ForensicAspectsof f Poisoning

DrDianneLittle ForensicPathology GoldCoastHospital,Southport

LectureLearningobjectives
This lecture aims to introduce.and discuss the following: f General aspects of Forensic Pathology and Coroners cases Forensic aspects of carbon monoxide poisoning

ForensicPathologyandtheCoroner

WhatisForensicPathology? Thatpartofpathologyconcernedwith implementationofthelaw. law

ForensicPathologyandtheCoroner

WhatisaForensicPathologist?

ForensicPathologyandtheCoroner

WhatisaForensicPathologist? Doctor D t with ithspecialist i li tt training i i i inautopsy t pathologyandrelatedforensicscience FellowshipoftheRoyalCollegeof PathologistsofAustralasia

NOT alawyer,Coronerorforensicscientist

ForensicPathologyandtheCoroner

FunctionoftheForensicPathologist Assist A i tin i investigation i ti ti of fdeaths d th that th tfall f ll withinthejurisdictionoftheCoroners Act Performautopsies+reports Expertevidenceincourt

ForensicPathologyandtheCoroner

OtherFunctionsoftheForensicPathologist

Deathsceneexamination Exhumations,forensicosteology Opinionsrecausesandcircumstances ofdeath DisasterVictimIdentification(DVI) Other(e.g.assisttissuebanks)

ForensicPathologyandtheCoroner

ForensicPathologists

InAustralia:approximately40 InQueensland:
Forensic&ScientificServices:7.5 75 Regional: 3fulltime(Cairns,GoldCoast, SunshineCoast)plusparttime

ForensicPathologyandtheCoroner

WhatareCoronersCases?
Nonnaturaldeaths
accident,suicide,homicide

Naturaldeathswherenodeathcertificateis available Healthcarerelateddeath Deathinpolicecustody,gaolorinapolice operation i Deathincarefacility Unidentifiedperson

ForensicPathologyandtheCoroner

CoronersRole

Determineidentityofdeceased Determinetime,place,cause&mannerof death RefercasetoDPPifoffencecommitted Exposureofmattersofpublicinterest

ForensicPathologyandtheCoroner

Identification

Visual

 Visual Identification

ForensicPathologyandtheCoroner

MethodsofIdentification
Visual PrimaryIdentifiers

Odontology Fingerprints Fi i t DNA

ForensicPathologyandtheCoroner

MethodsofIdentification

SecondaryIdentifiers

Clothing Personaleffects MedicalandRadiology Tattoos Circumstantial

Tattoos

ForensicPathologyandtheCoroner

Whyisidentificationsoimportant?
Coronerrequiredtodetermineidentification Importantforfamilytohaverightbody Importanttoprovewhodiedforlegal purposes Importantforforensicinvestigation,eg:
Linkdeceasedtoassociates&hencesuspects Identifypilot/driver Identifyterroristbomber

ForensicPathologyandtheCoroner

Mannerofdeath
Natural Accident Suicide Homicide Undetermined

ForensicPathologyandtheCoroner

?MannerofDeath

ForensicPathologyandtheCoroner AutopsyTechnique h i

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ForensicPathologyandtheCoroner

BeforetheAutopsy

Scene visit

ForensicPathologyandtheCoroner

BeforetheAutopsy
History
Policereport Medicalrecords

CoronersOrder
?objectionstoautopsy Extentofexamination
Full(3cavity) Partialinternal External

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ForensicPathologyandtheCoroner

BeforetheAutopsy
Radiology
Plainxrays CTscan Angiography

Why? y
Locateradioopaqueforeignobjectse.g.bullets Documentationofinjuries Identification

ForensicPathologyandtheCoroner

TheAutopsy

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ForensicPathologyandtheCoroner

TheAutopsy
Externalexamination
Checkidentification Examinebody(injuries,scars,tattoos, medicaltreatment) Photographs/diagrams Samples

Internalexamination Ancillarytesting

ForensicPathologyandtheCoroner

InternalExamination
3cavityexamination=fullautopsy
C Cranial i lcavity i Thoraciccavity Abdominalcavity

Systematicdissectionandexaminationof theorgans,includingweighing Notepositiveandnegativefindings Specimensforhistology

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ForensicPathologyandtheCoroner

Yincision

ForensicPathologyandtheCoroner

Examinationofchestandabdominalorgans

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ForensicPathologyandtheCoroner

Reconstructionofbody

ForensicPathologyandtheCoroner

Ancillarytests

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ForensicPathologyandtheCoroner

Ancillarytests
Toxicology Microbiology Serology Biochemistry g Genetictesting DNAprofiling Ballistics

ForensicPathologyandtheCoroner

AftertheAutopsy
Completion p offorms Dictationoffindings Additionalidentificationproceduresarranged Histologicalexamination Collatetestresults Summaryandinterpretationoffindings OpinionastoCauseofDeath Completedautopsyreport Evidenceatinquest,committal&/ortrial

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CarbonMonoxide(CO)Poisoning

ForensicAspectsofCarbonMonoxide Poisoning
Carbonmonoxide(CO)
Odourless,colourlessgas

Normal N ll levels l i inbl blood d

12%saturationinurbannonsmokers 56%saturationinsmokers

Source
Incompletecombustionoforganicfuels

e.g.smoke(4%CO)
carexhaustfumes(0.510%CO) petrol>diesel higherifidling,poorlytuned

Endogenousproduction(0.40.7%)

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ForensicAspectsofCarbonMonoxide Poisoning
Metabolism
Pulmonaryexcretion,unchanged t atsealevel onpureoxygen withhyperbaricoxygen 4hr 4080min 1525min

ForensicAspectsofCarbonMonoxide Poisoning
Toxicity
Chemicalasphyxia COhas200250xaffinityforHbthanO2
displacesO2 &decreasesreleasefromHb decreasedO2 delivery cellularhypoxia

Reactswithhaemproteinsinmyoglobinand cytochromes
depressesbrain&heartfunction

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ForensicAspectsofCarbonMonoxide Poisoning

www.orthosmoke.org/index.php/pt/Carbon%20Monoxide

ForensicAspectsofCarbonMonoxide Poisoning
Toxicity
510% mayaggravateheartdisease decreasedabilitytoperformcomplex tasks 1525% dizziness,nausea,headache,fatigue potentially p yfatal >50%

Physiologicaleffectslessifslowincrease(atlow levels)

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ForensicAspectsofCarbonMonoxide Poisoning

www.k25.co.uk/carbon-monoxide-information.html

ForensicAspectsofCarbonMonoxide Poisoning

www.lambtonfireservices.com

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Suicide
Vehiclerelated OthersourceofCO

Accidental
Vehiclerelated(car,plane,boat) House/otherfires Domesticappliances Industrialprocesses

Homicidal
Rare

ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Suicide
Carexhaustfumes Verycommonsuicide method Howlong?1500cccaridling insinglegaragetakes 10mintobefatal Effectofcatalyticconverters

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Suicide
Vehiclerelated Other

Accidental
Vehiclerelated(car,plane,boat) House/otherfires Domesticappliances Industrialprocesses

ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Vehiclerelated(car,plane,boat) Malfunctioninexhaustfumesentercab MaycauseaccidentbeforediefromCOpoisoning W ki onvehicle Working hi l in i enclosed l dspacewith i hengine i running(e.g.coldweatherwithdoorsshut)

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
h houseboat b t

www.dnr.state.oh.us

ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Housefire Smokeinhalationcommon MayalsobeHCN

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Domesticappliances Maybeseveralpeoplebecauseslowleaknotnoticed Inhouseorcaravan

ForensicAspectsofCarbonMonoxide Poisoning

www.100milefire.com/fire_prevention.htm

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Heaters/fireplaces H t /fi l with: ith inadequateventilation restrictedfuelsupplyincompletecombustion

ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Waterheaters COreleasedifflueblocked

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ForensicAspectsofCarbonMonoxide Poisoning
Scenarios
Accidental
Industrialprocesses e.g. Iron&steelworks(watergasproducedcontains 40%CO) nickelproductionusesCO coalmining(gasincoalseams) methylenechloride(paintstrippermetabolisedto COinbody)

ForensicAspectsofCarbonMonoxide Poisoning
Autopsy p yfindings g
HistorysuspiciousforCOpoisoning Cherryredcolouroftissuesandfluids Maybedecomposed(esp.carexhaustfumes)

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ForensicAspectsofCarbonMonoxide Poisoning

Cherryredcolour

ForensicAspectsofCarbonMonoxide Poisoning
Cherryredcolour

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ForensicAspectsofCarbonMonoxide Poisoning
Autopsyfindings(cont (cont.) )
Ifsurvival:brainnecrosis(basalganglia especiallyglobuspallidus)
Initiallyhaemorrhagicdiscolourationandsoftening Latercavitation Symmetricaloften

ForensicAspectsofCarbonMonoxide Poisoning
Long term sequela of CO poisoning: necrosis of globus pallidus

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ForensicAspectsofCarbonMonoxide Poisoning
ThoseatincreasedriskofCOpoisoning:
Peoplewithcardiac/respiratorydisease Anaemic Children/pets(increasedalveolarventilation) HighHbF(foetus,neonate,haemoglobinopathy;O2 dissociation
curveshiftedtoleft)

Highaltitude(lowerpO2)

ForensicAspectsofCarbonMonoxide Poisoning
Summary
Commonmethodofsuicide Commoncauseofdeathinfires(smoke inhalation) Insidiousaccidentalscenarios Typicallycherryredcolour

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References

Disposition of Toxic Drugs and Chemicals in Man by Randall C. Baselt and Robert H. Cravey, 8th edition, 2008 Ellenhorns Medical Toxicology: Diagnosis and Treatment of Human Poisoning by Matthew J. Ellenhorn, 2nd edition, 1997 Knights Forensic Pathology by Pekka Saukko and Bernard Knight, 3rd edition, 2004 Forensic Pathology: Principles and Practice by David Dolinak, Evan Matshes and Emma Lew, 2005 Neuropathology by David Ellison and Seth Love, 1998 Carbon Carbon monoxide concentration in donated blood: relation to cigarette smoking and other sources. by Aberg et al, Transfusion, Vol 49, February 2009, pp347-353
www.legislation.qld.gov.au/LEGISLTN/ACTS/2003/03AC013

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