Legal medicine 2

7/24/2019 Legal medicine 2

1/11

1. Thermal injuries Caused by an appreciable deviation from normal temperature, capable of producing cellular or tissue

changes in the body.

Scientifically, there is no such thing as cold. It's only absence of heat

Temperature deviation causes cellular or tissue

changes

May be due to very low or very high temperature

Thermal death is one primarily caused by thermal injuries

2. Death or Injury from Cold primary cause of death attributed to decrease

oxygen-hemoglobin dissociation and diminished oxygen utilization by the tissues

cold produces vascular spasm (resulting to anemia of skin surface) followed by vascular dilatation with

paralysis and increased capillary permeability.

prolonged exposure causes necrosis and gangrene due to decreased circulation and vascular spasm

3. Factors affecting severity of

damage

severity of cold

duration of exposure

area of the body involved

sex- women more resistant due to greater deposits of subcutaneous fat

age- children and aged individuals more susceptible to cold because of limited thermotaxic reserve

humidity

fatigue

previous illnesses

4. Local Effects of Cold o frostbite, immersion foot, trench foot

1st: Blanching and paleness of the skin due to vascularspasm

2nd: Erythema, edema and swelling du e to vascular

dilatation, paralysis and increased capillary

permeability

3rd: Advanced stage of vascular paralysis; blister

formation

4th: Necrosis, vascular occlusion, thrombosis and

gangrene with continued exposure to severe cold

5. Systemic Effects of Cold o cerebral anoxia causes a decrease in cardiac and respiratory rates and in metabolic rate

o cold stiffening with blister formation an gangrene in exposed areas

o Reflex in nature brought about by stimulation and paralysis of the nerves

6. Signs and symptoms of

Injury due to Cold

stiffness, weariness, drowsiness

lethargy, coma, death

o delusion, convulsion and delirium

Thermal injuries, Lighting and Electricity, Change in

Atmospheric PressureStudy online at quizlet.com/_20g6kn


2/11


3/11

14. Heat stroke Aka (sunstroke, heat hyperpyrexia, comatous form, thermic fever)

Common in laborers in ill ventilated workplaces with dry and high temperatures or direct

sun exposure

Common to those who work in sweat shops

15. Signs and Symptoms of Heat Stroke Sudden onset that may be followed by premonitory symptoms of headache, malaise,

giddiness and weakness of the legs

Sudd en rise in temperature and skin becomes dry with burn ing sensation and flushed skin

and complete cessation of sweating

Face is congested

Full and pounding pu lse

16. Constitutional and labor code

provisions on

the right of workers to humane

working conditions

The DOLE will always favor the workers in

medico-legal cases

17. VentilationLighting

Airflow

First thing that you should look for when visiting work place in occupational medicine

18. Alcoholism

Disease

Fatigue

may be predisposing factors

19. Local Effects of Heat Scald

- Produced by application of hot liquids at or near boiling point or in its gaseous state

- Generally less fatal than burns

- Death usually due to septic complications

- Usually accidental but may be homicidal in rare

cases

Burns

- Thermal burn

- Chemical Burn s

- Electrical Burn s

- Radiation Burns


4/11

20. Characteristics of Scald a."Geographical Lesion" distribution

b.Skin lesion may be located in covered portions of

the body without affecting clothing

c. Neither burning of hair nor deposit of

carbonaceous material on skin surface

d.Lesion usually 1st, 2nd or 3rd degree

e.Inhalation of heated vapor may lead to

inflammatory reaction respi obstruction

f. Redness of skin after application

blister formation

g.Sepsis with development of pus in one to two days

healing with scar formation contracture or keloid

formation

21. Thermal burns Dry heat

Caused by application of heat or substances to

external or internal surfaces

Most burns caused by localized source of heat

are accidental

Burn s from conflagration of buildings may be

accidental or intentional

22. Purpose of Intentional Fire Conceal victim identity and true cause and manner of death

Use of fire to kill victims

Insurance fraud

*Businessmen get their stocks from their warehouse then b urn the warehouse. The

will claim that their stocks were inside in order for the insurance to pay them.

Suicidal intent

Victim might have been trapped in building set on fire accidentally or intentionally

Person sets himself in fire in pursuance of a cause

23. Arson you just wanted to burn the property

24. Murder If you burned the property in order to kill the person inside, then that is already

murder

25. Importance of knowing the difference

between postmortem and antemortem

burns

in order to know if the fire was the cause of death or the fire was used to hide the

injuries that caused the death

26. Classification of Burns 1. Du puytren's Classification

2. Rule of 9's


5/11

27. Dupuytren's Classification The most generally accepted classification of burns is

that of Dupuytren, which is based upon the depth of the lesion

First degree - Erythema

Second degree - Vesication with blister formation

Third degree - Destruction of superficial skin

Fourth degree - Destruction of whole skin (dermis)

Fifth degree - Destruction of fascia and muscles

Sixth degree - Charring involving vessels, nerve, bones

28. Rule of 9s

The ru le of nines is a standardized method used to quickly assess how much body surfaarea (BSA) has been burned on a patient

29. Factors influencing Effect of Burns Degree of heat applied

Duration of contact

Extent of surface involved

Body part involved

Age of victim

Sex of victim

Complications (e.g., Sepsis)

Depth of burns

30. Involvement of more than 1/3 of the

body surface to a 2nd or third degree

burn

usually ends fatally (due to pain, hemoconcentration and shock)

31. 6th degree burns person is terminated due to shock

32. Burn on the face or genitals grounds for admission

33. Recent burns no pus, healing or edema

34. 36 hours burn pus present, disappearance of red inflammatory zone

35. 1 week burn superficial sloughing of 3rd d egree burn

36. 2 weeks burn deeper sloughs are thrown off and are attended with suppuration; presence of

granulation tissue

37. Importance of familiarizing with the age

of burns

If you are looking at a corpse, you h ave to be able to determine when the incident took

place, because in court you have to estimate the time because there might be alibis there

It is also very important to be familiar with the age of

burns to be able to establish the timeline because the

defense will usually use this to support their alibi.

However , although alibis are the most common

defense in court, it is also the weakest form of

defense. Hence, in the chart, the degree and age of

burns must be documented well. You must also note if

it is antemortem or postmortem burns.


6/11

38. Proof that victim was

alive before being burned

to death

Presence of smoke in air passages

Increase carboxy-hemoglobin blood level

Dermal erythema, edema and vesicle formation

Subendocardial left ventricular hemorrhage

39. Physicians must

determine:

1. Are the lesions due to burning sufficient to cause death by themselves?

o Main cause of death must be proven

o Other reasons must be ruled out

Pretrial conference- lawyers on opposing parties agree on things that they need not argue in court and

decide what the main contention of the case is. (Example: both lawyers agree that the decedent is the

employee of the accused)

2. Are there any other lesions which may account for the death?

Because most of the time this is used to conceal

murders and homicidal incidents

40. Findings that may prove

that death is due to

burning

Vital reaction at the heated areas

Carboxyhemoglobin in the blood

Carbon particles in the tracheo-bronchial lumina

41. Antemortem burn Blister contains abun dant albumin and chloridesArea of inflammation around b urn

Base of vesicle is red

Carbon particles in tracheobronchial lumina

Positive carboxyhemoglobin

42. Postmortem burn Blisters contain scanty albumin and chlorides

No area of inflammation

No color change

Carbon particles absent

Negative carboxyhemoglobin

43. Differential diagnosis of

blister due to heat

Blister due to putrefaction

Blister due to disease

Blister due to friction

44. Heat stiffening Limbs are flexed and fingers are partially

clenched in a "pugilistic position"- like a boxer

45. Investigation of death in

a conflagration

Identity of the victim

Whether victim was alive in the fire

Cause of death- insurance cases

Information indicating a possible cause of fire

46. Insurance law "The cause (fire) of the cause (falling of the post) is the

reason for the damage (death of victim)". The fire was

directly the cause of the falling of the post, so it would

still be covered by his insurance.

For example: the victim was insured in cases of death

because of fire. In this case, the fire was in a post in a

nearby building and the victim was beside a fish ball cart across the street, failing to notice the fire on the

post.

Then the post fell on his head and died. Remember that

the insurance is only for fire. You were called to examine the corpse, and you said that cause of death wa

due to the falling of the post.


7/11

47. Medico-legal aspect

of burns and scalds

Signs of torture for the purpose of gaining information-especially if this person was in the custody of the

authorities

Burning of a building to conceal a crime

Usually accidental but may occasionally be homicidal or suicidal

48. Characteristics of

Chemical Burns

Absence of vesication

Staining by the chemical

Presence of the chemical substance

Ulcerative patches of the skin

Inflammatory redness of skin surface

Delayed healing

49. Delayed healing hallmark of chemical burn s

50. Chemical burns Brought about by action of strong acids and

alkalis and other irritant chemicals which cause

extensive destruction of the tissue

51. Thermal vs Chemical

Burn

52. Chemical commonly

causing burns

1. Sulfuric acid

2. Nitric acid

3. Hydrocholic acid

4. Caustic soda and potash

53. Electrical burns suggestive of severe sloughing off after sometime

depth is greater than surface appearance

o Remember that electricity will follow the path of least resistance (water) so the damage is not only on the areof contact but there will also internal damage because 67% of the body consists of water.

o Remember that all patients who are electrocuted ALWAYS get an ECG because the patient might have an

arrhythmia, and monitor the patient


8/11

54. 3 types of Electrical

Burn

1. Contact burn

Due to close contact with an electrically live object.

May vary from small and superficial to charring of skin if contact is maintained. The injury can be found

where the electrode is placed on the skin

2. Spark burn

Due to poor contact and resistance for dry skinShows a pricked appearance with a central white zone and surrounding hyperemia

May be essential in proving electrical contact but is very difficult to identify An example would be when yo

plug in an appliance and would produce a spark because of the initial poor contact.

3. Flash burn

Appearance may vary from arborescent pattern of lightning burns to the "crocodile skin" appearance of a

high voltage flesh

*In this case, it is the heated air produced by flash that causes the burn. There is no contact between you

and the flash or spark.

55. Radiation burns Extend of burn depends upon degree of intensity and length of exposure

high degree of exposure may cause blister,atrophy of superficial tissue and obliteration of superficial blood

vessels

in very severe cases, there may b e tissue ulceration

56. Death or Physical

Injuries due to

Lightning

lightning is an electrical charge in the atmosphere

approximately 1000volts and 2000 amperes

usually accidental unless you tie someone on a lightning pole

57. Amperage voltage/resistance: Amount of Electricity

it is not the voltage that kills but the AMPERAGEThe voltage is merely potential energy.

Take note of the size of the electrode if it is

enough to kill

Example: You take a bucket and a glass and fill it

with water up to the brim. The water will represent

your resistance. Then you apply the same amount of

heat to both in the same amount of time. The glass

with water will be hotter compared to the bucket

with water.

The same goes for your current and resistance, the

lesser the resistance, the greater is the amperage.


9/11

58. Elements that cause injury Direct effect from electrical charge

o Human body-good conductor especially nerves

Surface "flash burns" from discharge

o Electrical Energy Heat

Superheated air causes burns

o May produce arborescent markings

Mechanical effect-lacerations, tearing of

clothes, etc.

Compression effect-"sledgehammer blow"

59. Mechanical effect As object is heated, it expands several times. Matter

that is heated will expand. The surrounding air will be

superheated and will expand and cause the

lacerations and tearing of the clothes.

60. Compression effect "sledgehammer blow" As lightning strikes (the ground), there will be

superheated air. This superheated air will displace the

non-heated air which occupies a specific area. Thedisplaced non-heated air will then h it the victim causing

the sledgehammer blow.

61. Points to be considering in making diagnosis 1. History of thunderstorm

2. Evidence of lightning strike in the vicinity

3. Metallic articles are fused and magnetized

4. Fusion of glass materials due to heat

5. Absence of wound or other injuries indicating

homicide or suicide

6. Arborescent markings

7. Burns maybe present but limited to areas

under pieces of metal (watch, bracelet)

62. Classes of burns due to Lightning 1. Surface burns- usually seen under metallic particles worn by victim

2. Linear burns - found in areas of skin which offers least resistance (armpits, groin

area: areas where there is moisture)

3. Arborescent burns or filigree burns- radiating bu rns originating from a point

"arborescent"-treelike

63. Medico-Legal Aspect of Death/ Physical

Injuries due to Lightning

Mostly accidental

No interest from medico-legal point of view

Investigation is geared towards the possibilty of

foul play (tied in lightning rod/ flag pole)

Maybe homicidal or suicidal in rare cases

Main cause of death in Electricity is Shock. 100-250V can cause death

64. Mechanism of Death by Lightning 1. Ventricular Fibrillation

2. Bulbar paralysis

3. Mechanical asphy xia

65. Barotrauma Normal atmospheric pressure is 760 mmHg at sea level or 14.7psi (pounds per

square inch)

Increase as one goes deeper

Decrease at higher altitude


10/11

66. Hyperbarism Increase in atmospheric pressure

Encountered by divers - Caisson's disease

o Treatment is decompression chamber

Atmospheric pressure is doubled at 10 meters

At 6 meters, a diver needs twice the amountof air and the amount increases to 4x at 33meters (Go up slowly!)

67. Caisson's disease nitrogen tissue tolerance gradient is exceeded, stays at depth for too long and surfaces too quickly, excess nitroge

bubbles out of solution into blood and tissues

is a dangerous and occasionally lethal condition caused by nitrogen bubbles that form in the blood and other

tissues of scuba divers who surface too quickly

68. Henry's Law At a constant temperature, the amount of a given gas that d issolves in a given type and volume of liquid is directly

proportional to the partial pressure of that gas in equilibrium with that liquid.

An equivalent way of stating the law is that the

solubility of a gas in a liquid is directly

proportional to the partial pressure of the gas

above the liquid.

"Rate of dissolution of nitrogen increases as pressure

increase" The gaseous nitrogen in the b lood will be

converted into a liquid state and would go in the

tissue as the atmospheric pressure increases. It would

again return to its gaseous state once the atmospheric

pressure is lowered. The body cannot readily absorb

the liquid nitrogen and will go to the joints and muscle

fibers and will cause bends (Kayson's disease)

69. Nitrogen

narcosis

Caused by the d issolution of nitrogen in b ody fluids

Preceded by feeling of euphoria

excessive amounts of dissolved nitrogen that produce giddiness and other symptoms similar to alcohol intoxicatio

also called the "rapture of the deep"

70. Other effects ofHyperbarism

Perforation of tympanic membraneCerebral anoxia

Physical injuries due to hitting of hard objects

Injuries caused by aquatic animals

Effects of hyperbarism on pre-existing d isease

71. Injuries during

ascent

Emboli due to air bubbles

Air b ubbles may also cause interstitial emphysema, pneumothorax and p ulmonary air embolism

May also lodge in capillaries of big joints causing it to adopt a semi flexed position (bends)

You should not ascend faster than your bubbles


11/11

72. Hypobarism Decrease of Atmospheric Pressure

More gas will be liberated from body fluids

Will cause:

o Bends

-joint and muscular pain due to air

bubbles

o Chokes

- substernal distress resulting from bubble formation in the pulmonary capillaries

o Substernal emphysema

-accumulation of bubbles underneath the skin; crepitation on palpation

o Trapped gas

-results in doubling of the size ofhollow viscous at 18,000 feet; size quadruples at 33,000feet

73. Anoxia Decrease oxygen content at higher altitude

Anoxia will be felt at 8,000-15,000feet

Aircraft flying above 33,000 (34,000) feet

must be provided with oxygen

74. Aircrafy Injuries

or Fatalities

(During Flight)

o Altitude- hypobarism

o Speed -may cause spatial disorientation & windblast

o Toxins-produced from fire inside the aircraft

o Temperature-negative 40 at 25,000feet

o Pre-existing disease

75. Speed Sudd en changes in direction may cause a person to blackout momentarily

Fighter p ilots have their G suites that has a bladder that pumps airto counter act the change in gravity

76. Aircraft Injuries

or Fatalities

(During the

crash)

Most injuries occur du ring take off and landing

Burns

Fractures

Ruptures of internal organs

77. Injuries occure

during take off

and landing

o Common in fixed wing aircraft esp. if there is mid shear

o In rotator aircraft (helicopter) accidents usually happen during the midflight

o Bird strike: birds can get inside the engine and damage it causing crash. To counter act this, airports play a sound

simulating ox to drive away the b irds

78. Turbulence

during

midflight

cannot take down an airplane because of its design.

Bags and other objects can be projectiles during sudden brakes of the aircraft. That is why they are strict with carr

on baggage inside the plane.

79. Helicoptercrash

Mostly due to structural, engine or control failureOther causes include obstacles suchas wire, weather and pilot error

Most occur dur ing flight

Head and spinal cord injuries are common

80. Cardiac

laceration

due to extreme compression are also common of death due to helicopter crash

Or bursting of the heart due to hydrostatic pressure (paper bag pressure)

81. Helicopter parts have an expiration date and needs to be replaced once expired. In newer designs today, there is already a safety

feature that allows a helicopter to safely land in cases where the pilot would h ave a h eart attack and release the

joystick. The helicopter would rotate slowly downwards until would safely land in the ground.

Documents

Legal medicine 2