Pathology
Lecture 22 Introduction to Forensic Pathology & Sudden Unexpected Death
1) To understand basic principles of death investigation. Six Critical Questions:
1. Who are you? I.D., family visual, physical traits, fingerprint, dental, DNA, etc.
2. When were you hurt/ill/killed? Wound healing, color of contusions, micro exams, rigor mortis, lividity, body temp, all estimations not exact.
3. Where did you get hurt/die? CSI, police records, hospital records, autopsy.
4. Did you die as a result of violence, natural causes, both? Careful consideration of evidence (scene findings, medical history, autopsy, lab studies).
5. If violence occurred, was it responsible (suicide, homicide, accident)? Take everything together and make your best estimate for the death certificate.
6. If someone killed you, who? Collect physical and trace evidence linking a person to the crime, testify in court, expert witness may state opinion.
2) To understand mechanisms, causes and manners of death. Mechanisms of death are physiologic derangements that, if prolonged, become incompatible with life. Airway obstruction is a mechanism, but the cause may have been anaphylactic shock, epiglottitis, or a foreign body. Respiratory arrest is a mechanism, but the cause may have been asthma, pneumonia, or drug intoxication. Cardiac arrest is a mechanism, but the cause may have been MI, PE, sepsis, or ruptured aortic aneurism. The cause of death is the specific disease, condition, or syndrome that initiates the mechanism. The manner of death is the categorization of the circumstances of death, natural, homicide, accident, suicide, or undetermined.
3) To be introduced to medical examiner law and death certification. Medical examiner law mandates that a death must reported if there is evidence of the death being unnatural, if the death was sudden (the person was previously in good health), or if the death was in any way related to medical treatment. Physicians must also report any suspicion of abuse, neglect, or exploitation of children or vulnerable adults. If a weapon caused the injury leading to death then the police must be notified. The death certificate is a civil law document, the conclusions must only be more probable than not. The listed cause of death is the opinion of the signing physician and only includes the cause not the mechanism or other medical conditions.
4) To recognize the spectrum of natural diseases that are associated with “sudden” death.
Cardiovascular SystemHeart
Peripheral Vessels / Atherosclerosis (+/- thrombosis) – MI, dysrhythmia
Hypertensive disease, Congenital anomalies, Myocarditis, Cardiomyopathies, Valvular disease, Pericardial Tamponade, Tumors
Aneurysms – atherosclerotic, dissecting (HTN, marfan’s)
Pulmonary thromboemboli, Vasculitis
Respiratory Tract
Upper airways
Lungs / Infections, Tumors, Allergic reactions
Pneumonia, Tumors, Asthma
CNS
Hemorrhage
Tumors
Infections / HTN, CVA, Ruptured aneurism, AV malformation, Vasculitis
Acute hydrocephalus, Cardiorespiratory suppression by compression, Hemorrhage, seizures
Encephalitis, Meningitis
GI / Varicies, Ulcers, Bowel infarction
Miscellaneous / Systemic infection, ruptured ectopic pregnancy, acute pancreatitis, Epilepsy, Fatty liver, Sickle cell disease
SIDS / Unexplained etiology