Looking for:Looking for:
WoundsWounds Contusions (Bruises)Contusions (Bruises) Unusual marks on the bodyUnusual marks on the body Overall impression of the bodyOverall impression of the body
Forensic AutopsyForensic Autopsy
An intensive search for informationTo locate PHYSICAL EVIDENCE to determine the cause of death
The Autopsy ExaminationThe Autopsy Examination
At this point, a general description of the At this point, a general description of the body is made. All identifying features are body is made. All identifying features are noted including: noted including:
Race Race Sex Sex Hair color and length Hair color and length Eye color Eye color Approximate age Approximate age Any identifying features (scars,tattoos, etc.) Any identifying features (scars,tattoos, etc.)
The Autopsy ExaminationThe Autopsy Examination
Opening the BodyOpening the Body Y-incision: incision made from left and Y-incision: incision made from left and
right shoulders to mid-chest and right shoulders to mid-chest and straight down to pubic region.straight down to pubic region.
No bleeding (usually) because there is No bleeding (usually) because there is no blood pressure.no blood pressure.
If head is to be opened, an incision is If head is to be opened, an incision is made across the head from one ear to made across the head from one ear to the other.the other.
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The Autopsy ExaminationThe Autopsy Examination
Rib cage is cut at the cartilage that Rib cage is cut at the cartilage that joins the ribs to the breastbone with joins the ribs to the breastbone with a scalpel, saw or knife to enter the a scalpel, saw or knife to enter the chest cavity. Soft tissue peeled back chest cavity. Soft tissue peeled back to look for abnormalities.to look for abnormalities.
Chest plate (ribs and breastbone) Chest plate (ribs and breastbone) are removed and examined. Often are removed and examined. Often fractured during CPR. fractured during CPR.
Skull is cut in front and Skull is cut in front and back for removal.back for removal.
The Autopsy ExaminationThe Autopsy Examination Removing and Examination of the Removing and Examination of the
OrgansOrgans Each organ is removed, photographed and Each organ is removed, photographed and
weighed. Organs are usually dissected and weighed. Organs are usually dissected and slides prepared to look for disease or slides prepared to look for disease or irregularities.irregularities.
THE HEARTTHE HEART
Checked for TRAUMA
Pulmonary arteryPulmonary artery
The The pulmonary arteriespulmonary arteries carry carry blood from the from the heart to the to the lungs. .
They are the only They are the only arteries (other than (other than umbilical arteries in the fetus) that carry in the fetus) that carry deoxygenated blood.deoxygenated blood.
Looking for a blood clot that has Looking for a blood clot that has dislodged from a vein traveling through dislodged from a vein traveling through the heartthe heart
To the pulmonary artery: SUDDEN To the pulmonary artery: SUDDEN DEATHDEATH
Blood samples are taken Blood samples are taken from the AORTAfrom the AORTA
Blood-typing and Blood/Alcohol Blood-typing and Blood/Alcohol testtest
Larynx and TracheaLarynx and Trachea
Checked for food bolus (choking)
Food lodged in trachea
LungsLungs
DrowningDrowning
DiatomsDiatoms
lungs
stomach
Blood stream
Bone marrow
Heroin UseHeroin Use
Carbonate crystals
Used to mix heroin
Will be found in the lungs
Death in firesDeath in fires
If aliveDuring
Fire there Will be
soot and ash in the Trachea
BronchiAnd
Lungs
If COIf CO22 levels in blood are greater levels in blood are greater
thanthan 2%2%
The victim was alive at the onset of The victim was alive at the onset of the firethe fire
Samples takenSamples taken
COCO2 2 and otherand other
gases in lungsgases in lungs
Microscopic slidesMicroscopic slides
LiverLiver
LiverLiver
A healthy liver:A healthy liver:
Soft, pliable, vulnerable to blunt-force Soft, pliable, vulnerable to blunt-force traumatrauma
Cirrhotic LiverCirrhotic Liver
Caused by hepatitus, malnutrition, drug & Caused by hepatitus, malnutrition, drug & alcohol usealcohol use
Jaundiced LiverJaundiced Liver
Kidneys – filter bloodKidneys – filter blood
The “Kidney Punch”The “Kidney Punch”
A World Boxing Association foulA World Boxing Association foul
Drug useDrug use
Drug addicts who have a cirrhotic Drug addicts who have a cirrhotic liverliver
cannot metabolize proteins……cannot metabolize proteins……
Toxins pass out of the liver andToxins pass out of the liver and
Damage kidneysDamage kidneys
Diseased KidneysDiseased Kidneys
Jaundiced kidneysPolycystic liver
StomachStomach
Important in drug-overdose casesImportant in drug-overdose cases
Helps establish activities prior to deathHelps establish activities prior to death
POISONSPOISONS
CYANIDECYANIDE
-red color of organs-red color of organs
-almond-like odor-almond-like odor
(only 50% of pop can detect the odor)(only 50% of pop can detect the odor)
-KCN used for executions-KCN used for executions
Estimated time of deathEstimated time of death
If TIME OF MEAL and MENU are If TIME OF MEAL and MENU are knownknown
IntestinesIntestines
Location of food can help determine time of death
Pair swallows 850 g Pair swallows 850 g cocaine..cocaine..
““Katriya Connor, 23, a chef from Waterloo in Katriya Connor, 23, a chef from Waterloo in Liverpool, became violently ill on a flight from Liverpool, became violently ill on a flight from Cancun in Mexico to Birmingham on February Cancun in Mexico to Birmingham on February 6, after scores of packets of cocaine that she 6, after scores of packets of cocaine that she had swallowed burst in her stomach. She died had swallowed burst in her stomach. She died within hours on an airport runway in the within hours on an airport runway in the Azores, where the flight had been diverted, Azores, where the flight had been diverted, while paramedics desperately tried to save her while paramedics desperately tried to save her life. A 21-year-old man, apparently travelling life. A 21-year-old man, apparently travelling with Ms Connor, also fell into a coma on the with Ms Connor, also fell into a coma on the flight and remains seriously ill on the island.”flight and remains seriously ill on the island.”
(from The Guardian)(from The Guardian)
Stomach of drug “mule”
Drug packets in rectum area
BladderBladder
URINE SAMPLE
Reproductive OrgansReproductive Organs
Inspected for pregnancy
(Teenage suicide)
The Brain The Brain
Removal of BrainRemoval of Brain
A blood clot caused by a blow to the head – can be fatal
Formaldehyde “fixes” the brain for better dissection
AutopsyAutopsy Conclusion Conclusion
Samples are obtained of bodily fluids Samples are obtained of bodily fluids and sent to toxicology for examination.and sent to toxicology for examination. BloodBlood UrineUrine BileBile
Manner and Cause of Manner and Cause of DeathDeath
MechanismMechanism – biochemical or – biochemical or physiological abnormality produced physiological abnormality produced by the cause of death that is by the cause of death that is incompatible with life.incompatible with life.
Manner of DeathManner of Death – homicide, – homicide, suicide, natural causes, accidental suicide, natural causes, accidental or undetermined. or undetermined.
CauseCause – disease or injury that – disease or injury that initiated the lethal chain of events initiated the lethal chain of events that lead to deaththat lead to death
Manner of DeathManner of Death
homicide homicide SuicideSuicide accidental – trauma occurring from accidental – trauma occurring from
acts acts NO REASONABLENO REASONABLE person person
would have felt have a high would have felt have a high probabilityprobability
of injury or deathof injury or death natural causenatural cause undetermined undetermined
Determination of Cause Determination of Cause of Deathof Death
One can die of a One can die of a massive hemorrhagemassive hemorrhage (the (the mechanismmechanism of death) due to a of death) due to a gunshot woundgunshot wound through the head (the through the head (the causecause of death) as a result of being of death) as a result of being shot (shot (homicidehomicide), shooting yourself ), shooting yourself ((suicidesuicide), dropping the gun and it ), dropping the gun and it discharging (discharging (accidentalaccidental), or not being ), or not being able to tell how it occurred able to tell how it occurred ((undeterminedundetermined). All of which are ). All of which are mannersmanners of death. of death.
Causes of DeathCauses of DeathBrain Damage:Brain Damage:
Subdural hematomaSubdural hematoma
Brain Brain Damage: Damage: Subarachnoid Subarachnoid hematomahematoma
Brain Damage: Brain Damage: Intracerebral hematoma:Intracerebral hematoma:
SuffocationSuffocation
Positional Positional AsphyxiationAsphyxiation
Positional Positional AsphyxiationAsphyxiation
SADSSADS
ChokingChoking
DrowningDrowning
Vomitos amigos: Vomitos amigos: Drug/alcoholDrug/alcohol
IntoxicationIntoxication
Neck InjuriesNeck InjuriesStrangulationStrangulation
accidental accidental
suicidesuicide
homicidehomicide
Petechial hemorrhagePetechial hemorrhageRuptures in the tiny capillariesRuptures in the tiny capillaries
Hyoid BoneHyoid Bone
HangingHanging
Nature of rope and knotsNature of rope and knots
Suicide by hangingSuicide by hanging
Male suicide Female suicide
Jugular veinJugular veinOn average, blood accounts for 8% of
total body weight5 to 6 liters of blood for
males
4 to 5 liters of blood for females
A 40 percent blood loss results in blood loss results in death.death.
The loss of 1.5 L canThe loss of 1.5 L can
cause incapacitation.cause incapacitation.Jugular vein
Stab Wounds: Stab Wounds: Sharp Force Trauma Sharp Force Trauma
Type of knife used (width, length, Type of knife used (width, length, single or single or double-edged)double-edged)
Stabbing woundsStabbing wounds
Slicing woundsSlicing wounds
Blunt Force TraumaBlunt Force Trauma
Caused by being struck by a flat Caused by being struck by a flat surfacesurface
Gunshot WoundsGunshot Wounds
International Gun International Gun StatisticsStatistics
Classification of Classification of Traumatic DeathTraumatic Death
Four Categories:Four Categories: ThermalThermal Chemical Chemical ElectricalElectrical MechanicalMechanical
Asphyxiation – interference of oxygen Asphyxiation – interference of oxygen to brainto brain Can be caused by all mechanismsCan be caused by all mechanisms
Mechanical TraumaMechanical Trauma
Blunt or SharpBlunt or Sharp Penetrating or Non-penetratingPenetrating or Non-penetrating Mechanical Trauma occurs when the Mechanical Trauma occurs when the
applied physical force exceeds applied physical force exceeds tensile strength of the tissue, tensile strength of the tissue, causing lacerations (blunt force) or causing lacerations (blunt force) or incised wounds (sharp)incised wounds (sharp)
Mechanical TraumaMechanical Trauma
Sharp Force TraumaSharp Force Trauma Most common cause of death = Most common cause of death =
exsanguinationexsanguination Major arteries or the heart are damagedMajor arteries or the heart are damaged
Blunt Force TraumaBlunt Force Trauma Cause contusions or lacerationsCause contusions or lacerations Most common cause of death = Most common cause of death =
significant damage to brain or internal significant damage to brain or internal bleedingbleeding
Mechanical TraumaMechanical Trauma
Firearm InjuryFirearm Injury Contact wound – blackening of skin Contact wound – blackening of skin
around wound (gas “burns” skin), small around wound (gas “burns” skin), small in sizein size
Distant wound – circular skin defect and Distant wound – circular skin defect and rim of abraded skin around the edgesrim of abraded skin around the edges
Exit wound is Exit wound is larger and more irregularlarger and more irregular than entry wound.than entry wound.
Chemical TraumaChemical Trauma
Death that results from drugs or poisonsDeath that results from drugs or poisons Alcohol = most common drug that causes Alcohol = most common drug that causes
deathdeath Rarely kills directly, but contributes to about Rarely kills directly, but contributes to about
50% of traumatic deaths.50% of traumatic deaths. Other chemicals: Other chemicals:
DrugsDrugs Carbon Monoxide Carbon Monoxide Cyanide / Arsenic (poisons)Cyanide / Arsenic (poisons)
Thermal TraumaThermal Trauma Exposure to excessive heat or coldExposure to excessive heat or cold
Hypothermia – excessive coldHypothermia – excessive cold Hyperthermia – excessive heatHyperthermia – excessive heat
Causes death via a breakdown in the Causes death via a breakdown in the normal mechanisms that maintain normal mechanisms that maintain body temperature.body temperature.
Thermal Burns – death usually occurs Thermal Burns – death usually occurs as a result of complications (shock; as a result of complications (shock; mechanism = multiple organ failure)mechanism = multiple organ failure)
Cause of death in fires – inhalation of Cause of death in fires – inhalation of CO, not burnsCO, not burns
Electrical TraumaElectrical Trauma
Passage of electricity through a personPassage of electricity through a person Low Voltage – heart experiences Low Voltage – heart experiences
ventricular fibrillation (quivering of the ventricular fibrillation (quivering of the heart; beats faster than the body can heart; beats faster than the body can handle)handle)
High Voltage – forces heart into tetany, a High Voltage – forces heart into tetany, a contraction that is broken when the contraction that is broken when the circuit is broken. Heart generally starts circuit is broken. Heart generally starts again with a normal rhythmagain with a normal rhythm
Loss of limbs or electrical burns are possible Loss of limbs or electrical burns are possible within seconds of shock.within seconds of shock.