DEPARTMENT OF FORENSIC MEDICINE, FACULTY OF MEDICINE, GADJAH MADA UNIVERSITY CONTENT OF LECTURE Drowning : Definition of drowning and immersion Cause and mechanism of death Characteristic’’s appearence at autopsy Laboratory examination Burn Definition of heat injury, scald, and dry heat Ante mortem vs post mortem burn Appearence at autopsy Laboratory examination DEFINITION OF DROWNING There are : DROWNING ( water entering to the respiratory tract or lungs), IMMERSION ( the corpse are covered from water) SUBMERSION (The face contact with the water) So if the dead body found out in the water, it not always mean caused of dead by drowning. There are two principle : Contact with the water Inhaled water into the respiratory tract PHYSIOLOGY OF DROWNING : When people sink, this condition will make : Breath holding Involuntary inspiration and gasping for air at the breaking point Loss of consciousness Death THE CAUSE AND MECHANISM OF DEAD : THE CAUSE OF DEATH IS DROWNING THE MECHANISM : ASPHYXIA (WET DROWNING) LARYNGEAL SPASM (DRY DROWNING) A VAGAL REFLEX (DRY DROWNING) AUTOPSY FINDING : In External examination: A “washerwoman” appearance in the hands and soles (Look white and wrinkled) “Goose flesh” (cutis anserina) “Mushroom like” appearance in the nostrils, mouth, and airways (white foam or hemorrhagic fluid). Some times we found signs of asphyxia and Cadeveric spasm. Internal examination : A white or hemorrhagic foam is found in the trachea and bronchi. Water may be found in the stomach. There could be dilatation of the right ventricle. Pulmonary edema Brain swelling Congestion How to make the diagnosis of drowning : It based on : The circumstances of death A variety of autopsy finding Chemical test /Laboratory test : - Histopathology/Toxicology - Destruction test /Diatoms test - Test of Lungs Juice - The Gettler chloride test Laboratory test : Destruction test/diatoms test : To identify diatoms in the tissue of drowning victim. Diatoms are microscopic unicelular algae (size 5-500 µm) Used closed organ sytem (femoral bone more or encapsulated kidney from a non-decomposed body). The sample is digested in consentrated acid, then examined the deposit in standard microscope. To see what type of diatoms in the water in which the victim drowned, and then comparison. The result negative is not mean, without drowning The Gettler Chloride Test To determine the victim that dead in fresh or saltwater. This is analysis of blood in the right and left sides of the heart. In freshwater ,the chloride level was high in the right than on the left. In saltwater, the chloride level was high in the left than on the right. DIFERENT MECHANISM OF DROWNING IN THE FRESHWATER AND SALTWATER IN THE FRESWATER : Much water entering to the alveoli and absorption to the circulation Hypervolume and hemodilusion Ventrikel fibrilation (Hyperkalemia) Death IN THE SALTWATER : Much water entering to the alveoli contain salt. Water from circulation exits to alveoli Hypovolume and hemoconsentration Edema of Lungs Death BURNS TRAUMA Can be divided into five : 1. Flame/Flash 2. Contact 3. Radiant heat 4. Scalding 5. chemical The definition : Flame burns : contact of body and flame (flash) Contact burns : physical contact between the body and hot object (70 oC or higher) Radiant heat burns : caused by heat wave (electromagnetic wave) Scalding burns : caused by hot liquids (water) Chemical burns : caused by chemical substance Flame burns/flash burn Flash burns are variant of flame burn. Caused by sudden ignition or explosion of gases. Typically is a short duration, burn uniformly. Result in partial-thickness burns and singed hair. RADIANT HEAT BURN There is no contact between body and flame, or hot object. Initially, the skin appears erythematous and blistered, with areas of skin slippage. With prolonged exposure to low heat, the skin will become light brown and leathery (a welldone turkey). Initially the hair is intact, if continues long enough, there will be charring of the body. The factor determine radiant heat burn occur : Temperature of the heat wave Time of exposure Clothing of the skin OR SEVERITY OF BURN INJURIES Depends on : 1. The extend of the burned area 2. The severity of the burn 3. The victim’s age 4. The present of inhalation injuries In living individual : The extent of the burn is indicated as the percentage of total body surface area This is determined by the “rule of nines” The rule of nines Death caused by fire It might be : 1. Immediate 2. Delayed Immediate death Caused by direct thermal injury to the body or smoke inhalation Delayed death May be two or three days are caused by shock, fluid loss, or acute respiratory failure and sepsis HOW TO DISTINGUSH ANTEMORTEM BURNS POSTMORTEM BURNS There is erythematous There is not erythematous surrounding blisters or burns There is not soot in larynx There is soot in larynx and and trachea trachea We can not find the livor The livor mortis will have a mortis with cherry red cherry-red coloration (mean coloration carbon monoxide Microscopic examination can intoxication) not be seen signs of Microscopic examination can inflammatory reaction be seen signs of inflammatory reaction CONCLUSION Cause of death by Drowning if we find contact with the water and inhaled the water into the respiratory tract There are signs to distinguish ante mortem from post mortem burns injuries