Forensic Medicine: Nothing Beyond for PGMEE [5 ed.] 9394525017, 9789394525016

Citation preview

'

,-

• ·._...,.;��---==--.. �:�r10;�;;:-.:�-�::;;.,:�j},���-:,fc, ""9T) Wlder& shallower

Large and oval

Small and triangular

Acetabulum

Large, directed laterally

Smal, directed anterolaterally

Ischial tuberosity

Inverted

Everted

JObturator foramen

Sacrum

Long

Uniform curvature Promontory more prominent

Pubis body

|Trlangular

Small

Upper half straight, lower half curved forward.

Promontory less prominent. Square

http://t.me/dr_pedagogy

33

Dr Pedagogy

Forensic Medicine Sex Determination from Theory LFeatures

|Architecture

Muscle markings &

Male

Female

Less obtuse angle

More obtuse angin

Square-shaped chin

V-shaped chin

Skull

Male

Rugged More pronounced

Female

Smooth

Less pronounced

bony ridges

(Glabella, supraorbi

tal ridges, occipital

protuberance, zygo matic arch, mastoid

process)

|4Frontal eminence 8

Small

Large

parietal eminence Orbits

Square with smooth margin

Forehead

Rounded with Sharp margin

Sloping &steeper Vertical U shaped

Smaller and parabola

Frontonasal

Distinct and

Smooth

junction

angulated

Palate

|Digastric groove

Mastoid process

Large, broader and

More deep

|Large and blunt

Less deep

Small and pointed Sloping forehead Prominent

Prorninent

VITAL INDICES FOR SEX DETERMINATION FROM BONES

supraorbital

Name of the

Acte fronto

index

nasal angle

Sclatic notch

Occiput

index Large

Washburn

mastoid

ischiopubic

Males Femle

Formulae

4-5

Width of notch Depth of notch

Width of notch Depth of notch

73-9491-15 100

index Verical forehead Smooth

CorporobasalBreadth of 1st sacral vertebra index of Breadth of base of sacrum

45

x 100

sacrum

46.2

frontonasal

angle

Sternal indexManubrial length

43

x 100

Body length

Ashley's Rule

Sex Determination from Mandible

" To determine the sex of the sternum

Features

Male

Female

Appearance

Large

Small

Chin

Angle of body with

Prominent muscle

Not prominent

markings Square shaped

muscle markings

Less obtuse 12s*

Roundeda

ramus

34

Angle of mandible

Everteda

Inverted

sternumlengt " It is also known as '149 rule' e female and >149 mm Male sternum length I is Is 0.59

human

In the scene of crime, bite marks on foodstuffs (apples, cheese a

Nature of Bite Marks

Pigment more towards the

Laiteatperiphery

mented, sometimes absent Medullary index c0.39

" "

Cortex thin

broad as medulla)

|Pigment more towards the

Sexual assault

Investigations Done Contd.

" Photographs from various angles

Swabbing of saliva

http://t.me/dr_pedagogy

Dr Pedagogy .

Inpression of bite mark: with Plastic substance (rubber or silicone based) or plaster of Paris.

skin carrying the bite is removed and

during autopsy.

preserved

in formalin

Human ldentification

LOCARD'S PRINCIPLE OF EXXCHANGE "

It states that "When two objects come into contact with each other, there is always transfer of some material between them: There will be a transfer of trace evidences between the accused, victim and the scene of crime.

Theory

" This is helpful in crime investigations, especially in sexual offences. TRANSFER OF EVIDENCES

Victim

Accused

Crime scene

DETERMINATION OF STATURE

iAnt

Stature can be determined from skeletal bones by formulae (Karl

Pearson's &Trotter and Glesser's) & multiplication factors

" Usually long bones are ideal for determining stature. "

Femur is the best bone used for stature estimation.

RECENT ADVANCES Newer methods of age estimation

Mehoda Rugesin Phcnle

From teeth: " Aspartic acid

racemization

Chemical method:

Estimation of nitrogen content of enamel (increases with age) PERCENTAGE OF STATURE CONTRIBUTED BY BONES

MULTIPLICATION FACTOR FOR STATURE DETERMINATION " Femur: 3.7

"Femur: 27%

" Tibia and fibula: (3.7+0.8)=4.5

Carbonate content (decreases with age) Radiocarbon dating of tooth enamel: Precise estimation of an individual's date of birth.

" Hurmerus: (4.5 +0.8)= 6.3

"Tibia 22% "Humerus 209%

Ulna: (5.3 + 0.8)= 6.1

Spinal column: 35%

"Radius: 6.5

-Shede Meken'

mahod

" Femur forms 27% of the entire stature of aperson.

Rau

Aopea,ane liament qrunles

Aien

Blasd- thik, higt 47

Lan vg hoir

http://t.me/dr_pedagogy

Resonirg-,TD

Dr Pedagogy a Glance

Forensic Medicine

F

Chapterat

Theory

IDENTIFICATION cOMPLETE INDENTIFICATION FINGERPRINTS DNA STUDY

PRESUMPTIVE IDENTIFICATION

LIP PRINT

PALATE PRINTS

RACE

FOOT PRINTS SCAR

AGE

SEX

STATURE

TATTOO SUPERIMPOSITION

STATURE rellable Is most Femur "Kart Pearson, Trotter

SEX DETERMINATION

Physlcal examination

RACE skull Cephallc lndex from

body

study (Barr . Sex chromatln In females) body Davidson nd and testes and "

and Glessers formulae used

AGE

Dental eruptlon

Ossificatlon of

epiphyses of long bones

biopsy of Gonadal Ovary (confimatory method) y Delection of SRY gene in chromosome

RELIABLE PELVIC BONE IS MOST

SEX

DETERMINATION FROM

BONES

MANDIBLE Male: Square chin, everted and less obtuse angle

MALE SKULL

fore head

MALE PELVIS

Heart-shaped pelvic inlet Funnel-shaped pelvic cavity Shallow pre auricular sulcCus

Acute sub publc angle notch Narrow greater sclatic

" Sloping "More pronounced glabella "Angulated fronto- nasal

Female: Rounded chin, inverted and more obtuse

lunctlon supra- orbital "Prominent

angle

rldgesmastoid process "Large

FEMALE PELVIS

Clrcularshaped pelvic inlet Bowl pelvicaiuricular ca sulcus Broad pre-au

Obtuse sub publc angle

Wider r

Everted isci

r sciatic notch

tuberosity

FEMALE SKULL "Large frontal eminence "Large parletal eminence "Rour

d orbits

Vertical forehead Smooth oth fronto-nasal junctlon

48

http://t.me/dr_pedagogy

Dr Pedagogy

Human ldentification

TEMPORARY DENTITION

Begins by 6 months Complete by 2 years

Theory

AGE ESTIMATION

20 In number

FROM DENTITION

In each jaw: 4 inclsors, 2 canines, 4 molars

BOYDE'S METHOD: INCREMENTAL LINES

STACK'S METHOD: WEIGHT OF THE TOOTH PEKMANENT DENTITION

METHODs OF CHARTING THE TEETH Universal

Begins by 6

.32 in number

in each jaw: 4 incisors, 2 canines. 4 premolars & 6 molars

.First permanent tooth to erupt is first molar.

SUCCESSIONAL TEETH

Teeth wthich don't have

.Teeth which replace the

deciduous predecessors All permanent molars

Secondary dentin

Haderup system FDI System (internationally

Root resorption

Transparency of root (most

reliable) Cementum apposition

SALIENT POINTS

From the age of 6-12 year the total| number of teeth in the jaw is 24,

deciduous teeth.

Period of mixed dentition": 6 and

"Incisors, canines and

premolars (20)

(12)

Paradentosis

Palmer notation

accepted) ·Modified FDI System

sUPERADDED TEETH

GUSTAFSON'S METHOD Attrition

12 years.

DEFINITIVE IDENTIFICATION

FINGER PRINTS

TYPES

DACTYLOGRAPHY 1st used in India by sir William Herschel first systematized by Sr Frands Galton first

fingeprit bureau of the world-

calcuta

16-20 pints of comparison are

accepled as proof of identity

Loops (most Common)

Whorls Arch

Composite

FINGERPRINTS

Most rellable

method of

identification "Different even it

jdentical twins " Not inheriled

PERMANENT

ALTERATION OF

POROSCOPY Study of pore structure between the fingerprint nridges.

s of sweat FINGERPRINTSPores are the openir od hy glands. Developed by Edmund

- Leprosy,

RUGAE:

electroculation, radiation and

ngraft

FOOTPRINTS: PODOGRAPHY LIP PRINTS: CHEILOSCOPY PALATE

The oores characteristics are

RUGOSCOPY

unique to each individual and

permanent

49

http://t.me/dr_pedagogy

ForensicMedicine

Theory

Dr Pedagogy ConceptsLast-Minute Tidbite

Freguently Asked

essence of crime. index, humerofemoral index. index, intermembral of offence or body the brachial index, crural Dolichocephalic index, Corpus delicti is is Cephalic index, nasal Cephalic index of Aryans Mesaticephalic.; Indices for Race: inn Mongoloids. scen are Indian skull is incisors and taurodontism motive. Cephalic index of an Shovel Caucasoids, cross-dressing with a cusp is seen in sex by real their " Carabelli's hide who bones. Concealed sex: Individuals accuracy in sexing from individual: Pelvis (95%). Diagnostic of Krogman's accuracy: accuracy about the sex shallow in females and nar maximum & wide pelvis; the in gives sex differentiate " Bone which most important feature to is 90% & long boncs - 80%. Greater sciatic notch is thedetermining skull sex from in The degree of accuracy by 10-12 years of age.

Pisiform gets ossificd years of age. Anterior fontanel closes by 1½ responsible. is not criminally years below7 person a IPC, years. Under 82 basiocciput around the age of 18-21 Basisphenoid unites the Sagittal. sutures, the most reliable is guardianship of the court is 21 years. under those For age estimation from skull for majority of the age of 18 years; Age Aperson becomes major at identification of sex, The last carpal bone,

Preauricular sulcus is useful for index. ischiopubic index and sciatic notch index, sternal more A female has compared to female is Corporobasal Index. male in more is which Index " (sternum) is related to Sex determination. " Ashley's rule of 149 is completed by 2 years. " Eruption of temporary teeth age of 6-7 years, First permanent molar appears at the incisor. erupt is Lower central The first deciduous tooth to to crupt is First molar The first permanent tooth

Period of mixed dentition is 6 to ll years. superadded teeth. All permanent molars are of age of adult over 21 years, Gustafson's method is used for estimation incremental lines. Boyde's method is based on counting leaves a trace. Locard's principle states that every contact personal identity is Dactylography. Most reliable method of determining fingerprint is; Loop. The most common pattern of fingerprint is: Composite. The least common pattern of patterns are different. In identical twins, fingerprint LOCARD, of sweat glands only. Invented by Poroscopy is the study of counting pores papillary ridges.

the edges of Edgeoscopy: Study of the characteristics formed byAnthropometry. using Bertillon systerm is method ofidentification

Cheiloscopy is the study of Lip prints.

palate. Rugoscopy (palatoprints) is study of rugae in Hard

In females, obturator foramen is triangle-shaped. to heel length. Rule of Haase is used for calculating age of the fetus from crown

among the long bones. For stature determination, femur is reliably used " Medullary index is used to determine sex of the individual.

If tattoo marks are destroyed, their presence can be inferred from presence of pigment in the regional lymph nodes.

" Feature which differentiates hunman hair when examined under microscope from animal hair is: Fragrment medulla.

50

http://t.me/dr_pedagogy

Dr Pedagogy

Human ldentification

IMAGE-BASED QUESTIONS L Cephalic Index of 80-85 is seen in which of the following race?

4. The minimum age of the given X-ray is:

Image-Based Questions

Head length

a. 12 years

b, 14 years

C. 16 years

d. 18 years

5. The minimum age of the given X-ray is: a. Mongols

b. Chinese

c European

d. Negroid

2. The minimum age of the given X-ray is:

a. 12 years

b. 15 years

C 6 years

d. 18 years

a. 12 years

b. 16 years

C. 18 years

d. 20 years

6. The minimumn age of the given X-ray is:

3. The minimum age of the given X-ray is:

a 12 years

b.

C 18 years

d. 20 years

14 years

a. 9 years C. l6 years

b. 6 years

d. 1l years

http://t.me/dr_pedagogy

51

Dr Pedagogy

Forensic Medicine

7. The minimum age of the given X-ray is:

Image-Based Questions

a. 9 years

b. 6 years

c.

d. 11 years

16 years

8. 8. AIl are thc featurcs present in male skull as compared to (PGI May 2018) female skull; except:

10. True statement about this skull is:

a. Prominent supraorbital ridges, prominent glabella, so chin, acute frontonasal angle-Male

b. Smooth frontonasal angle, round shaped orbit, promine frontal eminences-Male

son c. Prominent supraorbital ridges, prominent glabella, chin, acute frontonasal angle-Female d. Smooth frontonasal angle, round shaped orbit, promine frontal eminences-Female

11. Identify the sex of the displayed pelvis:

Sciatic notch

b. Larger foramen C. Larger frontal sinuses d. Larger parietal eminence 9. All of the following are the features of the displayed pelvis; a. Larger teeth

except:

a. Male

b. Female

associated with thi 12. Who among the following person is

study?

a Sub-pubic angle more obtuse 52

b. Pelvic inlet circular shaped c. Triangular obturator foramen

a. Francis Galton

b. Locard

d. Sacrum long and narrow

c. Krogman

d. Orfila

http://t.me/dr_pedagogy

Dr Pedagogy 3

The image shows which of the following method of identification?

Human ldentification

16. What is the name of the technique of studying the print given in the image?

Image-Based Questions

a. Blood stain pattern

b. Podography

c. Superimposition

d. Cheiloscopy

17. Name the technique of comparing the skull with the photograph. a. Dactylography

b. Poroscopy

d. Cheiloscopy c Rugoscopy 14, What is the name of the technique of studying the print given in the image?

a. Facial reconstruction b. Rugoscopy d. Cheiloscopy c. Superimposition 15. What is the name of the technique of studying the print given in the image?

a Facial reconstruction

b. Rugoscopy

G Superimposition

d Cheiloscopy

a.

c.

Facial reconstruction

Superimposition

b.

d.

Rugoscopy

Cheiloscopy

18. Which of the following techniques is used to these monozygotic twins?

1. DNA fngerprinting b. Dactylography c. Blood grouping typing d. None of these

http://t.me/dr_pedagogy

differentiate

53

Forensic Medicine

Dr Pedagogy

Image-Based Questions 19. The methods used to demonstrate old or faint tattoos are all; except:

21,

Features of the animal hair are all; exent

a. Scales are lange b Medulla thin &fragmented c. Medullary index >0.5

a Infrared photography c UV lamp

Magnifying lens d. Laser

d. Pigment more toward medulla 22. Features of the human hair are all; except:

20. One of the following statements is false regarding aging of Scar:

a. Cuticular scales are short & flattencd

a. Firm union occurs in from five to six days.

b. Medulla is thick &continuous

b. Reddish angry scar in five to six days

c Cortex is thick &medulla is one-thind of the shaft dur

c The scar becomes pale by second week

ten

d. It becomes tough and glistening in two weeks

d. Pigment in medulla is light &broken

23. Identify the naming system used for charting of teeth in the form given below:

a. Palmar notation

c Universal system

b. Haderup system

d. Diagram chart

24. Identify the naming system used for charting of teeth in the form given below:

13|| 12|| 11

4

a. FDI temporary teeth b. FDI permanent teeth

21222252272 c. Modified FDI temporary teeth

d. Modified FDI permanent teeth

http://t.me/dr_pedagogy

Dr Pedagogy 25. The highlighted part of pelvis is helpful in determining: (Recent Question 2016)

Human ldentification

28. Identify the sex of mandible:

Image-Based Questions

29. Which of these rules is associated with the hghlighted bonet a. Age C. Sex

b. Race d. Time since death

26. Age of this person is:

a. 6 years

C. 10 years e. 12 years 27. Identify the race:

a. Negroid race .

Caucasian race

b. 8 years

d. 17 years

a. Rule of Haase

b. Rule of half dozen

c. Rule of Ashley

d. Rule of Nysten

b. Mongoloid race d. All races

http://t.me/dr_pedagogy

55

Forensic Medicine

Questions

Dr Pedagogy

ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS 10, Ans, d. Smooth frontonasal angle, round-shabed prominent frontal eminences - Pemale

1. Ans, a. Mongols

DolichocephallcLong headed

lmage-Based MesaticephalicMedium

headed

Aryans,

70-74.9

Important Features of female skull

Europeans &

75-79.9

" Large Parietal eminence

Negroes Chinese

Brachycephallc

| Short headed

Mongoloids

" Large Frontal eminence

" Rounded orbits with Sharp margin 80-84.9

" Vertical Forehead

" Smooth Frontonasal junction

2. Ans. d. 18 years

" In the given X-ray, the centers for carpal bones appeared. to Ossification Center for lower end of radius & ulna appeared & fused. ExplanationsThe age for fusion of radius center is 18 years. The minimum age of the person must be 18 years.

11, Ans. b. Female

" Female pelvis shows characteristic wide & shallow gre sciatic notch

12, Ans, a. Prancis Galton

Francis Galton Dactylography

3. Ans. d. 20 years

" In the given X-ray, the last center, i.e., ischial tuberosity has appeared & fused.

with 4. Ans. d. 18 years Answers In the given X-ray

" Hence, the minimum age is 20 years.

" The ossification center for iliac crest & ischial tuberosity has

Locard

Poroscopy, Exchange principle

Krogman

Accuracy of Sex determination from bon

Orfila

Father of modern toxicologY, Father of forensic psychiatry

" Francis Galton systematized the fingerprint systems 13. Ans. b. Poroscopy

appeared.

The head of femur, great trochanter & lesser trochanter has fused with the shaft of femur.

" Iliac crest center has not fused. 5. Ans. a. 12 ycars In the given X-ray " The ossification center for lesser trochanter (12 vears) has

appeared. " Triradiate cartilage has not fused. (15 years) . Hence, the minimum age of the person is 12 years. 6. Ans. c. 16 years

14. Ans. d. Cheiloscopy 15. Ans. b. RugoscopyY

16. Ans. b. Podography 17. Ans. c. Superimposition

Dactylography Poroscopy

" In the given X-ray, all the ossification centers around the

elbow have appeared and fused. " Hence, the minimum age of the X-rayis 16 years. 7. Ans. d. 11 years

Rugoscopy

Chelloscopy

Podography

" In the given X-ray, the centers for head of radius, capitulum,

| Superimposition

Identification from fingerprints Identification from the arrangement of

Sweat pores in fingerprint ridges

ldentification from rugae In hard palate ldentificatlon from lip prints ldentification from footprints

Identification from skull & photograph

trochlea, olecranon process have appeared. The minimum age of the person must be 11 years.

Ans. d. Large parietal eminence

Important Features of female akull Prominent glabella, supraorbital rldges, prominent zygoma,

square-shaped orbit, square-shaped chin, prominent mental tubercle, Jess prominent frontal and parietal eminences. 9.

56

Ans. d. Sacrum long & narrow. " The displayed pelvis show circular pelvic inlet, sub-publc angle more than 90, sacrum short & wide, which ore Uggestive of female sex.

18. Ans. b. Dactylogruphy " Fingerprints will be different even in monozygotic twins

is 1 in 6 " Chances of two persons having jdentical prints billion 19. Ans d. Laser

" Laser is not used to demonstrate faint tattoos, 20. Ans. d, It becomes tough and glistenlng in two weeks Age of Scars:

" Flve to six days- reddish or bluish "'angry" scar.

http://t.me/dr_pedagogy

Dr Pedagogy . End of 14 days, the scar becomes pale! It is still soft and

sensitive; there is no further change up to the end of second month. In about two to six months, the scar becomes white and

glistening

21. Ans. b. Medulla thin &fragmented

.

not continuous

.Cortex thick (4-10 times as

Answers

with

Additional cusp in maxillary first molars

Present in Caucasjan race

Coarse and thick

Cuicular scales are short.

lateral inciwr have

" The image shows Carabelli cusp.

Animal hair

Fine and thin

" Permanent molar 1, central incior erupted.

27, Ans, c. Caucaslan race

continuous

Human hair "

26. Ans, b, 8 years

" Firt premolar has not erupted. " The minimum age of this peron must be years,

Afer this, there is no further change.

thick 22. Ans. b. Medulla is

Human ldentification

Explanations

28. Ans, Male mandible

Cuticular scales are large, step like projections Cortex thin

broad as medulla)

Pigment more toward the

"Pigment more toward the

medulla

to

Medulla broad, continuous

periphery

" Medulla thin and

Image-Based

and always present

fragmented, sometimes

"

Medullary index >0.5 " Precipitin test specific for

absent

Medullary index 22 years d. >25 years 7. First carpal bone to ossify:

a. Scaphoid

b. 93.59 cm

a. Dental

C. 42

approximate age is:

(INI-CET Nov 2020)

stat

According to FDI, the left lower canine is designated (Recent Questioa 2h a. 32

incisor

b. > 18 years

(AIMS

f

Following mass disasters, best way to identify bodi:i

6. X-ray showing fusion of sternal body segments and fusion of medial end of cdavicde. The a >15 years

130.095 cm

C. 143.00 cm

(EMGE June 2021) b. Upper central d. None

of eight

person will be:

16.

appear is:

prints

13. The skeletal remain in a building tol male, the length of humerus is 24.5wascm.suspected The

d. Mandible

a. Lower central incisor G. First molar

Height

(FINDER),

C. Ring finger

12-year

b. Hip

C. Femur

me

d. Litle finger

(FMGE Dec 2020)

a. Skull

d.

b. Middle finger

mal ridges

Epidermal ridge thickening

Fetal sex

c. Race

a. Thumb

Irreversible change in epider

b. 1-1, 2-1II, 3-IV, 4-I d. 1-I1, 2-, 3-1I, 4-1V

b.

are recorded excluding:

2-IV, 3-11, 4-11 (INI-CET Nov 2021)

Complete atrophy of epider mal ridges Partial atrophy of epidermal

body

(Recent Queslon

a. Fetal age 12. In a fingerprint reader

Ouesion

using the

ment

5. Heavy mandible

6,

(Recent

a. Theory of exchange b. Fingerprint study

bar vertebra

b. Breadth of fifth Jumbar vertebra X l00/breadth di sacral vertebra

C. Breadth of first sacral vertebra X 100/breadth of bas sacrum

d. Breadth of fifth lumbar vertebra X 100/breadth ot ba Sacrum

18. Sternal index is for: a. Age determination b. Sex determination

G. Species identification None of these

d

http://t.me/dr_pedagogy

(Recent Question 20

Dr Pedagogy

Human ldentification

ANSWERS WITH EXPLANATIONS 1. Ans bi,236

Ref The csentials of Forensic mnediine and taxicolog% Dr. KS Naryana Reddy, 33 ition, pg no: 80-82 Important Features of female skull

" Large Frontal eminence " Large Parietal eminence

Answers with

Sequence of eruption in Temporary teeth

Sequence of eruption in Permanent teeth

Lower central incisors

" First molar Second premolars

Upper central incisors

Upper lateral incisors "

Central incisors

Lower lateral incisors

Canine .

First molar

. Rounded orbits with Sharp margin

" Vertical Forehead " Smooth Frontonasal junction

Lateral incisors

Second molars

Canine

Explanations

Second molars

First premolars " Third molara

2 Ans a. 1-IV, 2-1, 3-I1, 4-1l[ The essentials of Forensic medicine and

Dr. KS Narayana Reddy, 33rd edition, pg.taricologs no:

80-82

Age estimation from skull

. Cosure of Posterior fontanel (Lambda): 3 months - 6

SEQUENCE OF TEMPORARY INCISORS ERUPTION

(UPPER CENTRAL INCISOR

UPPER LATERAL INCISOR

7 MONTHSs

8 MONTHS)

6 MONTHS

9 MONTHS

(LOWER CENTRAL INCISOR

LOWER LATERAL INCISOR

months

Cosure of Anterior fontanel (Bregma): 14-2 years

. Cosure of Metopic suture: 9 months- 2 vears

. Two halves of mandible fuse together: 1-2 years

" Basocciput and basisphenoid: 18-21 years Sagittal suture

Coronal suture

Posterior one

Upper half:

Upper half:

third: 30-40 years

40-50 years

S0-60 years

Anterior one

Lower half:

third:

50-60 years

Lower half: 60-70 years

Lambdoid suture

40-50 years

6. Ans. c> 22 years (refer to earlier discussion) Clavicle:

" The clavicle is the first bone to ossify in the body from two

Middle one third:

|50-60 years Body of Sternum & Sacrum ossification completes by 25

primary ossification centers in 6th week of intrauterine life. A secondary ossification center forms in the sternal end between 18-19 years and fuses by 21-22 years. 7. Ans. c. Capitate (refer to earlier

years.

3. Ans. b. 1-I, 2-III, 3-IV, 41 (refer to earlier discussion)

8. Ans. c. 75-80 (refer to earlier

discussion)

discussion)

4 Ans. b. Hip

9. Ans. b. 18-21 years (refer to earlier discussion)

Ref The Esentials of Forensic medicine and toxicology Dr. KS Narayana Reddy, 33 cdition, pg no: 65

" Pelvis is the best bone for sex determination before puberty. " The accuracy of sex determination from pelvis is 959% (Best bone) 5. Ans. a. lower central

incisor.

Ref. The Essentials of Forensic medicine and toxicolog, Dr. KS

Narayana Reddy, 33rd edition, pg. no: 68 " In the Permanent dentition, First Molar is the earliest to erupt.

" In the Temporary dentition, Lower central incisor is the

eariest to erupt.

10. Ans. a. Theory of exchange Ref The esentials of Forensic medicine and taxicology Dr. KS

Narayana Reddy; 33 edition, pg no: 86

Locard's Principle of Exchange: " It states that "When two objects come into contact with each

other, there is always transfer of some material between them."

This is helpful in crime investigations, especialy in sexual offences.

l1. Ans. a. Fetal age (as explained earlier)

61

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Explanations Answers with 12. Ans. d. Little finger

15. Ans.

b. 33

Ref

Ref The essentials of Forensic medicine and tuxicolog

Forensic Anthropology

AM

Dr. KS KS Nannuna Reddy, 33rd cition, PR. no: 85

"Fingerprinting is the most specificmethod ofidentifcation.

Christenson, DÊ Barteli

Bassalacqua; lst Ed, Ch

" In the question, left lower canine is asked.

Galton's system describes about fingerprinting.

. In FDI

Fingerprint reader (FINDER) is a computerized automatic

" Canine is represented by second number '3

Method of dental charting. left lower quadran

represented by first number '3'

fingerprint reading system which can record each fingerprint data in half second.

" Prints of eight fingers are recorded excduding little finger,

16. Ans. b. In negroes, the cusps of molars are wid.

deep and shovel-shaped cusps in incisors. (refer to e discussion)

13. Ans. a. 130.095 cm

Ref The exsentials of Forensic medicine and toricolog, Dr. KS Narayana Reddy, 33rd edition, pg. na: 655

The multiplying factor for humerus in calculating stature in males is 5.31.

Caucasoid

Mongoloid

aped upper teal incisors

Carabelli Cusp

= 24.5 x 5.31 = 130,095 cm

two lingual cusp

Taurodontism

on mandibular

first premolars

upper Srd molars

are common

Males

Females

Humerus

S.31

S.31

Radius

6.78

Ulna

6.00

6.0

3.8

3.08

" IN MALES: >42 IN FEMALES: 2 mm -Ecchymosis

neoryASPHYXIA

Seen in eyelids, forehead, conjunctiva, visceral

pericardium, heart, lungs, scalp. etc.

Asphyxia literally means Pulselessnes9, Acondition caused by interference with the exchange of oxygen

ostoucu

Due to increased intracapillary pressure and endothelial damage, resulting in rupture of

and carbon dioxide in the body.

venules.

Visceral congestion

Classical Signs of Asphyxia (Asphyxia Triad)

capil aries

Congestion of the visceral organs, like liver, spleen, ete Occurs due to incrcased capillary permeability

ECHIAL

Rt. Ventricular enlargement

HEMORRHAGES

Postmortemn fluidity of the blood

(All the above S features are termed Quintet of asphyxia) IAttention: In all suspected asphyxial deaths, neck she ASPHYXIAL TRIAD CYANOSIs

be dissected at last.

Skull is opened first followed by dissection of the neck at los Drainage of blod from cavities gives bloodless dissectio

VISCERAL CONGESTION

of neck

artifacta. To avoid Prinsloo Gordon

Peripheral cyanosis

sa Sites: Tip of the nose, nail bed, car lobule, etc. Occurs when deoxy-hemoglobin is >5 gm% mgla

Prinsloo Gordon artifact

Form of hypostasis

Hemorrhage on the onterior aspect of the cervical spine. posterior to the trachea and esophagus

is If the patient is severely anemic, total amnount of Hb itself low. Thus, this sign is not seen in anemic patients.

Poses confusion in the interpretation of neck injuries

Petechial hemorrhages (Tardieu spots/Bayard's spots) Minute, pin-point shaped hemorrhages (2 mm in size)

MECHANICAL ASPHYXIA

|NECKCOMPRESSION

NECK COMPRESSION

SPENSION OF BODY NO SUSPENSION OF BODY WITH SUSPE HANGING

STRANGULATION

HANGING

LIGATURE STRANGULATION

uDICIAL

HANGING

LYNCHING

NO NECK COMPRESSION NO BODY SUSPENSION

sUFFOCATION ERING

SVING GAGGING

OVERLAYING

STRANGULATION BANSDOA

" TRAUMATIC ASPHYXIA

GARROTING MUGGING

" DROWNING

"POSITIONALASPHYXIA

HANGING

body by a ligature encircling the neck. " Hanging is a form of asphyxia caused by suspension of themethod uude m- phyi

t oe

The constricting force being the weight of the body rne

Types of Hanging HANGING

BASED ON DEGREE OF SUSPENSION BASED ON POSITION OF KNOT

TYPICAL HANGINGATYPICAL HANGING a cepu Knot o rthan 62

is placod centrally.

COMPLETE HANGING

http://t.me/dr_pedagogy on the occiput

Body ls fully suspended

"No body part touches the ground

Constricting lorce ls weight of the body.

PARTIAL HANGING

Any part of the body is touching the grouo For example, SItüng, kneeling. lying

position forc) Weight of the head is the constricting

Dr Pedagogy

Asphyxial Deaths

Fatal Perlod

" Death is immediate, if cervical vertebrae are fractured (as in

Theory judicial hanging) or if the heart is inhibited, rapid if cause is

asphyxia and least rapld if coma is responsible. " The fatal period is usually 3-5 minutes.

" Hanging is the most common method of committing suicide. Typical hanging Knot at occiput

Ligature Materlal

Atvpical hanging

Knot at side of neck and front of neck

" Material that is readily available (rope, metallic chain, electric

cord, cable, belt, scarf, dupatta, lungi, etc.)

If, found in situ, the ligature should be cut away fromknot and reconstructed by joining cut ends with tape or another cord and then examined Noose Fixed noose

Knot

. Simple slip knot

Complete Hanging

" Fixed knot, granny knot Incomplete

hanging

"

Running noose

" Soft ligature causes wide/faint ligature mark

" Narrow wire causes deep ligature mark (Cheese cutters method)

POSTMORTEM APPEARANCES IN A CASE OF HANGING

Carobd arlery

Splne (30 kg)

External Findings

Esophagus

Slgns on Face

Vagus

(5 kg)

Jugular vein

(2 kg) Trachea (15 kg)

Force of constriction for obstruction of

-2 kg (Cerebral venous

Jugular vein ml

Congestion)

-3405kg (cerebral anemia)| -15 kg (asphyxia)

6 Carotid arteries Trachea

-30 kg (cerebral anemia)

Vertebral arteries

Thyroid cartilage laminafracture-14.3 kg -18.8 kg " Cricoid cartilage Causes of death in hanging

" Tardieu's spots: Over the eyelids, under the conjunctiva and near the temple

" Swollen, cyanosed face (due to impaired venous return) " Subconjunctival hemorrhages and bleeding from noselears Protrusion of tongue due to pressure on floor

" Le facie sympathique® fu arseled (anhy veini angerteo)

" Dribbling of saliva9 ?aepae when bh eh lay ") Le Facle Sympathique (originally described by

Etlenne Martin (1950))

" Sign of antemortem hanging.

If the knot/ligature presses on cervical sympathetic chain, eyelid of that side remains open and the pupil is diloted.

" Asphyxio: Due to narrowing of laryngeal and tracheal lumina

" " " "

Venous congestion: Blockage of Jugular veins Combined asphyxio and venous congestion Cerebral anemia: Blockage of carotid artery Reflex vagal inhibiton resulting in sudden cardiac arrest.

" Fracture/dislocation of cervical vertebrae: Seen in judicial hanging

Asphyia is the cause of death in compete hanging, occlusion of

vessels (veins) in partial hanging

Dribbling of saliva:

Surest sign of antemortem hanging". " Excessive salivation due to pressure on submandibular glands Dribbling of sallva occurs from angle opposite to the side of knot.

(When the knot is on the nape of the neck, it occurs across the

middle of lower lip)

65

http://t.me/dr_pedagogy

Forenslc Medicine

Dr Pedagogy

TheorySlgns on Neck HANGING-LIGATURE MARK

Suspension

peak

Oblique suprathyroidal incomplete ligature mark

Ligature Mark (Suprathyroidal°, Oblique, Incomplete9)

Transverse ligature mark is seen in

Partial hanging

" Pressure abrasion (Sometimes patterned-Patterned abrasion9),

Low point of suspension

Above the thyroid cartilage (usually).

Slip knot with running noose

I runs obliqucly discontinuous, backward, upward and toward the point of suspension.

Mark is discontinuous because of a gap produced by the knot at the nape of neck. Skin at the site: Usually pale in color, but later becomes yellowish, le reproduced in the mark. Pattern of ligature material may be

dry and parchmentlike'ade

Signs on the Body

Postmortem staining in the lower part of upper limbs and

limbs: Glove and Stockings Fashion,ass

" Involuntary discharge of fecal matter and urine may be se In males, there may be penile erection and involuntary dide

ofsemen. ein dinae

Location of ligature mark Abovec tthe level of thyroid cartilage, between the larynx and the chin: 8e%B5.

Internal Findings

At the level of the cartilage: 15%

Neck

Below the cartilage: 5%, especially in partial suspension.

Subcutaneous tissue underneath the ligature mark is dry, â firm and glistening,

Knots: Fixed knot

"

It produces oblique ligature mark and incomplete ligature mark.

Hyoid Bone Fracture (15-20%) More commonly above the age of 40 years",

Slip knot running noose SlipcormnlS knot

It

The location is usually the great horns, at the junction of

encircles the neck and produces transverse and

two-thirds and outer one-third.

Amussat's sign9: Transverse carotid intimal tears seen in

complete ligature mark

drops (Judicial hanging"). Fracture of superior horn of the hyoid bone may be present

Patterned Ligature Marks with Different Ligature Material

of cases)

Fracture of vertebra "

vertebra | Most commnon fracture seen is of C2 cervical

CaHangman's fracture. Associated with hyperextension of neck. Greater horn

Lesser horn

66

Ardeshae

http://t.me/dr_pedagogy

Body

Hangmin kost

Dr Pedagogy

Asphyxial Deaths

Extra Edge

Theory

Fracture of Hyoid Bone in hanging:

Abduction frocture or Anterior Compression Fracture is seen.

Most common site: Junction of the inner two-thirds and outer-third of greater cornu.

LYNCHING " Lynching is a form of homicidal hangin.

Asuspect is overpowered and hung by several persons by means of a rope from a tree or somne similar object.

It was practiced by Captain William Lynch in North America,

where the blacks accused of rape, were hanged publicly without anyy trial.

Judicial hanging

Lynching - Homicidal hanging by mob

JUDICIAL HANGING In india, Knot is placed under the angle of jaw

Traumatic

Knot under the chin is more effective (sub-mental)

spondylolisthesis

" Length of rope from the point of suspension is equal to the

of axis

heighttof the individual

The ligature around the neck causes a forceful jerky impact on

the neck and results in Hangman's fracture.

Pars

Extra Edge Hangman's fracture:

interarticularis fraclure

Fracture of pedicles or pars interarticularis of the axis

vertebra (C2)./L Aiso Resulting in spondylolisthesis of C2 over C3. In judicial hangings, odontoid process is usually not

fractured. May also be seen in snorts. fall or road traffic accidents.

Hangman's fracture Contd...

67

http://t.me/dr_pedagogy

Forensic Medicine

Theory Extra Edge Simon's sign: A

Dr Pedagogy Suicidal hanging Hanging is a common method of committing suicide Ant long. lig

" Hemorhages seen oncor ventral surfoce of the intervertebral discsa beneath the anterior

V disc

Point of suspension should be approachable. Suicidal note° may be present.io th 3 " Fibers of the ligature material used, may be presen

-Simon's bleed

longitudinal ligament

hands. o s ea

in the lumbar spine.

Homicidal hanging

Due to overstretching

" Very rare.

of spine.

n At

" False positive: Putrefaction,

drowning &RTA

Suspension peak:

. The ligature mark of hanging is incomplete at the position of

3503-Srir

Difficult to hang an adult victim, unless he is intoricats uncon-scious.

Homicide should be suspected, when:

Signs of violence in the scene br Clothing of deceased deranged

Injuries present. abica d gahe met,d L

the knot.

" The gap resembles a triangle with the apex upwards. . Thissis called suspension peok. Indicates the position of the junction of the vertical part of rope and the noose. Mechanism: The junction of the noose and the vertical part of the rope is is pulled upwards and away from the skin and thus no mark

left there. Importance: t disinguishes hanging from ligature strangulotion.

Postmortem hanging

Person may be killed and then the body suspended to mimic suicide.

Signs of dragging to the place of suspension. " Branch of tree shows evidence of the rope having moved from below upwards

Absence of rope fibres in the hands of victim. Accidental hanging

Common in children, while 'playing hanging' or getting

suspended from play equipment.

Autoerotic hangingP in adults w d l e

Jlustratiue

Suspension peak

2015 Dimapur Mob Lynching A20-year-old college student was allegedly raped in Hotel

MANNER OF HANGING

Oriental Dream at Dimapur on 23 February 2015. Farid Kh the accused and his accomplice Nikavi, forcibly assaulted he

and intoxicated her. Then Farid Khan had allegedly raped he multiple times. Both were arrested on 25 February 2015

Jail. rape and assault, and were lodged in Dimapur Central The rape victim caimed that the accUsed was known

intoxicais her neighbor. She was lured into the car and was and shen times seyeral by him. She said that she was raped abour remain silent to accused been given Rs 5000 by the incident. During police interrogation, the accused Fario N sex. told that he had given her money and had consensual into the Dimu On 5 March, about 7000-8000 people broke Central Jal. maoe They dragged the accused out of the prison, stones. pelted him with and him naked, beat paraded away, by dragged the accused to a clock tower about 7 km publicy o was he mgtorcvcle and a a rope to his waist from

A 45year oid man was found hanging from a tree in the Outskirts of Delhi. The man was spotted alive the previous day around 10 pm. Relatives suspect foul play in his death. What Coud be the manner of Death (homicidal/suicidal/accidental)?

from the clock tower's ralings.

The police had fired blanks and tear gas at the croa was kille failed to disperse them. One member of the mob

52 police personnel were injured in the clashes.

http://t.me/dr_pedagogy

Dr Pedagogy

Asphyxial Deaths

STRANGULATION "

igature Strangulation (When Ligature Material is

used to Constrict Neck)

Signs of asphyxia more marked.

Face is congested, livid and marked with petechiae.

Neck Findings

Theory

Complete

intrathyroidal

transverse

Ligature strangulation ligature mark

Ligature Mark Ligature mark is transverse, completely encircling the neck,

below the thyroid cartilage (usually).

Transverse, horizontal

"

Base is reddish with ecchymosis.

below the thyroid cartilage

"

Iracture of thyrotd cartilage is more common', Involuntary d1scharge of feces and urine more common.

ligature mark in ligature strangulation

"

THROTTLING/MANUAL STRANGULATION

Multiple, disçoid

bruises (Due to fingertips)

Multiple crescentic

fingernail marks

" When hands are used to compress the neck, it is referred to as

manual strangulation/throttling. " Signs of asphyxia are more evident.

69

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Adduction fractureof hyoid bone present. Throttling is almost always homicida|9 Suicidal throttling is impossible, because

Neck Findings

Theory

nail abrasions are seen

" Externally, crescentic or linear frger n compression by finger tips are Multiple discoid bruises, due to

seen. Aiplay bnw

musclesjs " Internally, extensive contusion ofneck subcutaneous "

in Intense extravasation of blood

unconsc

Throttling .Homicidal throttling" >> Accidental| throttling (

Seen

tissues under

impossible . Suicidal throttling

is the most signifhicant the external abrasions and bruises

internal sign

as

occurs, the hand will relax and pressure is relieved

Very rare

n nde tsp

Concept Alert

Manual strangulation-muitiple bruises &finger tip abrasions

Ligature strangulation

Hangingoblique

transverse ligature mark

ligature mark

one of the frequently asked areas in AlIMS exams. Notes: Friends, image-based question on throttling has been

MUGGING

BANSDOLA Constriction

of

neck

by

bamboo sticks9, one across the

Mugging

back of the neck and another across the front. Both the ends are tied with rope due to which the victim i

squeezed to death. "

Bruise is seen across the neck,

corresponding to the width of the object used.

"

Strangulation

assailant.

of neck by the benddof the elboPor

farearmd

The attack is usually from behind. and may leave no e 70

internal injury mark

http://t.me/dr_pedagogy

Dr Pedagogy GARROTING

Asphyxial Deaths

PALMAR STRANGULATION

tisa form of strangulation of neck by a ligature, in which a

Gnsle assailant can kill a healthy adult male.

warning. . The victim is attacked from behind without tightened, by neck and quickly over the is thrown Aligature results in which ruler, etc), stick, (rod, it with a lever twisting

" One palm is placed over both nostrils and the mouth and another Theory palm is placed perpendicular to the 1st palm.

" The base of second palm is compressing the neck.

pdden loss of consciousness and collapse',

Spanish Method Sogin. It was a method of judicial execution in

Soanish windlass-a device is used. It consists of iron collar placed around the neck and ghtened by screw for strangulation.

HYOID BONE FRACTURES Greater hom fracture with bruising

Abducbon or anteroposterior compression fracture

Adductonor

Inward compreseion fracture

Inward compression/ adduction fractures Seen in case of throttling Inward compression actúng on the hyoid bone.

Fractured segments disploced inwards

Periosteum Is torn on the outer side of the bone

Side to side

compression fracure

Anteroposterior compression"/ Avulsion fractures

Side to side compression

abduction fractures

fracture

" Seen in coses of hanging

" Outward compression acting on the hyold bone. " Fractured segments

displaced outwards

Due to muscular overactivity " Also known as bilateral

No direct injury to the hyoid bone.

"Tug" or "Troction" fractures.

fractures- seen in hanging One greater horn is

fractured outwards and the other inwards.

Periosteum ls torn on the

Inner side of the frocture

Attention

NoTE

Frcure of Hyoldd Bones: Hyoid diractures most common in Manual strangulotlon Monual stronqukotionA> Hanging > Ugature strangulabon

Ahyaid fracture shouid be diagnosed as antemortem in origin only if there Is recent hemorrhage and brulsing at the site.

http://t.me/dr_pedagogy

71

Forensic Medicine

Dr Pedagogy

TheoryLong Scarf Syndrome/Isodara Duncan Syndrome

strangulation. " It when ligoture a clothing around the victim's neck ('dupatta') becomes entangled, usually in. a moving mechanical device (e.. occidental It is occurs neck, resulting in strangulation death. clothing encircles and constricts the

motorbike wheel), and the

Deaths due to Commando Punch sudden cardiac arrest due to x of larynx with the edge of the hand, may result in Aforcible blow across the side of neck/front

inhibitory reflex.

Jlustratiue female was referred by On 5th October 2011, a dead body of a for autopsy. As College, Medical police to the mortuary, Madras police, a group to the husband by her per the statement given house in the midnight of 4 people broke the back door of their the woman resisted While point. at knife couple the and robbed robbers slashed to give the gold "Mangal sutra', one of the lost consciousness,

her neck and snatched it. As the woman of crime was the robbers fled the scene of crime. The scene

SUFFOCATION DEATHS Smothering® Choking Gagging

Traumatic asphyxia

Burking

Positional asphyxia

Overlaying Smothering Asphyxia caused by mechanical occlusion ofexternal air pas (nose and mouth) by hand, cloth, etc.

disturbed.

the During autopsy, one transverse cut injury was noted in

only rlght side of the neck. The wound was superficlal, cutting left side the skin and platysma. Multiple bruises noted on the of neck with underlying intense extravasation of blood. Hyoid fractured. bone ne wass Tound to be side of nree small scratch abraslons were seen on left were seen areas brulsed and adjacent laceratlons nose, two the lower lip, Owing to the superficlal nature of cut, it was

unlilkely to be the fatal injury. With the other findings, it was concluded as a case of smothering and throttling. The husband

arrested on the charge of murder and for faking it to be a

murder for robbery

Postmortem Findings Hraesa h i - p U r

Abrasibns and bruises around the mouth and nostrils

Injuries on the inside of the lips seen.

tu an

Bruising of gum and rupture of frenulum Smothering is usually homicida!?,

Choking pasa " Asphyxia caused by mechanical occlusion offinternal air by aforeign object, like coin, seeds, fish, etc. o brlu

http://t.me/dr_pedagogy

Dr Pedagogy

Asphyxial Deaths

Cause of Death

Asplhyxia Vagal inhibition

Theory

Laryngeal $spasm

ePresence of food items or foreign body in respiratory tract Choking is usually accidental? Common in children

Gagging Aform of asphyxia due to pushing a gag (rolled up cloth or

paper balls) into the mouth and blocking the pharynx.

Collections of saliva, excessive mucus with edema of pharynx and nasal mucosa causes complete obstruction. Almost always homicidal Victim is usually an infant or an elderly person.

Overlaying

eOverlaying results from compression of the chest, nose and mouth to prevent breathing

" Form of accidental smothering

hreuh

pha

. A nursing mother, sharing a bed with her child, may roll over

during sleep and occlude the air passages.

Postmortem Findings " Face, nose and chest of victim child may appear compressed and pale.

" Purely accidental in nature.

Burking " A combination of homicidal smothering and traumatic

asphyxia!.

sing mah crd

Method

Postmortem examination

Masque ecchymotique

Ahngon est

Florid red or blue congestion of face and neck Demarcation line: Level of compression is indicated by a well-defined demarcating line between the discolored upper

Victims were invited, made to drink alcohol and thrown on the

portion of body and the lower normal part.

ground. " Burke would kneel or sit on the chest and close the nose and

mouth with his hands, and Hare, his accomplice used to pull him around the room by the feet till he is dead.

Traumatic Asphyxia/Perthes Syndrome Asphyxia resulting from respiratory arrest due to mechanical Jxation of chest, so that the normal moements of chest wall are prevented,

Causes " Due to collapse of

" "

wall/house

Stampede by crowd, running in panic Run over by a vehicde

Rib and clavicle fractures are common; extremity and pelvic fractures may be seen. "

Mostly accidental in nature.

http://t.me/dr_pedagogy

73

Forensic Medicine

Theory

Dr Pedagogy Smothering

Burting Bruises over the inner surface of the lips

Positional/postural asphyxia: Positional asphyxia is due to abnormal body position that prevents adequate respiration/gas exchange Eramples: Death in inverted crucifirion, Jack knife's position

Café-Coronary

Jlustratiue

The name, cafe coronaró is amisnomer. " Acase of accidental chokingwherein, a bolus of food produces complete obstruction of the larynx.

Dead body of a 70-year-old male was brought for autopsy

23rd August 2010. The alleged history was that deceased az

Victim, who was apparently healthy, collapses suddenly dying

staying alone along with a caretaker at home. The person W

It mimics a heart attack and is usually seen in an intoxicated

The caretaker found him in an unconscious state in the be. the next morning. Postmortem examination revealed th

while eating.

restaurant patron.

apparently normal, the last night with no other relevant histo

small bruises and a laceration on the inner side of lower

Cause of Death

Frenulum of the upper lip was also slightly contused. Muiti

cardfac arrest Irom 'vagal inhibition' as a consequence of

stimulation of laryngeal nerve endings.

luganoe)diy

Petechial hemorrhage were noted under the scalp, Intet fissure of the

lungs-sub-pleurally.

Both lungs were congest No other injuries were present anje on the body. The cause of death was opined as death due smothering. The caretaker was taken into custody. Du and

edematous.

Interrogation he confessed that he had smothered the v

while sleeping and later wanted it to be disguised as natu death. 74

http://t.me/dr_pedagogy

Dr Pedagogy

Asphyxial Deaths

Extra Edge

Theory

Wedging

. This occurs when the face, neck or thorax is compressed between two firm structures. tis common In 3-6 months old children when they start to

nve to the corners of beds and cribs, but they cannot free themselves out of a wedged position. They become wedged between the mattress and either the wall or any structures.

Types of Drowning

DROWNING

Atypical drowning (no fluid entryintoalveoli)

Typlcal drowning (primarily

WHO Definition

tluid entry into alveoli)

Drowning is a process of respiratory impairment due to the or immersion in liquid. submersipn Mode-AGdedal

Wet drowning

Dry drowning

Secondary drowning (near

Hydrocution

drowning syndrome) Wet Orowning

Atypical Hydrocution

Pathophysiology depends upon the

Dry drowning

amount of water aspirated

HYDROCUTION

DRY DROWNING

FALL IN cOLD WATER

FALL IN WATER

(34 mUKgBW) ((MC) Enters alveoli and washes away surfactants

SUDDEN RUSH OF WATER

NERVE ENDINGS STIMULATION

INTO PHARYNX

Alveolar collapse

LARYNGEAL SPASM

Mismatch VP ratio

VAGAL INHIBITION

erla'

ASPHYXIA & DEATH CARDIAC ARREST

Cerebral hypoxemia

Diffuse end organ damage/death Wet Drowning

11 mL/kg (Pathophysiology depends upon the type of water) Salt water (hypertonic)

Fresh water (hypotonic) FRESHWATER DROWNING

SEAWATER DROWNING SALT WATER INHALATION

WATER INHALATION INTO LUNGS

INTO LUNGS

FLUID FROM LUNGS

ENTERS BLOOD

HAEMODILUTION

FLUID FROM

PULMONARY OEDEMA

BLOOD ENTERS LUNGS

HYPEROSMOTIC

SALT WATER IN LUNGS

(CARDIAc OVERLOAD &

VENTRICULAR

FIBRILLATION

HAEMOLYSIS

HAEMOCONCENTRATION

7 NaUTA,1

MASSIVE PULMONARY OEDEMA

HAEMOGLOBIN LEVELS

HYPERKALAEMIA

CARDIAC

INCREASE BY 30%

ARRHYTHMIA

aspirated is about 22 ml/kg oe tlectrolyte imbalance is noted when amount of water

http://t.me/dr_pedagogy

75

Forensic Medicine

Dr Pedagogy ApecheAM Postmortem Appearance

Wet Drowning (Primary or Typical Drowning) Theory

are wet. In this type, Water inhaled into the lungs and lungs NaCl) and sea water Two types Fresh water drowning (0.5-0.6%

External findings Livor mortis In stagnant water: face, upper part of chest In moving water: No appearance Washer woman's handa

drowning (3-4% NaCl).

Pathophysiology of Wet Drowning

owerer

atm

Cutis anserinea Froth in nostrils Cadaveric spasm

the alveoli The aspirated water commonly (3-4 mlkg) enters with the edema and destroys the surfactant inducing pulmonary

transudation of protein-rich fluid into the alveolar spaces.

This surfactant washout decreases the lung compliance and ventilation-perfusion mismatch resulting to hypoxemia and

Internal findings

Emphysemo oquosum Presence of sand particles in the airway

cerebral anoxia.

Presence of water in stomach and small intesine

If the aspirated volume is more:

Paltauf's hemorrhages . Temporal bone hemorrhages

Fresh Water Drowning (0.5-0.6% NaCl) " The aspirated water is rapidly absorbed from the alveoli, and in turn into the circulation leading to hemodilution and hemolysis.

Signs in a Drowning Case

" Circulatory overload, hyponatremia, hyperkalemia followed by

Cutis Anserina

ventricular fibrillation. te pd ySra

" (Goose skin/goose bumps/horripilation)

Sea Water Drowning (3-4% Salinity!

e

State of puckered and granular appearance of skin inte cold water

" The 2spiration of salt water results in shift of water from the

Due to contraction of erector pilorum muscles.

pulmonary circulation into the alveolar spaces due to osmosis,

Nonspecific for drowning. (Can aso occur in rigor mos

while at the sarne time electrolytes (sodium, chloride, magnesium

erector muscles).

from sez water) pass into the blood. There is hemoconcentration with crenation of RBCs, but not

Lungs Findings in

hemolysis and litle change in the sodium/potassium balance.

Drowningeb,Sorty

Secondary Drowning

" Lungs are voluminous, distended and show ballooning.

" Death occurs within half an hou to days after resuscitation.

Emphysema aquosum.wadls nyy aa,e

Distended lungs show rib markings.

" Death due to Cerebral anoxia-irreversible brain damage, heart

failure due to myocardial anoxia. Dry Drowning "

Froth in Drowning Afine, whit, lathery froth is seen at the mouth and noari

Waer does not enter the lungs.

"

Mechanisms for Cause of Death " Largngeal spasm and airway closure causing asphyxia " Refer cardiac arrest due to vasovagal stimulation.

HydrocutionNmmersion Syndrome/Submersion Inhibition "

Dezh results from sudden cardiac arres due to vagal

of heart?

"

. Intra-alveolar edema with thinning of interalveolar seta

aeba loephao o Copious frothy fluid exudes

inhibition

Itis one of the most

characteristic eternal signs of drow The froth may project as a balloon/mushroom-ike massfon mouth and nostrils.

f wiped away, it gradually reappears, on appling press! the chest.

Washerwomen's Hand Wrinkled, sbadeh, bleached appearance of skin. ¡di " Site: Palms,

palmar aspect of fingers and soles of feet in Occurs in drowning in cold waler, which stimulates the vagal plantar surface of toes. nerve endungs at surface of the body or water striking the " Nonspecific sign for or cold vter epigastrium entering the car passage. drowning. . It occurs due to imbibition of water its into outer layer Iime: First seen in the fingertips by 3-4 hours and whok

24 hours. Time sineAst can 'be nd

http://t.me/dr_pedagogy

Dr Pedagogy Codaveric Spasm

Cs gravel, sand, weeds or aquatic denched hands due to cadaveric spasn9,vegetation held firmly in Itis a proof of antemortem drowning,

OASDVxial Deaths

Middle Ear (Ueno's Sign) "

Presence of water and hemorrhage in middle ear is one of the positive proofs of antemorten drowning Theory

Sveshnikov's sign

Paltauf's Hemorrhage alee aillee daras of hemorrhage in lungs Mottled

"

Presence of water in the respiratory sinuses.

Emphysema

Edema aquosum

aquosum9

Rubture ofalveoli due to forced expiration.

Mostly seen in the lower lobes on anterior surface and margins

Lungs contains

lungs with the

froth

victim of

drowning

the person is

dead body is

unconscious

thrown into

at the time of

water

the conscious

.Presenceof sand, mud aquatic vegetations in the trachea and lower

hronchial tree are characteristic positive findings of antemortem drowning. Cue wehite froth mixed with sand in the lumen of trachea and

bronchi is highly suggestive of death from antemortem drowning.

Stomach and Small Intestines

Passive filing of lungs with

airless water and no formation of froth Occurs when

Occurs when

Airway

Hydrostatic lung

" Mere flooding of

both water and

of lungs.

0

struggles for Survival

water due to

hydrostatic pressure

Occurs when

drowning

IAttention:

Stamach (70% of cases) and small intestine (20%) contain water

Froth formation will not be seen in case of dry drowning

antemortetm drowning

and hydrocution.

Water in the small intestine-This is regarded as positiveevidence of death by drowning as it depends on peristaltic movement wwhich is antemortem.

because hyperventilation causes flushing out of CO,, which

. Sehrt's sign: Micro ruptures of the gastric wall due to the Swallowed flujd

" Wydler's sign:

The gastric content is taken into a beaker and allowed to settle for an bour.

Three layers are formed-foam in the uppermost, liquid in the

middle and sediment in the lowermost.

Hyperventilation before drowning causes rapid death,

is necessary for respiratory drive.

Laboratory Investigations Diatom Test " Diatoms are microscopic unicellular algae, which aecrete silica? skeletons called frustules.

" They are chemically inert and almost indestructible, being

resistant to strong acids ,dkal. yeistant to pute

Diatoms of size 60u enters the circulation.

DIATOM TEST PERSON FALLS IN WATER IF THE PERSON IS DEAD

IF THE PERSON IS ALIVE WATER ENTERS THE LUNGS ALONG WITH DIATOMS

DIATOMS PRESENT ONLY IN LUNGS

Vla Pulmonary Veins, Lymph Channels DIATOMS ENTERS

Diatoms circulated to

CIRCULATION

distant organs Bone marrow

Brain

Liver, pue

BEATING LEFT HEART

Kidneys

77

http://t.me/dr_pedagogy

Forensic Medicine

Theory

Dr Pedagogy

tissues like bone marrow Presence of diatoms in the distant antemortem

SEAWATER DROWNING

is the proof of of femur (best site for analysis)

dug ooning decomnposed bodies as diatoms in even Diatoms test is useful

drowning Poson ai

HAEMOCONCENTRATION

resist putrefaction

bodies thrown into water and in dry The test is negative in dead

CHLORIDE IN LEFT HEART INCREASES

drowning Gettler Test

LEFT HEART CHLORIDE RIGHT HEART CHLORIDE

chambers

content of blood in heart " Based on chloride of heart content of the right and left side " Normally, the chloride600 mg/100 mL. is nearly same, about antemortem or more, it is suggestive of " If the difference is 25 ng% ventricle drowning chloride reduces by 50% in left In freshwater drowning, 30-40% in left drowning, chloride increases by " In seawater

content of heart: No change in chloride inhibitinn Drowning due to laryngeal spasm or vagal Putrefaction

Patent foramen ovale

ventrice N wsel in dy dreg FRESHWATER DROWNING

Entertainer Great Cricketer,DROWNING Ms Dhoni -ANTEMORTEM

MNEMOA

and Finisher

SIGNS OF

M-Mud particles in airway marrow D-Diatoms positive in bone

HAEMODILUTION

C- Cadaveric spasm

CHLORIDE IN LEFT HEART DECREASES

G-Gettler's test positive E-Emphysema aquosum

F-Froth in mouth LEFT HEART CHLORIDE RIGHT HEART CHLORIDE

Forensic Riddle

clenched froth spilt unto his face, "Acold hand tightly the deceased part of the indicted, it is clear

wreathing on the under water, was breathing".

nm SEXUAL tASPHYXIA/AUTOEROTIC ASPHYXIA/HYPOXIPHILIA/ASPHYXIPHILIA/KOTZWARRISM

asphyxia. orgasm depend on self-induced and arousal sexual which a paraphilia in " Autoerotic asphyxia is AUTOEROTIC ASPHYXIA

PRESSURE OVER NECK COMPRESSION OF NECK

BLOCKAGE OF

CAROTID ARTERY

COMPRESSION LEADING

RELIEVED

TO DEATH

Accldental failure of

CEREBRAL ANEMA EROTIC HALLUCINATIONS

PERSISTENT NECK

NECK CcOMPRESsION

release mechanisms

PERSON RELEASES

THE PRESSURE

SEXUAL GRATIFICATION & ORGASM

78

http://t.me/dr_pedagogy

Dr Pedagogy

Asphyxial Deaths

Methods . Hanging: Most frequent method

"

Victims are usually young males

Electrical stimulation

. Gue sniffing

Thie condition is usually

associated

transvestism

with

Scene is usually the victim's own house, bedroom, bathroom Theory NO disturbance in the scene of crime Manner of death is accidental?

"

masochism

and "

NO suicidal note present.

RECENT ADVANCES New Markers of Antemortem Hanging

Along with the carotid intimal tears, intimal injury in

vein a emano

ir

P

hanging.

jugular

aroud aaventitial layer are renorted

Hemorrhages at the clavicular origin of the

sternocleldomastold muscles is a consistent autopsy finding in death by hanging.

.Bowel wall hemorrhage, especially in small intestine is recently suggested as a sign of death by hanging (after excluslon of othercharacteristic conditions leading to intra-abdominal congestion).

Petechlal hemorrhages

of the tympanic

membrane.

New Markers of Strangulation " Symmetrical bleeding of the vocal folds and laryngeal mucosa as a result of lateral laryngeal compression (strangulation) after exclusion of ubation artefacts. New markers of antemortem drowning

Elevated serum calcium and magnesium level is especially

useful for the diagnosis and differentiation of salt and

freshwater drowning.

Higher levels of serum strontium in left ventricle (>75 Hg/) than in the right is the best parameter for diagnosis of sea water drowning. " Higher levels of serum magnesium in left ventricle (>1.25 mg/L) than in the right is also used for the diagnosis of

seawater drowning

- ahe io not in

csndihon to exbesat

will

Lsng

- yat the ll d pat

79

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

CHAPTER AT A GLANCE

Theory

ASPHYXIA

Pelechial haemorrhages

(Pulselessness)

Visceral congestion

sUFFOCATION

ATION

STRANGULAn

HANGING

Neck compre No suspensk of body

Neck comp ssion with ncinn of hody suspension

.SMOTHERING CHOKING

JUDICIAL HANGING: (LIGATURE MARK:

Oblique, suprathryroidal incompleie

Glove & stocking distribution livor mortis

.GAGGING

THROTTLING

Hangman's fracture LYNCHING Homickdal hanging by mob

Culaneous abrasions & bruises

Adduction fracture hyoid Intense haemorrhage of soft tissUes of neck

" OVERLAYING

TRAUMATIC ASPHYXA .POSITIONAL ASPHYXIA

Abduction iraclure of

hyoid

SIGNS OF ANTEMORTEM

HANGIG dribbling

. Le facie symptahique

BANSDOLA

LIGATURE STRANGULATION

GARROTING

Ligature mark:

Transverse, below thyroid cartilage &complete Signs of asphyxia more intense

MUGGING

Thyroid cartilage fracture more common

SUFFOCATION

SMOTHERING Occlusion of extemal

CHOKING Occlusion of inlernal

air passages with foreign object Accidental

air passages

Homicidal

oVERLAYING Asphyxia due to chest

GAGGING Occlusion of intemal air

compression when obese

passages with a gag

mother shares bed with baby

TRAUMATIC ASPHYS Mechanical fuatrn

chest resulting in ash

DROWNING

WET DROWNING Water enters the lung

DRY DROWNING Water does not enter lungs

laryngeal spasm

HYDROCUTION Fall in cold water cardiac arrest

NEAR DROWNNK Dies in 6-12 hous after droWnin

due to vagal inhibition

Waler enlers

alveou &washes out surfactants

Aveolar collapse Mismalch VP ratio!

Cerebral bypoia Death

FRESH WATER DROWNING

|SEA WATER

Hemodiluion Hemolysis

Hemoconcantration "Crenation of RBCs

Hyperkalemia

"Pulmonary edema Resplralory failure

Ventricular flbrilaton

DROWNING

SPECIFIC SIGNS OF

|ANTEMORTEM DROWNING " Cadaveric spasm

Fine froth in Nostrils

"Emphysema aquosum

"Froth & sand In airway

"Pallauf hemorrhage

Waler in stomach &small

Intestine

Waler or hernorrhage in ear

80

http://t.me/dr_pedagogy

NON SPECIFIC SIGK Cutis anserine

Washerwoman a

Dr Pedagogy

Asphyxial Deaths

Frequently Asked Concepts-Last-Minute Tidbits tw asphyxial deaths, Cranium should be dissected first and neck at last (o avoid Prinsloo Gordon's artefact).

Theory

Partial hanging is common in Autoerotic asphyxia.

hangine Dribbling of saliva - surest sign of antemortem Le facie sympathique seen in antemortem hanging.

Carntid intimal tear (amussat sign) and Hangman's fracture are seen in judicial hanging. twdicial hanging is the method of execution of death sentence in India. It results in dislocation in 2nd and 3rd cervical vertebra (Hangman's fracture).

Spanish windlass technique is form of garroting.

Einger nail marks, fingertip bruises, hyoid bone fracture, extensive bruising of neck tisues diagnostic of throttling/Manual strangulation.

Adduction fracture of hyoid is seen in throttling. Abduction fracture of hyoid bone is seen in hanging.

Bansdola is constriction of neck by bamboo stick.

Mugging is constriction of neck by bend of elbow or fore arm,

Washer woman's hands and feet usually occur within 12-18 hours (non-specifíc sign).

Cutis anserina or goose skin is anonspecific sign in drowning.

Presence offine white leathery froth in mouth and nostrils is seen in drowning.

Hemoconcentration is seen in sea water drowning; hemodilution is seen in fresh water drowning. Io fresh water drowning. there inmay be hyperkalemia, hemolysis and ventricular fibrillation. wet

is seen " Emphysema aqueosum

wet drowning.

In sea water drowning, there is asteep rise in Na and Mg, Chloride, strontium. . The presence of fine white leathery froth in mouth indicates drowning.

.Diatoms test is negative in dry drowning and in dead bodies thrown in water.

In atypical case of drowning, diatoms are found in the brain and bone marrow. . Getler's test is to determine the chloride concentrations in the blood of heart chambers. " Convincing proof of burial alive is sand in trachea and bronchi.

. Smothering is a form of suffocation.

. Hydrostatic lung is seen when adead body is thrown in water. Emphysema aquosum is seen when a conscious person drowned in water. " Edema aquosum is seen when an unconscious person drowned in water.

" Hanging is usually suicidal, the most common method of suicide. Accidental hanging is seen in autoerotic asphyxia (sexual asphyxia/kotzwainism). Lynching is aforn of homicidal hanging.

Manual strangulation is almost always homicidal, suicidal throttling is impossible.

Choking is accidental. Smothering is usually homicidal

Masque ecchymotique is seen in traumatic asphyxia.

81

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Image-Based Questions

IMAGE-BASED QUESTIONS

1. The most probable cause of death is:

4. ldentify the type of hanging:

1 Hanging

b. Throttling c Ligature strangulation d. Choking

2. The cause of death is:

b. Partial hanging

a. Complete hanging

d. Atypical hanging

c. Typical hanging 5. ldentify the type of hanging:

a. Manual strangulation b. Lynching c Ligature strangulation d. Smothering 3. The cause of death is:

6. The sign shown in the image is:

82

a. Mugging G. Smothering

b. Choking

Manual strangulation

a. Tardieu spots c. Vibices

b. Paltauff haemorrhage

d. Marbling

http://t.me/dr_pedagogy

Dr Pedagogy death is: 7. The cause of

Asphyxial Deaths

10. This sign is indicative of:

Image-Based Questions

Obstructlon

a. Wet drowning

b. Dry drowning

c. Postmortem immersion d. Hydrocution b. Smothering a. Gagging d. Choking c Mugging indicted for: is mancuver Heimlich 8.

11, The manner of death shown in the image is:

12

1 Near drowning c Choking

a. Accidental

b. Suicidal

c. Homicidal

d. Postmortem

This method of execution is termed:

b. Wet drowning d. Gagging

9. The fracture seen in X-ray is seen in:

a. Spanish windlass technique

b. Burking c. Bansdola

d. Pithing 13, This type of asphyxia is termed:

& Partial hanging

b. Manual throttling

c Judicial hanging

d. Bansdola

a. Smothering G. Choking

b. Garroting

d. Mugging

http://t.me/dr_pedagogy

83

Forensic Medicine

Dr Pedagogy 16. This sign is more suggestive of:

14. ldentify the condition: Image-Based Questions

a Antemortem drowning b. Postmortem drowning

a Environmental asphyia b. Traumatic asphyxia

c Non-specific d Hydrocution

c Postural asphyxia

is: 17. The type of asphyxia shown in the image

d Pathological asphyxia 15. The cause of death is:

smothering Combination of traumatic asphyxia and

choking

asphyxia and b. Combination of traumatic asphyxia and strangulation

c. Combination of traumatic asphyxia and throttling d. Combination of traumatic

a Strangulation b. Hanging c. Suffocation

d Traumatic asphyxia

84

http://t.me/dr_pedagogy

Dr Pedagogy

Asphyxial Deaths

ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS L. Ans, b. Throttling

" Itis termed as Hangmank fractureQ.

The photograph shows hyoid bone, with fractured greater

cornu displaced lnwards,-seen in throttlingQ 2. ANs. a. Manual strangulation

. The photograph shows multiple Crescentic nall marks In the neck, more suggestive of throttltne.

3. Ans. c. Smothering

Answers

" Itis associated with judicial hanging (hanging with along drop) 10. Ans. a. Wet drowning

" The photograph shows profusefroth over mouth and nostrils,with indicative of wet drowning

" Froth in drowning is an antemortenmQ feature of wet drowning. Explanations

" Froth is absent in hydrocution, dry drowning and post

. The plhotograph shows the presence of bruises over inner

aspects oflips and abrasions and over the perioral region, 4. Ans. c. Typical hanging

mortem drowning. 11. Ans. c. Homicidal

The photograph shows lynching

" Lynching is lhomicidal hanging, of an alleged suspect of rape or murder by a mob in a public place without any trial.

5. Ans. Partial hanging

.The image shows the knot is located at the occiput - Typical hanging.

Based on the position of knot:

" Over occiput- Typical hanging: Anywhere other than ociput - Atypical hanging

Based on the degree of suspension:

" Whole body suspended-Complete hanging: Any part of the body touching the ground - Partial hanging 6. Ans. b. Paltauff haemorrhage

" The photograph shows paltauffhemorrhage. " Paltauff's hemorrhage is asign of drowningQ.

to

12, Ans. a. Spanish windlass technique Image-Based " Spanish windlass technique is aform of garroting. 13. Ans. d. Mugging

" The image shows neck compression by the bend of elbow. " Mugging is constriction of neck by bend of clbow or bend of knee. 14. Ans. b. Traumatic asphyxia

Questions

" The photograph shows masque echymotic.

" Masque ecchymotic: Subconjunctival hemorrhage and

purple-blue discoloration of the face and neck that suggest traumatic asphyxia.

7. Ans, d. Choking

15. Ans. a. Combination of traumatic asphyxia and smothering

8. Ans, c. Choking

The image shows the obstruction at the level of larynx-choking " Smothering; Occlusion of external air passages by hand, pillow, plastic bag, etc.

. Choking, Occlusion of internal air passages by foreign

The image shows burking an asphyxia death produced by the

combination of traumatic asphyxia and smothering.

Was practiced by William Hare and William Burke, to kill 16 people and supply dead bodies to Dr. Robert Knox for

anatomy dissection.

body, food particles, etc.

Overlaying: Compression of chest, when mother shares bed with baby Gagging; Occlusion of internal air passages at pharyngeal level by agag Heimlich manoeuvre is a first aid procedure used to treat

16. Ans. c. Non specific " The photograph shows 'cutis anserina' " Cutis anserine or goose skin is the puckered and granular appearance of skin immersed in cold water " Cutis anserine is a nonspecificQ sign for drowning

choking or upper airway obstructions by foreign objects. 17. Ans, G. Suffocation

9. Ans, c. Judicial hanging

" The X-ray shows anterior dislocation of C2 over C3

(spondylolisthesis of C2)

" The photograph shows smothering " Smothering is a type of suffocation and is usually homicidal.

85

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

NEXT/CLINICAL CASE BASED QUESTIONS CBQ they fought for a Two friends consumed alcohol, after whichother onto the floor the pushes them common girlfriend. One of breathing while from him and covers his face/nose preventing

(INI-CET Nov 2021) as sitting on him/chest. This is known C Overlaying a. Smothering b.

5

casualty dead was brought to the ind the find cause of death. eters4 autopsy was performed to a mark on the chin On as sL eLamination only finding was

brought

A person

first picture. And on internal examination of fneck tthere wasfhe

Gnding on the anterior surface of neck as shown below possible diagnosis is:

(AIMS May 2017 Ny 217

d. Gagging

Burking

CBQ

2

Acase of hanging was brought for autopsy. On examination, ligature mark present in 1/3n of neck Right eye was open and the left eye closed. Salivary dribbling from the right side of eye? opening of right behind the cause mouth noted. What is

(INI-CET Nov 2021)

Sympathetic chain compression

a.

a Throttling b. Strangulation

b. Jugular vein injury c. Carotid artery injury d

C Mugging

d Hanging

Vagus nerve stimulation CB

6

CBQ

3

Postmortem shows nail scratches in A person was found dead. Hypostasis is

lip. the face, lip laceration in the inner side ofthethereason? be cannot following fixed. Which of the (FMGE Dec 2020)

room was unlocked. On ped Awoman died in her room. Her Subconjunctgl

dissection, there was contusion present. probable hemorrhage and froth in the mouth present. The

(IN-CET N¡v 212

condition is

a. Cause was throttling

b. Postmortem was done within 24 hrs c Due to asphyxia d. tis homicide

CBQ unlocked. Her blood Awoman died in her room. Her room was shown below. On neck alcohol levels were 350 m/mlL Image is (AIIMS Nov 2018) contusion present.

a. Traumatic asphyxia

b. Strangulation

G Hanging d. Drowning

dissection, there was

7

CE

A50-year-old chronic alcoholic while having dinner sudde

becomes aphonic and is brought to the casualty with complaint of respiratory distress, Immediate managemc should be:

a. Cricothyroidotomy 1 Throttling

c.

b. Bansdola

d Alcohol intoxication

Cafe coronary

b. Emergency tracheostomy c Humidified oxygen d. Heimlich maneuver

86

http://t.me/dr_pedagogy

Dr Pedagogy CBO A6-.vear-old male dead body was found in a hotel room.

llal indingsby the forensic team include glove and stocking

nnslasis, protrusion of the tongue, and dribbling of saliva.

The dribbling of sallva is suggestive of? Antemortem hanging

Amiddle-aged male body was found hanging from the Answers ceiling

On external examination, engorgement of penis and glove and

stocking distribution hypostasis noted. Which is true about the above mentioned signs?

Death due to sexual asphyxia

hanging NEXT/Clinical

ANSWERS TO NEXT/CLINICAL CASE-BASED QUESTIONS " Though alcohol intoxication is mentioned in the question,

Asnlhyxla due to sitting on the chest (traumatic asphyxia) and

it is not choking, as there is no obstruction noted in the

dosing the mouth and nostrils (smothering) is burking

|Smothering?

Occlusion of external air passages by hand, pillow, plastic tbag, etc.

Choking

to

b. Death dueeto hanging c. Death due eto strangulation and post-mortem d. None of the above

c Postmortem hanging d. Throttling

Burking I. Ans. b.

CBQ

a.

b. Strangulation

Asphyxial Deaths

tracheal lumen.

5, Ans. a. Throttling

The picture shows discoid bruises and brusing of the soft

Occlusion of internal air passages by forelgn body, food particles, etc.

Overlaying

Compression of chest, when mother

Gagging

shares bed with baby Occlusion of internal air passages at

Burking

Smothering and traumatic asphyxia

Case-Based

tissues of the neck - Suggestive of throttling 6. Ans. b. Strangulation

Questions

The picture shows discoid bruises and nail scratches in the

neck- Suggestive of throttling

pharyngeal level by a gag

7, Ans, d. Heimlich's maneuver

It is a case of choking.

Choking: Occlusion of internal air passages by foreign

2. Ans. a. Sympathetic chain compression.

body, food particles, etc. a. Heimlich's Maneuver

twas mentioned in the question that one eye is open and one

i can prevent choking and Cafe Coronary.

eye is closed.

ii. It's a first-aid procedure used to treat choking or upper airway obstructions by foreign objects.

This sign in hanging is la facie sympathique. Le facie sympathique: One of the surest sign of ante

iii. The term was coined after Dr. Henry Heimlich.

mortem hanging.

" Compression of sympathetic chain by the knot of rope.

Ans. a.

" Results in ipsilateral dilatation of the pupil and partial opening of the eyelids. 3. Ans, a. Cause was throttling

Presence of nail scratches in the face, lip laceration in the inner

side of the lip suggestive of death due to smothering.

4.

Antemortem hanging

Signs of antemortem hanging: 1. Salivary dribbling is seen on the opposite side of the knot. 2. Le facie sympathique 9.

Ans, d. None of the above

Hypostasis is fixed (Time since death is more than 6-8 hours) " Option A: Cause was throttling-false

" In this case, the presence of glove and stocking distribution

" Option B: Postmortem was done within 24hrs- True " Option C: Due to asphyxia- True " Option D: It is homicide- True (The findings suggestive of

and stocking hypostasis indicate the vertical position of the

homicidal smothering) Ans. a. Throttling8

body after death. Not a sign of death due to hanging.

Hypostasis is dependent on the position of body and non

specitic in hanging

" In males, there may be penile turgidity and involuntary

" The picture shows discoid bruises and brusing of the soft

tissues of the neck.

and engorgement of penis is due to the hypostasis, Glove

discharge of semen. " In both sexes, there may be an involuntary discharge of fecal matter and urine.

87

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

MULTIPLE CHOICE QUESTIONS

Multiple Choice Questions

(INI-CET Nov 2020)

1

Drowning True about Fresh Water b. Hypokalemia a Hemodilution

6. Hanging causes a large amount of injury to:

d. Arrhythmia

c Hyponatremia

features are seen in Sea water 2. Which of the following (INI-CET July 2021)

drowning ?

b. Hypokalemia

yponatremia

d. Hemodilution

c. Hypernatremia e Arrhthmia 1, a, b,d

7.

(Recent Question 26)

Lynching is:

a. Accidental hanging

b. Homicidal hanging

c. Accidental drowning d. Homnicidal drowning at: 8. The knot' in judicial hanging is placed

(AIIMS 2006, Recent Question h

2. a,e

3. The above phenomenon is due to

d. Esophagus

C. Trachea

4. b, c, d

3. C,e

(Recent Question 2h1

b. Carotidd artery

Vertebral artery

Behind the neck Below the chin

(Recent Question 2021)

b. Side of the neck d. Choice of hangman

commonly seen in? 9. Hyoid bone fracture is most

(Recent Question 201s

b. Gagging

a. Hanging Choking c. Throttling due to: (AIIMS 201 10. Death in jack-knife position is b. Positional asphyxia a. Burking c. Traumatic asphyxia

d. Wedging

11, Which of the following is not a type of suffocation:

(Recent Question 2016

a. Choking

b. Gagging

d. Throttling c. Smothering Question 2016 12. Immersion syndrome is called as (Recent b. Wet drowning a. Hydrocution d. Secondary drowning c. Dry drowning 13.

Feature of ante mortem drowning is:

(Recent Question 2016 a.

Cutis anserine

b. Rigor mortis & Case of torture in hot water

C. Washer woman's feet

b. Case of post-mortem hanging d

in water for 36 bours Case of tmfalanga Case of case

4. Partial hanging may resemble strangulation by

(FMGE June 2021)

d. Grass and weeds grasped in hand 14. Emphysema aquosumn is associated with? Dry drowning

C. Immersion syndrome

2 Knot mark

b. Situation below the thyroid cartilage

c. Dribbling of saliva

d. Transverse ligature mark

5. Judicial hanging is the method of execution ofa condemned

criminal in our country. The cause of death in such cases (FMGE June 2021) would be a. Vagal inhibition b. Fracture dislocation of cervical vertebrae c. Cerebra l hypoxia d. Asphyxia

15. Gettler test detects:

(Recent Question 2013, 5 b. Wet drowning Secondary drowning (Recent Question 2014

Diatoms in drowning

b. Chloride content of blood in drowning

c. Weight of lungs in drowning d. Magnesium content of blood in drowning 16. Most common form of drowning in India: (Recent Question 2014 a. Suicidal

c. Accidental

88

http://t.me/dr_pedagogy

b. Homicidal d. Infanticide

Dr Pedagogy

Asphyxial Deaths

ANSWERS WITH EXPLANATIONS llemodiltlon, c.

Hyponatremla, d. Arrhythmla

Internal FHndings: Explanations Answer with " Fracture lyold Bone: Abduction fracture " Amussat slgn: Carotld artery transverse intimal tear!

2. Ans, J.Ge water for 36 hours LAns, c lmmerslon in

(Ref The esentials of Forensic medlclne and toxicolog. Dr KS Nanyuna Redy: 33nl elition, pg no:369)

Signs of antenortem hanging Sallvary drlbbling? Le facie sympathlque? Features

Hypertonle

Hypotonle

Mechanism

Strangulatíon Constriction of neck

Constriction of neck

without suspension of body Homicidala

with suspension of

Fluld entering

Water Entering Into the blood

enters into alveoli

Resulting ln hemodilution

Pulmonary Edema

Hemolysis

body

Manner (usually) Sulcldal9 Signs of struggle Absent Ligature mark

Below thyroid cartilage

cartilaged Incompletea Obllque

falure

Complete

TransverseQ Subcutaneous

" Subcutaneous tissuesos under the

Here lt ls Hemo Concentration

Cardlac arythmia

Present

" Above thyroid

Respiratory

Hyperkalemla & Hyponatremla

tissues under the mark reveals

mark reveals pale,

ecchymosis.

white, glistening, Na',

Death

Ugature

Hanglng

Salt Water

Fresh water

hard skin

CIl ‘Mg4,‘ Strontium

in blood

4. Ans. d. transverse ligature mark

Hyold fracture

Common (>40 yeors)

Thyrold fracture

Uncommon

Uncommon

Common More marked

External signs ofLess marked asphyxia

5. Ans, b. fracture of cervical vertebra

(Ref The essentials of Forensic medicine and toxicology,

Dr. KS Narayana Reddy; 33rd edition, P8 no: 345) Transverse ligature mark in hanging seen in partial hanging, slip knot with running noose.

Face

Pale

Congested

Bleeding from

Less common

More common

Present

Absent

Less common

More common

At glans is more

Less common

nose and mouth Carotid intimal tear

Involuntary

discharge of

6. Ans, b, Carotid artery

Ref The essentials of Forensic medicine and toxicology Dr. KS

Narayana Reddy; 33rd edition, pg no: 345

urine and stools

Seminal fluid

common

Amussat sign:

" Carotid intimal transverse tear on the side of the knot

Associated with long drops. " It is due to combination of RADIAL FORCE (ligature materlal) and AXIAL TRACTION (weight of body due to Suspension)

POSTMORTEM FINDINGS IN HANGING

External finding:

7. Ans. b. Homicidal hanging [Ref The essentials of Forensic medicine and toxicology. Dr. KS Narayana Reddy; 33 edition, Pg. no: 346]

Lynching is aform of homicidal hanging. 8. Ans, b. Side of the neck

"cases) Ligature mark: Obilique, above the thyroid cartilage (80% and incomplete. Le facie symphathiqueQ: Unilateral opening of cyelid and

pupillary dilatation on the side of knot

" sign Driblng ofsalivafromthe angle of mouthº (most Important 8 of of ante mortem hanging) " Seminal emission is common,

(Ref The essentials of Forensic medicine and toxicology,

Dr. KS Narayana Reddy,; 33n edition, Pg. no:346]

Judiclal Hanging

" In India, the knot is placed near the side of the neck

" But the knot below the chin is highly effective.

" There is a sudden drop, resulting in hangman's fracture.

89

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Explanations with Answers9. Ans. c. Throttling (as explained earlier)

1, Ans. d. Throttling

10. Ans. b. Positional asphyxia

12. Ans. a. Hydrocution

[Ref. Concise textbook of forensic medicine & toxicology by

Hydrocution/Immersion Syndrome/

Anil Aggrawal, P272.]

Submersion Inhibition

Jack knife position:

Death results from sudden cardiac

arrestQ inhibition of heart, " Occurs in drowning in cold water, which : nerve endings at surface of the body or

"A restraint position where the thighs and the knees are flexed against the chest.

due

to

vagl

stimulates the vagi water striking epigastrium or cold water entering the ear passage

" As a result, the body is subjected to indirect compression. attributed to the impaired movement of chest wall

. Death is

due to this position.

" Death is due to positional asphyxia 13. Ans. d.

Grass and weeds grasped in hand

High-Yield Info

Signs of antemortem drowning External findings

" Cadaveric spasm holding grass, gravel and sand in hand " Fine, white lathery froth in mouth and nose

Internal findings

Emphysema aquosum: Voluminous, ballooned and crepitant lungs

Presence of froth° mixed with sand particles in the trachea and bronchi Presence of water in stomach and Presence of water in middle ear

small intestine

Temporal bone haemorrhages ab tests:

Diatoms in the femur bone marrow Gettler's test

14. Ans. b. Wet

"

drowning [Ref. The essentials of Forensic medicine and toxicology, Dr. KS Narayana Reddy, 33rd edition, pg.

Emphyysema aquosum is a sign of wet drowning.

15. Ans.

b.Chloride content carlier)

16. Ans. c.

(Ref: The essentials of Forensic medicine and toxicolag

no:369]

of blood in drowning (as explained

Accidental

"

Dr. KS Narayana Reddy; 33rd edition, pg. no 32 is drowning accidental.

Most common manner of

(Ref The essentials of Forensic medicine and toxicology Dr. KS Narayana Reddy; 33rd edition, Pg. no:372]

90

http://t.me/dr_pedagogy

Dr Pedagogy

Forensi

Araumatology "Push Yaunoelf Because, Na'One Ese io Gaing a De t for Yau"

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Theory

LEr's KNow THE TERMS FIRST Mechanical Injuries

Blunt force injuries (Ground, Sharp force: Light cuttng

Sharp force: Heavy cutting

weapon (Surgical blade)

weapon (Chopper, axe)

Sharp force: PoPointed

Abrasion (scratch)

Incised

Chop injury

Stab injurya

Contusion (bruise)

(cut injury)

stone, hammer)

Laceration (skin tear)

(Kitchen knife, crewe pencl)

wt

Fracture of bones

Injury (Sec. 44 IPC): Any harm, whatever illegally, caused to any person in: . Body Mind Reputation Property

Wound: A breach of natural continuity of skin or mucous membrane Open head injury: When the dura is torn Closed head injury: When the dura is intact Non-penetrating or closed abdominal injury: When the peritoneum is intact,

Penetrating or open abdominal injury: When the peritoneum is ruptured.

" Mass disaster: Death of more than 12 victims° in a single event, like fire, air crashes or floods. .............

ABRASION General Characters of Abrasion of the skin (epidermis) only Destruction of the skin, which usually involves the superficial layers

" Slight bleeding, heal rapidly and no scar formation,

ABRASION

Tangtial LATERAL RUBBING OF SKIN

COMPRESSION OF SKIN

WITH ROUGH SURFACE

GRAZE

SCRATCH

PRESSURE ABRASION

PATTERNED

ABRASION/

Pressure Graze

Scratch

inear abraslon caused by pointed or sharp object

" FingernaiP/Thorn/Pin

Friction with rough surface over wider area

ole uneven, longitudinal

Uel Hnes ost common

of abrasion Mo In road traffic Also called brush burn/sliding

dents

abraslon/rai

92

Pressure over the

skin with crushlng of

epithelium. Ligature marka

in hanging and strangulation.

c

http://t.me/dr_pedagogy

rt ar Patterned

eplthelium " Crushing of pattern

fthe weapo

Imprinted on the skin Ligature mark " Radlator grill mark Tread marks of tire

Dr Pedagogy Forensic Traumatology Differential diagnosis of abrasions

Theory

" Ant bite marks

SIte: Mucocutaneous junctions-around the eyelids, nose, mouth, axlla &groins

Appearance: GRAZE ABR

LINEAR

SCRATCH

UNEVEN LONG NGITUDINAL WWIDED AREA

PRESSURE

Irregular margins

ABRASION

Normal skin in between (Sand paper appearance")

LINES

" Vital reaction is absent. "

Extra Edge

Pressure sores

"Npppy rash

Nature of Injury: Ilualy abrasions are simple hurt (as they are superficial) except corneal abrasion,

Antemortem vs. Postmortem Abrasions

, Corneal abrasion is grievous hurt (Sec. 320 IPC) because

ahrasions over the cornea may cause corneal opacity and

permanent visual restriction.

Features Site

Medicolegal Significance of Abrasions

Antemortem

Postmortem

abrasions

abrasions

Anywhere on the

Bony prominences

body

Abrasions give an idea about the direction of force® Patterned abrasions are helpful to find out the causative weapon. Age of injury can be determined In open wounds, dirt or sand is usually present which is used to

Scab formation

Present

Absent

Color changes

Present

Absent, mostly

Manner of Injury

Vital reaction

yellowish without any change

connect to the scene of crime

Present9

Absent

Direction of force

Heaping of epithelium or epithelial tag:

. Surface epithelium is scrapped &deposited at the tail end

CONTUSION/BRUISE

Tal

of the obrasion

" Contusion is the extravasation of blood under the skin due to rupture of blood vessels, usually capllaries, as a result of blunt

Abrasion distribution and manner

. Crescentic finger nail abrasions over neck: Throttling

Abrasions around mouth &nose: Smothering Ua

dc

force injury. Present not only in the skin, but also in internal organs-lung, brain or muscle.

" Abrasions on breast, genitals & thigh: Sexual assaults

MNEMONIC

Blunt force

Time since injury from Abrasion

RRRBB8-R'g 1 A -Raw without scab (fresh) - 12 hours

Collection of blood (extravasation)

Abrasion heals from the periphery by growth of new

epithelial cels. After 7 days, Scab dries and falls off, leaving depigmented

area underneath

Swelling and discoloration of skin (contusion)

tgradually gets pigmented.

http://t.me/dr_pedagogy

Ho) whed uen

Forensic Medicine

Dr Pedagogy

Theory

Six penny bruise (as it

resembles six penny)-Hes

Discoid-shaped bruises

Due to pressure from fingertips Seen in neck of throttling cases & arms, forearm or wrist of child abuse cases

Butterfly brulse

lad

Due to skin pinching Moy be seen in child abuse cases.

NoTE Extravasation, i.e., blood outside the vessel is an important

feature of contusion, by which postmortem lividity can be

easily differentiated.

Types of Contusion Description

Type

Common type

Superficial/

Location: Subcutaneous tissue in fatty

subcutaneous

layer

bruise

Deep bruise

Below deep fascia. It may take

LOcat hours to 1-2 days to appear at the surface

Ankle contusion with bruise

(delayed brui Ect

Appearance of bruises ata site other than the site of injury, e.g., black eyes. Thus, site of bruise does not always

bruise

ti Patterned bruise

indicate the site of injury For example:Blackeye/spectacle hematomaQ Patterned bruise indicates the nature of the weapon

XDeep organ

n 2 eau

g

Aging or Dating of Bruise

Based on the color changes. destruction & removal dt As bruises heal, there is a gradual

extravasated blood

extends inwards tat Color change starts at the periphery and

center.

Contusion of the internal organs

hon

N

- uhnuorim

Oxyhaemoglobin (Red)

contusion

Deoxyhaemoglobin (Blue)

type-oH3 Railway line or tramline parallel, stick or a whip produce two Blows with a rod, linear haemorrhage.

Hemosiderin (Brown/violet)

Haematoidin bilyerdin (Green) Bilirubin (Yellow) 7-14 Fresh

Few hours

4-5 days

6-7 days

3 days

94

The intervening skin appears pale, The diameter of the pale area may indicate the diameter of the weapon.

OXY-H

DEOXY - Hb Hemosiderin

http://t.me/dr_pedagogy

Haematoidin/ Br Biliverdin

Dr Pedagogy Forensic Traumatology Prominent/easy bruisíng with

Extra Edge color changes Sites where are not contusion

" Multiple bruises of different ages in a same person isa

of seen-Subconjunctival hemorrhage (due to continuOus

feature of child abusea

phases) Postmortem lividity (in early .Artiicial bruise/Pseudo bruise Certain irritant substances and plant juices are applied on the

stin to mimic articial bruise. Trlomma)y Bruise R

Jluotrative A 28-year-old female was in a semiconscious state, brought to casualty by her newly-wed husband with history of giddiness and vomiting since 2 days. She was declared 'Dead on Arrival'. On autopsy, multiple areas of dark patches simulating birthmarks,

True bruise

Pseudo bruise

Blunt Trauma

Plant poisons like

were pale. Kidney showed acute tubular necrosis on microscopic

Semicarpus

examination. The cause of death was given as shock and

Cause

Calotropis

hemorrhage due to multiple soft tissue injuries sustained. Owing to the opinion, the husband was taken into custody. He confessed

PlumbagO Location

Theory

Males

were present all over the body. Extravasation of blood were noted on incising the patches, indicative of bruises. Multiple incisions were put on discolored areas all over the body. Numerous contused areas were noted (45 in no). Internal viscera

Pseudo/False Bruise Characteristics

e

obesity, leukemia, hemophilia, scurvy, bleeding diathesis, vitamin K& prothrombin deficiency

Contusion

Differences between True

" Females Conditions like cirrhosis,

exposure of air

Diferential Diagnosis of

Lesser/delayed brulsing

little force

Anywhere on the

bodya

Accessible parts of body

Like forearm, thighs, abdomen

Blisterfvesication

Not present

Presenta

Itching

Not present

Present

Color Changes

Characteristic of

Absent

changes as it heals) Blood

Chemical analysis

Negative

LACERATION A5 4e0) Tissues are torn as a result of application of blunt force. Tissues may be skin, mucous membrane, muscles or internal organs.

true bruise (color

Contents

to have tortured and beaten his wife with a stick covered by cloth.

Laceration is three-dimensional (length, breadth and depth)

las

Acrid serum

General Features of Laceration

Chemical/plant

" Irregular Shape®

juice detected

0tfvieN

Irregular and uneven Margins

MNEMONIC Substances producing pseudo bruise

" Contused edges Floor of laceration shows following features:

Tissue bridges (tissue, blood vessels and nerves bridging

Social Preventive Medicine Sermicarpus

across the gap of the wound)

Plumbago

Less hemorrhage because of crushed blood vessels.

Crushed? -Hse,ne, aix buls

Foreign particles like mud may be seen embedded in the

Madar (calotropis)

wound, which gives clue about the scene of crime

Factors Influencing Contusion Appearance Prominent/easy bruising with Lesser/delayed bruising

little force " Falr complexioned

skin

Dark complexioned skin?

Lax and vascular tissues,

Tissues with firm fibrous tissue or thick

eyelids

Dermis, such as abdomen,

such os foce, scrotum&

back, scalp, palms and soles

Children and elderly age

Good muscle tone

group

Contd..

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

Theory Iregular margins

Contused

Crushed hair bulbs

edges Tissue

bridges

Lacerated wound

Types of Laceration Split Skin is split .

Mechanism

Tissues are crushed between two hard surfaces, i.e, the weapon and the undertying bone

Incised likefincised looking

Tear

Stretch

Mechanism:

Localized pre[sure with pull

.

Tearing of skin and SC tissue due to localized impact with

hard irregular object

torce.

Overstretching of the skin

Avulslon/rinding Mechanism: Sheari delivered at an oblicy angle to skin. , Seen in Run overinr The rotating wheel riosl

causing laceration with

of skin and subcutanesg tissues from the under

flapping

Striae-like lacerations or

bone-FLAYINGO Direction of forceca

stretch mark-like lacerations

lacerotion

determined

MNEHO Extra Edge

bny Sites of incised looking lacerations:Fatal 8leeding

to ranges from skin flaps (minor) The severity of avulsion amputation of a finger or limb (moderate) and

& Sharp Knife Causes Slash Injury S- Scalp

(severe). skin over a force of a wheel tears off the " Flaying: The rotating frequenthy on the legs large area - flaying, and most where the large area of skin type severe Degloving injury: A rolled off a Iimb (like a glove) and subcutaneous tissue is and SC tissue is rolled off the Scalping: A large area of skin trapped hair is trapped and being scalp (especially when the in machineryl

K- Knee C-Chin

degloving

S-Shin 1-lliac crest F-Forehead

B-Brows eyebrows) lacerations are seen are Notes: Sites where incised looking PGMEE. commonty asked in various

INCISED WOUND (CUT/SLASH/SLICE) laceration Incised Uke/incised Looking incised wound. (A laceration will look like an This injury

looking like an incised wound)

ky eOu ney

tisa type of split laceration wounds, easily detectable on These are essentially lacerated lens.-ier eamination with a magnifying

Common sites:

the underlying bones, I.e., Scalp, " Wherever skin is dose tochin, Ilac crest, shin face, forehead, cheek,

24

N

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology Regular Margins: Clean cut9,

HESITATIONAL CUTS |Tdetsa /Tadahe t /

dimensionQ . Length: It is the maximum

Depth/direction:

>b

debth)+o

Head end: deeper at the beginning of the wound Tail end: Shallow at the terminationQ Hemorrhage: More bleeding due to cutting of vessels

PROFUSE BLEEDING

CLEAN CUT MARGINS

IN THE FLOO

Indicates suicidal nature of the wound

Fees

toke

Theory

Multiple, small, superficial, parallel cuts noticed over the

accessible body parts Sites - Over throat, wrist, elbow, front of chest and abdomen. Multiple, small, superficial, parallel cuts noticed over th¹ accessible body parts

VESSEL NERVE

TalingY

" It is a feature of incised wOund

. Usually deeper at the beginning (head end) and toward termination, the cut becomes progressively shallow, known

as tailing of the wound.

Direction of the forcecan be determined

CHOP WOUND

Caused by a blow with the sharp-cutting heavy weapon.

Deep gaping wounds, Chusrito o h e U

Weapons used: Hatchet, axe or meat cleavers. Margins are sharp, and may show abrasion or bruising.

" Undermining occurs in the direction toward which the chop is

HEAD END

made. TAILING

DEEPER

Most of the injuries are homicidal

STAB WOUND (PUNCTURED WOUND) " Produced from penetration of weapons with pointed ends " Depth° is the maximum dimension of stab wound TAILING

" Penetrating wound: Weapon enters into the body cavity producing only one entry wound.

Perforating wound (through and through punctured wound): Weapon after entering into one side of the body will come out

4uTS

BEVELLING

through the other side, producing two wounds (Entry wound and Exit wound) Features

Undereut

Everted

Inverted

Margins Shelved

Exit wounds

Entry wounds

Smaller

Larger

Size

Characteristics Margins " Edges

(Bevel: Asurface having sloping edge)

Produced by oblique cuts ne blade of the weapon enters obliquely, tissues wll be MisiDie at one margin and other margin wll be undermined

Indicates homlcidal nature of the wouno

Direction of application of the weapon, and the relatGve

POSion of assallant and the vlctim can also be determined

Length

Bade Breadth

of the

Length Is slightly

"Roughly corresponds

WOund

less than

to the thickness of

are

the width

clean

of the

Cu

weapon

the blade

because

of stret

Depth Depth is the greatest dimension of a stab wound.

.

Depth corres ponds to the

Llength of

ching of

the blade of the weapon

the skin

entering the

http://t.me/dr_pedagogy

body

Dr Pedagogy

FOl

Tailing: wound " Seen in incised can be determined force Direction of "

Shape of Stab Wound Theory be triangular or wedge Single-edged weapon - Wound will will be sharp and the other shaped (one angle of the wound U rounded, blunt or squared off) elliptical or slit-like, and

Swallow tails: . Seen in laceration.

Small uneven tears at angles diverging trom the male laceration. Fish tailing:

Double-edged weapon - Wound will be

both angles will be sharp

" Seen in stab injury". wound . Small splits from the blunt end of the stab

acute angle. Sharp edge of knife produces angle. blunt produces Blunt edge of knife

.Produced during withdrawal of knife or the blunt end nt

DEFENSE/PROTECTIVE WOUNDS r It results from victim's spontaneous instinctive toward self-protection.

One angle is acute and other angle is blunt

Acute angles on both

sides-double edged

single edged knife

knife

and

Wedge shaped

Spindle/Oval shaped

"

bruises If the weapon is blunt, injuries will If the weapon is sharp, the cutting. attack, whether stabbing or

sare produced

abraend upon the ty

homicidal naun The presence of defense wounds indicate

'HILT MARK'INJURIES

the injuries.

abrasions/contusions produced by the hilt " Hilt marks are the body. guard of the knife during full penetration into the the location of by determined can be . Direction of the force

Active Defense Injuries tries to grasp the weapon They are seen when the victim flexor sides of the fingers and the

Location: palms, the between the interdigital spaces, more common in the web

hilt mark.

thumb and index finger. Passive Defense Injuries the hands or arms for These are seen when the victim raises

Hilt mark

protection. wrists, knuckles and the Location: Ulnar surfaces of forearms,

Hilt guard

back of the hands

Cut Injury in first web

LANGER'S LINE OR CLEAVAGE LINES " The pattern of collagen 6ber?

arrangements

are

the lines of cdeavage of the skin and their linear

representations are known as "Langer's%line li of cleavage.

Lines of Langer determine .

the Gapingof stab injury.

An íncised/stab wound at

Lright angles to the deavage lines- gaping wil be more. An incised/stab wound that runs parallel to these nes -

gaping will be less and slit

like shaped. 98

Defense wounds are absent if the victim is: Not me^

"

Attacked from behind

Unconsclous

" Under the influence of alcohol/drugs Taken by surprise

rabnled Wgunthrd by himsel,

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology HARAKIRI (SEPPUKU)

It results in immediate death by sudden evisceration of the

internal organs and circulatory collapse.

is an unusual type of suicidal' stab injury and disembowel.

ment. A ined

warriors. .Practiced by Japanese Samurai sword Asingle large abdominal stab wound is inflicted by a short he left side, drawing the blade across to the right side and

Theory

Concealed punctured wounds:

" Punctured wounds on the concealed parts of body " Sltes: Nostrils, fontanels, inner canthus of eyes, axilla, vagina,

rectum and the nape of the neck. " Fatal penetrating injuries without leaving any visible external

then turning it upwards producing an L-shaped cut.

marks or bleeding.

REGIONAL INJURIES Types of Skull Fractures

Vault Fractures of Skull Types of fracture

Fissure Fracture

Causative force

Blows with an agent having a relatively broad striking surface

Description " Due to general deformation of skull

Most common fracture Thin linear cracks passing over the vertex or base without any displacement of the

fragments. " Difficult to detect, may not be seen on X-ray,

and can only be detected at autopsy. Depressed fracture

(fracture ala signature)

Heavy weapon with a small striking surface?

Example: Hammer, stone, chopper

Due to local deformation of skull.

Aportion of fractured bone is depressed inwards into the cranial cavity

The fractured segment resembles the pattern

of the striking surface of the weapon.

" It is also called fracture ala signature Comminuted fracture

It is oftena complication of fissured or depressed fracture.

(signature fracture) " There are two or more fracture lines

intersecting and dividing the bone into three of

more fragments.

duHQnert

When there is no displacement of fragments, it resembles a spider's web or mosaic.

Pond fracture

Obstetric forceps

(indented fracture)

Asimple dent in the skull without a fracture line

The inner table is not fractured, but fissured fractures may occur in the outer table around the periphery of the dent.

Dura and brain are not damaged. Occurring only in the skull of infants and

children due to pliability. elaah

o)

Also known as ping-pong fracture, as it looks similar to a dent in ping-pong ball.

Diastatic/sutural fracture

Blunt injury to skull of young adults

. Separotion of skull sutures Common in sagittal suture Occurring in the skull of children and young adults.

Gutter fracture

Oblque bullet wounds Cor'g hu'e

When a part of the thickness of the skull bone

Is removed so as to form a gutter/channel/ trench.

It is usually accompanied by comminuted depressed fracture of the inner table of skull, and the fragments causing injury to the meninges and brain.

Pertorating fracture

daggers, knives and axe Pointed sharp weapons like

Both the tables are involved

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

Theory

FISSURE

DEPRESSED

cOMMINUTED

DIASTATIC

GUTTER

POND

SkullBase Fractures " Fall from a height° landing on feet or

Ring or foramen Fracture

buttocks

Fall of heavy load on head " Heavy blow to chin

Hinge/transverse fracture

eI

" With heavy blowS or side impacts to head.

It is a type of fissure fracture that

encircles the base of skul around n

foramen magnum.

As a result, the skull gets separated from the spine.

" Linear fracture separating the skul

two halves, creating ahinge ('nod

foce' sign)., 9 doCrad

The fracture line extends from petry ridge on one side to the contralatera

(veccume Hes)

ype

petrous ridge through sella turcia. " It is also called 'motorcyclists froctur

FORAMEN MAGNUM

FRACTURE LINE

TRANSVERSE FRACTURE LINE

BATTLE'S SIGN 100

Bruising/ecchymosis over the mastoid proces in the line of posterlor auricular artery.

It is an indication of fracture of middle cranial fossa of the skul, and may suggest underlying brain trauma

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology rOACRANIAL HEMORRHAGES Estradural hemorrhage

"

Subdural hemorrhage

.

Subarachnoid hemorrhage

Intracerebral hemorrhage Theory

Extraduril HemorthageSubdural Hemorhagesubarachnoid Hemorhagentracerebral Hemorthage

Between the skull & duraBetween dura &

Locatlon

Between arachnoid & pia

Within the brain parenchyma

arachnoldbd c

Middle meningeal

Mostcommon

Brldging veins*Arterial aneurysms

vesselaffectedarterva

Lenticulo-striate branch of MCA

AV malformations

ExtraduralHemorrhage

Site and Vessels Involved Blow impact over lateral convexity of head ’ fissure fracture

Causes

of squamous temporal bone ’ rupture of underlying middle meningeal artery.

unilateral Mostly traumatic in origin, and

SalientFeatures

Common Vessels Involved

It occurs usually on the side of the impact (coup injury).

Anterior branch of middle meningeal artery

Posterior branch of middle meningeal artery Age Group

" Middle meningeal veins

Common in adults between 20 and 40 years.

Bare in the elderly and children due to greater adherence of dura

Autuyladud, odsh

to the skull.

. Fracture (fissurc type) is present in most of the cases. DIRECT BLOW TO SIDE OF HEAD

FRACTURE OF THE THIN

TEMPORAL BONE RUPTURE OF MIDDLE

Scalp

MENINGEAL ARTERY

COMA AND DEATH

Skull

BLEEDING IN BETWEEN

cpidurdspte Fracture line

HEMIPARESIS AND PUPILLARY

DURA AND SKULL VAULT

CHANGES ON THE SAME

in skull

OF HEMATOMA |KERNOHAN'S NOTCH EFFECT

PM

(GRADUAL STRIPPING OF DURA AND HEMATOMA COLLECTION

Hematoma MIDLINE SHIFT Dura

HEMATOMA

RAISED INTRACRANIAL

COMPRESSING BRAIN

TENSION

Clinlcal Features

Medicolegal Aspects

Loss of consciousness due to concussion.

Dilation of pupil

the side of hemorrhage with conjugate

deviation of eyes to opposite side.

Lucid interval; It is a state of consciousness between two cpisodes of unconsciousness. CI Kn: Biconvex lentlcular-shaped° hemorrhage

Treatment

" Patient may be discharged from hospital during lucid interval

and may die at home; doctor may be charged with negligence. 304 A)

" Extradural hemorrhage may resemble drunkenness and patient

may die in police custody. Lucld Interval Definition: State of consciousness between the two periods of unconsciousness.

asurgical emergency, requiring emergency craniotomy.

Early diagnosis and intervention usually save the patient.

Etlology: Epldural hemorhage &insanity Slgnlficance: Legally responsible for criminal acts

http://t.me/dr_pedagogy

Can make a valid wil and can give valid evidence

10

Dr Pedagogy doyot conelese ? frding sty Forensic Mediçine

bdGnhee

-Se side

Theory

Jllustratiue

On a Sunday, Ramu, 18-year-old boy, was playing cricket with his friends in the ground. While fielding, he was hit with a cricket ball on right side of face around 1:30 pm. He was drowsy & fell immediately. His friends tried to wake him up by sprinkling

-Dura

After her repeated failed attempts, he was brought to casualty, where he was declared dead on arrival. During postmortem

Hematom

water. Ramu woke up in sometime and continued playing. By 2:30 pm, he returned home. His mother, returned home by 4:00 pm and found him sleeping & tried to wake him up.

examination, diffuse contusion with extravasation was noted

over right cheek &right pre- and postauricular region. Linear fissure fracture of size 7 cm was noted in right temporal bone.

On opening the skull vault, a large hematoma 450 g was seen in

the extradural space compressing the underlying brain. Midline

CT Scan: Concav0-convex or crescent-sh

shift to the opposite side noted. The cause of death was opined as effects of head injury due to blunt force.

in subdural space

Subdural Hemorrhage Bleeding is always from vein or capillary, not from artery. Cause "

It is usually traumatic, following an assault or fall (due to

acceleration- deceleration injury), sheng Age Group Children

Elderly

Shaken Baby Syndrome/Infantile

Follows a minor

whiplash Syndrome (most consistent

trauma

Feature)

ehd ba

t-shaped hyperdense col

According to the time of onset of symptoms after

divided into three types. Ae d b-b0te 3w Sub-acute sDH Chronic SDH Acute SDH

(immediately)

(several days to 2-3 weeks)

Rupture of

Occurs when

large bridging

bleeding is

vein, rupture of one of the cortical

from smaller

(pachymeningts

hemorrhagica intery

bridging veins

arteries or

injury

After about awe

chronic subdur

hemorrhage be

cerebral

to organize froms

lacerations

dural side. By 3-4 weeks,

nd

the hematoma

Vessels Involved

gets completely

encapsulated

" Rypture of bridging veins (Most common) The most

Mechanlsm of SDH: " Traumatic acceleration/deceleratton of the head causes differential movement of the brain relative to the skull.

" This differential movement results in stretching and tearing

of bridging veins. anu coto]

nyUh

common type of hemorrhage among boxers is suhde

hemorrhage. SDH 0s seen in child abuse (Shaken baby syndrome) When an infant or young child has an SDH, the diagnostic

prlority is to exclude shaking injury.

Dlagnosing Extradural &Subdural hematoma In CT scan

Extradural hematoma " Typically lentiforma (lens-shopebiroe " Do not cross

It presents usuah

3-6 weeks ater

sutures.Umiebha

5 LM

Subdural hematoma

Typically crescentic (crescent moon-shaped) More extensive than EDH

SDH crosses sutures.

Tatmnt

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology subarachnoid Hemorrhage Causes

AA

Duration of boxing is more relevant than the severity of the blows.

himheean

Goontaneous (Atraumatic

Features

Traumatic

eto rupture of aneurysms in. Head trauma: Direct injury lCircle of Willis. AV nereeh Blow over jaw or side of of Rupture upper part of neck may age: Younger berry aneurysma cause rupture of vertebral of Elderly age: Rupture hypertensive aneurysms

artery with basal SAH.

Site: Mostlyinthee basal surface of brain (due to the location of the cirde of Willis)

Clinical Features Thunder clap headache., Sudden vomiting. ruha

Autopsy findings

Dementia

" Chronic SDH

Slurred speech

Theory

Degenerative changes in corpus

Parkinsonian-like facial

striatum NeUril lo

appearance TyemS

Enlargement of the ventricles

" Slow thought process, stiff limbs " Ataxia

Moed dstrbanw

alds

due to loss of white matter

(cortical atrophy) Perforation of the septum pellucidum

INJURIES OF SPINAL CORD

Whiplash Injury onset

of

severe headache with

. Features of raised intracranial pressure.

" Rocal neurological l deficits: hemiplegia, dysphasia. o stpbit Sudden loss of consciousness. 8e0 . In 40% of recovered patients, rebleeding occurs in 6-8 weeks which is commonly fatal.

ne mas lle

" Investigations: Lumbar puncture: Xanthochromia scen. (lo Aan (yE)

" In road traffic accidents, involving acceleration/deceleration trauma.

" Sustained by the occupant of a car?

" Sudden hyperextension and hyperflexion of neck "

Resulting in fatal contusion or laceration of spinal cord without

fracture of spine.

Extra Edge Commotio Cerebri: Concussion brain Commotio Cordisa: Concussion heart

Commotio Spine: Railway spine

-bdoss slig ienIllus trative Ms XX. a 16-year-old girl, was brought from a rural village to a

w . . . . . .

Histochenmical changes of antemortem wound In case ofa trauma to a living tissue, two zones are seen

Government Medical College Hospital casualty in unconscious

around the wound.

state with alleged history of snake bite. She had been to fetch

Central (superficial) zone:

water from the nearby well around 5 pm. She had not returned

after a long time &her parents went in search of her; found

her lying in semiconscious state near the well. They suspected

Azone of 0.2-0.5 mm close to the edge of the wound This zone has decreased enzyme activity Zone of negative vital reaction.

Snake bite as they noted a small bleeding scratch in her left

Peripheral zone:

leg. She was admitted as a case of snake bite & was treated with Antisnake venom and other measures. Despite antisnake

" Immediately beyond this layer, there is a 0.1-0.3 mm zone.

venom, her condition worsened & was referred to higher center

in Chennai city for further management.

She was re-admitted in the higher center as a case of snake bite, and was given the same line of management. Her condition

deteriorated and she died.

During postmortem examination, there was superficial healing scratch abrasion noted in left ankle. No fang marks detected. On opening the cranial cavity, thick layer of subarachnoid hemorrhage was noted in the base of braln. Multiple small saccular aneurysms found in the circle of Wllis.

This zone has increased enzyme concentraton during reparative process Zone of positive vital reaction

In postmortem wounds, positive vital reaction does not develop. It is demonstrable as a diminishing stainability and becomes visible in 1-4 hours after wounding. Enzyme histochemistry of antemortem wound Zone of negative vital reaction

Zone of positive vital reaction

Decreased enzymic activity

increased enzymic activity

One of the aneurysms in anterior communicating artery was in

ruptured state. The death was attributed to the ruptured berry

aneurysm.

Punch Drunk Syndromertraumatic Encephalopathy/Dementia Pugilistica Acondition occurring in old boxers, which may arise years

after the last injury. tis the cumulative result of recurrent non-fatal tiny hemorrhages in the brain.

103

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

TheoryExtra Edge

TRANSPORTATION INJURIES

Enzyme Histochemlstry Enryme hlstochemistry

Injuries due to road 1 destrian 2

trathe acidents are ot three tvs

Motor cyclist

33 Orupant of the vehicle

10 8

Injuries to Pedestrian Usual sequence of the impacts with vehicle: " First, the vehicle hits the person (hrst impact with v After the first innpact, the victim is scoo Opt oft the falls on the vehicle (seond impact with vehicle) Then the victim is thrown on the ground.

injuries

Secondary impact injuries

injuries caused by

Injuries caused by

Primary impact

DEnzyme Histochemistry

vehlcle when It irst

second Impact of

struck the person

victim and vehicle

PRIMARY IMPACT INJURIES

SECONDARY IMPAGT INJURIES

SECONDARY INJURIESI

TERTIARY IMPACT INJU

ES

Transportation inurres

PRIMARY MPACT INJURIES

1ST SITE OF IMPACT WITH THE VEHICLE

Phe irnst o

bufnper o radiator Burmoer iniunee preert

104

Patternsd iniurast

SECONDARY IMPACT INJURIES

SECONDARY INJURIES

2ND IMPACT OF VICTIM

VICTIM FALLS

WITH THE SAME VEHICLE Same side of prnnnary inpact injuriee Seyere head inuriss

ON GROUND

.Oppote ande io primary inpact inures

Head inËury with brain Jamag t more comon Mesns, bruises

4aCrstohs

http://t.me/dr_pedagogy

Secondary injunes

impactnne Injuries susta by a

victm e

talls on the g

Dr Pedagogy Bumperlnjuries

Sparrow foot marks; Multiple small facial lacerations produced by

rimaryimpact injur)Q Injuries on skin, sot fracture)

Forensic Traumatology

tissues and fracture of bone (bumper

The level of bumper injuries varies with the height of bumper in Ailerent vehicles., Ligo

shattered glass of windscreen of a car. Dicing injuries: Theory " Supericial cuts of the skin produced by the shattered glass of the

side and the back windows of a car.

" Right angled or V-shaped laceration seen over face, forehead and arm.

Dashboard fracture:

BumperFracture

Posterior dislocation of hip joint with fracture of posterior rim of acetabulum Duc to impact of knee against dashboard

Ihaally in tibia° (sometimes in fibula)

wedge shaped . Triangleor

se of triangle is vehicle. the site of impact &the apex of triangle

points the direction of

Patellar fracture and Posterior cruciate ligament injury associated

Front passenger

Driver

Face:

Face: rmu lhplecut

Impact against windscreen’ sparrow foot marks

Impact against

eO wd windscreen’

sparrow foot marks

Bumper fracture

Splne: Whiplash injuryK

Spine: Whiplash injury Leg

Leg

Impact against clutch, brakes ’ Abrasion, bruise & laceration over

foot, fracture ankle.

Impact against dashboard’

Fracture femur, posterior dislocation of hip

Abdomen & chest

Impact against steering wheel’ Fracture sternum & ribs, cardiac contusion, Rupture of liver, spleen

l on o How to Interpret bumper injuries? the striking Vehicle leg: back of " Bumper injuries at the victim from behind Person was Bumper injuries at same level on both legs:

standing at the time of impact. on both legs: Person was " Bumper injuries at different levels impact. of the time walking or running at

Extra Edge Tail gating& under-running: back of the heavy " The motorcyclist/car driver hits into the vehicle. " This may be due to unexpected stoppage of the heavy

vehicle.

Head and shoulder injuries, sometimes decapitation.

Injury to Occupants of a Vehicle Neck: hyperextension and hyperfiaxion

Hea

against

indshield

Sleering

Wheel impact

http://t.me/dr_pedagogy

Dr Pedagogy

ihue Forensiç Medicinen, Subwtaneas Theory Extra

External Features

Edge

"

Ladder rung tears:

Patches of pink discoloration are seen over the large joints (usually on knees, elbows

extensot

Multiple transverse intimal tear in aorta, adjacent to the

sor outside of the " Pink postmortem staining°ub oeis

main rupture.

Internal Features

Seen in aortagin deceleration Injurles.

"

Blood: Bright red in color.

" Stomach: Wischnewsky spots may be seen.

Extra Edge Paradoxical undressing: " This may occur in severe hypothermia, the

Rupture site

partially or fully undressed. Noked Anina

Ladder-ung' tears

" During terminal hypothermia, the victim becomes

disoriented and confused, and may undress himself

" In such case, there may be suspicion of sexual offenta

" The manner of death is usually accidenta Terminal burrowing or Hide and Die Syndrome:

" Seen in severe hypothermia.

Due to terminal hallucinations.

Victim is often found under bed or bench, behind Wardrk. on a shelf.

This may also lead to the assumption of a homicide cide or ro

THERMAL INJURIES

Trench Foot and Immersion Foot " Result of prolonged exposure to severe cold (5°-8°C)

Heat injuries General heat

Local heat

|Heatc n i e

Burns (due to dry heat)-nes Scald (due to moist heat)

" Heat syncope/ehaun

hot l i ,seam

" Heat stroke

Cold injuries General cold

|Hypothermia

" Typically seen in soldiers during winter warfare, especil trenches and in persons exposed to prolonged immersion t The extremities are affected in those conditions,

Frost Bite "

Result of exposure to dry cold (-2.5°C)

" Infarction of the peripheral digits with edema, rednes and'a necrosis of the tissue. p anaye

Local cold

ath

Frost bite (due to dry cold)

Stages

Trench foot (due to molst

Itching &pain followed by numboes First degree (rTOsl

cold)-denws

" Second degree (

frosthite Painless blisters

" Third and fourth degrees (deep frost bite): Necrosis &garg

Hypothermia loh d, ellas LRRH¾, LQP

formation; sometimes autoamputation

Body core temperature less than 35°C.

Treatment -Protetn body pats

Common in elderly alcoholics and newborns.

" Moist cold is more lethal than dry cold.

Rewarming

General Hyperthermla Mental status

Pathogenesis

Heat cramps/MIner's cramps/

Molst and cool Electrolyte disturbances due to dehydration,‘ wahn

Normal

Cardiovascular collapse & syncope due to Intense

Sweating

Normal

Dry &hot skin In

Impaired

FIreman's cramps 4us e Heat exhaustlon/heat syncope/

prostration Heat stroka

Triad of cerebral dysfunctlon with 106

Skin

Disorder

Impaired consciousness, Increosed body

core temperoture (rectal) more than 40.5'C ond hlstory of heot exposure)

Cerebral dystuncton

isd

ehn classical heat stroke conscousness |Dlaphoresls In

exertional heat

stroke rhdm

http://t.me/dr_pedagogy

Other features

|" Constricted pual

Tachycardia Tachypnea calorieih0-vo Postmortem

Dr Pedagogy Forensic Traumatology RURNS (DUE TO DRY HEAT)

Theory

Classificationn of Burns Dupyutren's

Characteristics

Hebra's

Wilson's

Modern

Painful,

1

Superhcial

No scar

1 s0Epidermal

Reddening

Vesication/Blistering skin Destruction of superficial

Characters

2

Superficial

(epidermis)

2*

(Dermis) 4 Destruction of whole skin Muscles5 Destruction of deep fascia, nervei 6 Complete charing (vesses,

fastn

Scarring S Heals in 3 weeks e a

Dermo-epidermal

Painless°. N 3

bone)

Deep Burns

e

Heals in 3-6 days-, danta Painful

3

ad

aria

Deep

t

Scarring

May take months/may

need grafting- s

Etimation of affected body surface area:

Lund and Browder Method

" For infants, head is 18% of TBSA and each leg is 13.5% of TBSA.

Trunk & upper limb is the sarme

(For each year above 1year-old, add 0.5% to each leg and reduce 1.0% to the head until adult values are reached)

Rule of palms:

Back 18%

For estimating smal burns The surface area of a patient's palm (incduding fingers) 1%

Front 18

1%

" For burms in oduts: "Rule of Walloce' or 'Rule of nine' us

se

For burns in children: lund & Browder chart

" For patchy burns: Rule of palm'

causes of Death Immediate

Delayed

Rermote

complications Primary or

neurogenic shock Area

%of skin burns Rule of Nine adult

Lund &Browder chart children

Head y k

rnk -Front Brurlk -Bad

GeniLoertal aieb -L ower Limb-&

Accidents and

18

|09 09

18 18

01

Infection

Renal failure 1Curtling ulcer Toxemia

Jaundice

injuries

Vagal inhibition 09

Pper lmb -

Ugper mb -R

AsphyiaN

Secondary

hypovolemic shock

Inflammatory complications

Autopsy Findings

09

sdrs

Specific findings of antemortem buns

18 01

18 -

13

18

13

100

100

Soot in respirotory trocta Carbaryhernoglobi in blood

Nonspecific findings {can be present in postmortem burns also) "Pugilistic attitude Heat rupture

Line of redness

Heat hematoma?

Alburnin& chloride in vesicles Healing granulation tissue

Heat fracture

Infection

hement of 1/34of body surfce area (30-50%) s usually

Curting ukcer

http://t.me/dr_pedagogy

107

Dr Pedagogy

Forensic Medicine

Postmortem bli. How to differentiate Antemortem from

MNEMONIc

Theory Signs of antermortem burns: F-Fluid in blisters (‘

proteins &chloride) |-Inflammatory reaction/ Ireaction, infection/signs

Content: Serous fluid containing

fire' was alive at the time of

albumin & chlorides and red with The base is inflamed

A 'CS are seen

Carbon/soot deposition in airway 2 iN

vital t of healing lgranulation tissue)

Postmortem vesice Content: Ga_

Antemortem vesicles

Findings that indicate "Person

The base is dry, har and yellow.

ordere erythemotous bord

co elevated (>10 mg %)-%

R-Line of Redness

" Cyanide levels elevated

E- Elevated enzymes

"

SCALDS

Curling's Ulcer in stomach

Injury caused by moist heat;

.

Heat Artefacts Nonspecific for ante-mortem burns. and, therefore, not much Present in postmortem burns also

liquids above 60C

Abbe donEL Iniury at and below the site of contact. commencement Maximum damage at the point of point of contact Restricted to exposed body parts or

or " No charring, carbonization

hair singeing in scalds.

present. " Evidence of splashing bleachedQ,

medicolegally significant.

Skin sodden &

Pugillstic attitude

"

proteins.ehat Mechanism: Coagulation of muscle

ELECTROCUTION INJURIES

attitude/heat Also known as (boxing, fencing or defense stiffening) 5 t

Blisters over the burnt area.

et ays

Jes

Attitude: "

knees, the arms are The legs are flexed at the hips and in front of the body and flexed at the elbows and held out

the Pattern of Factors that Determine

(like a boxer) the fingers are hooked like claws

Heat rupture/split

burning9. Skinsplits occurring due to severe

Electrocution Injuries Kind of current:

surfaces and joints. Sites: Fleshy areas, extensorcentimeters)

except in lightning. DC injuries are uncommon,

(several " Multiple and Large

Large (several centimeters)

"

tetanoid spasms Amperage is more dangerous, as it causes 5 mA

Mechanism: boiling blood. venous sinuses due to " Rupture of extrodural hematomoa " Resembles Comb gppearance Appearance: dark brown, HoneySite: Parieto-temporal region

"

Haby Due to exXcessive

ndran

Newk u " Street &Avenue frocture

e

in wet skin is only 200-300

Duration of current: "

No vital reaction or brul_ing

eneaa4 at the marginsI s

Crocodile burns: Loose contact with High voltage cu

t

Current pearls:

conductor into Deposition of molten meal from the

108

tissues

ldentiñed by scanningelectron microscopy.

Vital reaction/brulsing present at the margins

Presence of intact nerves &

Nerves & vessels Cut or

vessels in the floor

crushed

Irreguiar margins

Varlable

PM b with low voltage current

" Spark burn/lash burn: Loose contact with air gap D

Presence of blee ding

Absence of bleeding

duration of current Severity is directly proportional to the

Efects of Electrocution

Incised/lacerated wound Heat rupture

progorko

The principal bodily barrier is the skin. (1000-1500 ohms), but resisti" Dry skin offers high resistance ohms > nMot

" Joule burns: Firm'contact

which exert shrinkage of the muscles,

Rreat pull on bones.

40 mA - ventricular arrhythmia >50 mA - instantly fatal.

Resistance:"

o bne i e e dmig oMwechrak 1t fracture Heat ‘itreLYaNesm Skull fractures on either side above the temples.bheqe

ding

numbness, pain.

muscles of hand and forear 10-15 mnA - tetany within the flexor

Heat hematoma space due to heat "Hematoma in extradural

" Usually stellate vcþid Long bone fracture

Awith hd be

Current: d.tu Pohr

lacerated wounds2, Resembles incised or

" Usually seen

Injung

times more dangerous tha Alternating current (AC) is 4-5 direct current (DDC).

dehudr

Zenker's degeneration in skeletal muscle "

Bone pcarls: Heat generated by the current may melt the

phosphate in bone.

Radiographically seen as rarefactive foci in X-ray lim

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology Grocodile Burn

ole Burn

.Endgenous burn

hecmsqldbin he

Multiple punched out

as ebuns a'so known electcobuns which is

Theory

spark lesions over the exposed parts of the body

specific and diagnostic of

On June 12, 2015, 20 people died and 30 suffered burn injuries due to fall of live high voltage electric wire on a bus at Tonk

due to arcing of high

district in Rajasthan. 60 people were travelling in the bus and all of them were going to attend a wedding party in a nearby village.

tension current

electric burns

Jlluotratiue

the point ofentr

at " found LOW Votage Current

The loose wire got entangled in the wheel of the bus. In fear and anxiety, people tried to get down from bus and got electrocuted.

Morphology ofJoule Burns

In such incidents, where the live wire touches the bus, the

Bard shaßos pale central crater, with a raised border around.

The cater ioor is lined by pale fiattened skin.

rubber tire of the vehicle provides insulation and there is no flow of current and chances for electrocution is minimal. When

ret burn is commonly found on palmar aspects of hands.

the passenger tries to get down, there is contact with bus and

the ground simultaneously. This completes the circuit allowing the flow of current and passengers got electrocuted.

NoTE nebumis endogenous bun, while flash burn is exogenous? bun

CaSe of Death Iiar fbrilation (low votage current)-most common

The omse of death depends on the path of current. .Whr onganis present in the path of current that organ will fected becaise of the current.

Emples

When the current flow is from ight arm to left arm, cardiac rimia develops due to the involvement of heart. . When the current flow is from head to foot, victim will die of

ioryfaiure due to the invoBvement of brainstem. Joule burns

Medicolegal Aspects " Dezts are usualy accidental.

" Jaz dectrocution: Death penalty is carried out using the dectic chair in some States in the US.

Extra Edge Aao-reaction test:

" efor detection of metals at the site of entry of electric urent

LIGHTNING INJURIES ay inlan indiidun by direct strike,asidelash or conduction deat-ctLdd Fng or magnetization of metallic articles seen.

trough another object.

Filigree burns

Arborescent

ara Lchtenberg'sBurns/Filigree Flowers/ Burns"l Uirphi " Ldenberg Bowers: are pathognomonic of lightning strike,

Pracil thin irregular tortuous markings on skin resembling

brancbes a atree.

oes not coTesoond to vascular

Fond ova shoulders or fanks channels Nt asociated vith

burning

EXPLOSION INJURIES: INJURIES PRODUCED BY BOMB EXPLOSION "

A bomb is a container filled with an explosive mixture and

missiles, which is fired either bya detonator or a fuse.

" When a bomb explodes, the explosive material produces a large

volume of gas; and releases alarge amount of energy.

http://t.me/dr_pedagogy

109

Dr Pedagogy

Forensic Medicine

TheoryMechanisms of Injurles by Explosion Victim Displacement

Blast Wave

An explosion produces a 'shock wave

which spreads

"

concentrically from the site of explosion,

When the blast wave passes through the body, the organs containing air fluid interface get afected. Examples: Ear, lung, GIT.

.

When a bomb

explodes, the victim is

structure resulting in skeletal injuries.thrown

away againt a

Building Collapse/Burns ialirCh Due to explosion, structural collapse may occur, Ieuh traumatic asphyxia, crush injuries or ire

producing fah

Flying Missiles &Projectiles

Terrorists often implant screws, nails and Ishrapnel in the bomb.

Radiation, Chemical, Bacteria

On explosion, such things fly as projectiles and inflict injuries.

.

" Such flying objects may strike any part of the body resulting in penetrating trauma.

Hyper-inflammatory state due to exposure to the contami

of explosive blasts (dirty bombs).

including, bacteria, chemicals and

Blast Injuries are of Five Types PRIMARY BLAST INJURY - BLAST WAVE

SECONDARY BLAST INJURY- FLYING OBJECTS

TERTIARY BLAST INJURY

VICTIM DISPLACEMENT

QUATERNARY BLAST INJURY- BURNS-MislowA

Primary blast injuries

Secondary blast injuries Tertiary blast Injuries

Blast wove

Flying projectiles Victim displacement

High-Yield Info " Most common blast injury: Secondary blast injury

Most common fatal blast injury: Secondary blast injury

Most common organ involved in primary blast injury: Ear

Second most common organ involved in primary blast

Quaternary blast injurles

Structural collapse/fire

injury: Lung Most common organ involved in underwater blast with he

Quinary blast injuries

Hyperinflammotory state due

above water: GIT? Most common organ involved in underwater blast with h

to chemical/rodiation

under water: Ear

Most common organ involved in secondary blast wave: s Most common fatal injury primary blast injury: Blast luns Most common injury In solid blast- Skeletal injuries

110

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology EXPLOSION INJURIES Theory PRIMARY INJURIES Due lo tblast wave

SECONDARY INJURIES Due to lying

Air blast: .Organ involvement: Ear >Lung GIT

Tympanic perforation COmman

m

9projectiles

TERTIARY INJURIES Due to victim thrown away

Triad of abrasions,

QUARTENARY INJURIES

Due to victin thrown away

Skeletal injuries

bnuises & puncture lacerations are

Flash burns, crush

injuries, traumatic ijuries & respiratory injuries

diagnostic- Marshal's trlad.

Blast lung (fatal)

Incendiary bombs:

Contains phosphorus &magnesium

TORTURE METHODS

Malotov cocktail:

burns " Primarily produces

" The participation of physician in torture or abetment of torture is

Simple incendiary weapon. It is also known as a petrol bomb. ne illed with petrol &gasoline. " The bomb is

" Section 330 IPC: Voluntarily causing hurt to extort confession, or to compel restoration of property

Wick is lighted &thrown at the target.

Order of organ involvement in primary blast injuries: In Air: Tyrmpanic membrane, Iung &GIT

prohibited by the guidelines in 'Declaration of Tokyo' Jtaob p t ) " Section 331 IPC: Voluntarily causing grievous hurt to extort confession, or to compel restoration of property.

Underwater (head above water level): GIT, Lung&Ear

Underwater (head under water level): Ear,GIT &Lung. Methods of Torture Falanga bastinado)

Canes or rods used to beat on the soles

Telefono Wet submarine Dry subrmarine?

Repeated slapping on the side of head over ears Tying a plastic bag over the head until suffocation

Parrot's perch

Head down from a horizontal pole placed under the knees with wrists bound to ankle

Forced immersion of head in watercontaminated with urine or feces

Cattle prod

Electric shock, especially over the genitals

Chepuwa

The legs and thighs are tied very tightly with bamboo sticks to induce severe pain

Ghotna

Rolling a wooden log over the thighs up and down, while the log is weighed by one or two policemen standing on it

Sham execution

Victim is blindfolded and asked to stand before a wall and then threatened that a vehicle is going to hit him

Dunking Back slave La bandera

Mercelago

d planton

Saw horse Hog tyin

He hears the sound of a vehicle very near to him, causing fear and shock Victim is irmmersed into water, taken out after some time and given a chance to confess

Heated metal skewer inserted into the anus Suspension by wrist

Suspension by ankles Prolonged standing Forced straddling of a bar Tying the wrist & ankle of a person in a prone position

11

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

Theory

Parrot perch Telefono

Falanga

Dry subrnarine

Wet submarine

Saw horse

LA Bandera

Mercelago

EL planton

FORENSIC BALLISTICS

LET's KNow THE TERMS FiRST

ammunition and their effects. deals with the study of firearms, " Forensic ballstics: Science that

Proxdmal (intenal)

Intenediate

(externn)

Teminal balistics

ballistic

112

Ghotna

Internal or proximal balllstics: Study of the projectile within the gun. air. External or Intermedlate balilstlcs: Study of the passage of the projectile through the Wound or Terminal ballstics: Study of the effects of projectile on the tissues.

http://t.me/dr_pedagogy

Dr Pedagogy Rasic Structure of a

Forensic Traumatology

Firearm Bolt

Barrel

Breech end

Muzzle

Muzzle end

Theory

Taper

Bullet Chamber

Butt Percussion

Trigger guard

pin/

Rim of cart

Bore-inS dis

P. Cap

Chamber Taper

Bore

main parts: Any firearm has three

.

Butt/handle

.

Barre!

Action - Bolt, percussion pin, hammer, spring and trigger.

Tágger

Grooves

Land

Barrel T. Guard

. tisa long hollow metal cylinder. . The lumen of barrel is known as bore.

Riflings

. The end where cartridge is inserted - Breech end.

"

. The front end where bullet exits - Muzzle end It has three parts: Chamber, taper & bore.

The interior of barrel, ie,, bore has 4-6 grooves running parallel

to each other from breech end to muzzle end. " They are twisted spirally from breech to muzzle end (which gives

1 Chamber - To lodge the cartridge

Taper -Connects the chamber to the bore. Bore- Long tube lies between the chamber &muzzle end

the spinning motion to the bullet)

" The elevated areas are called lands and depressed areas called grooves,

Classification of Firearm

Firearms can be broadly dassified into Rifled frearms &Smooth bore firearms. Smooth bore gun/shotgun/pepper gun

Rifled gun Any gun hoving grooves (rifling) in the bore is called rifled gun.

The bore is uniformly smooth without any grooves in shot gun.

RIFLED BARREL

'Riles: 0.22, single shot, lever action, bolt-action, LoD0

.Revovers Single shot5340 pistols Auto-loading pistols4syd

Men

d

RPM

Typical shotgun barel E.g.

" Depending on loading: Muzle loading or breech loading

" Submachine guns

Depending on barrel: Single barrel, double barrel bee

Machine guns

" Depending on choking: Unchoked or cylinder bore Quarter choked . Half choked Fully choked

Projectiles used in rifed gun: BULLET rode

To

" Projectiles used in smooth bore gun: Lead shots/Lead pellets

|Smooth bore guns are caled shot guns5, ,as lead shots are used in projectiles)

113

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

Theory

Choking: In shotgun, the distal 10 cn of barre

Spiral grooves in the bore of rifled gun. 1 G

It can be oft diterert grades.

Unchok6d

otages of choking in shot gun: Advantages Advantages of rifling: Imparts Spinning moton to the bullet.^

Straight trajectory rar

. Increases the velocty of the pellets.

Maximum pellet dispersion-’ Unchoked (Cyfinder P

Prevents wobbling of bullets.

" Increoses accuracy & range

Reduces the pellets dispersion Increases the erploive forces of the

shotgun.

.

Least pellet dispersion -’ Full choked shngun.

BORE/CALIBRE/GAUGE:

Itis measured by the internal dimension of the barel RIFLED GUN CALIBRE

FOR LARGE BORES:

SMOOTH BORE GUN CALIBER

Indirect method: 1POUND (454 grarns) OF LEAD TAKEN

It is the diameter of the dor of interior of the t harrel of a

LEAD BALLS ARE MODE.

FOR SMALL BORES: rifled

SIZE OF THE LEAD BALL=SIZE OF THE BARREL

Direct method:

The internal diameter of the barrel

.Measured between

nally oppos

lands

Epressed in inche

meters, e.g. 22, 32

38

The number of equally sized lead bals- o% made from 1 pound of lead = Gauge Bore = Number of spherical lead balls taken

to fill the barrel.

For example, 12 bore gun -12 lead bals are ma

from 1 pound lead 24 bore gun-24 lead bals are

made from 1 pound lead 14

Structure of Ammunition

Projectile in rifled gun - Bullet

Projectile in shot gun- Cartridge with lead shots. Constituents of shotgun cartridge (from base to top)

Constituents of rifled gun-bullet (from base to top)

(Detonator cap) Percussion cap containing primer mixture

(Detonator cap) Percussion cap containing primer matue

Gunpowder

Gunpowder

Thick fet-wad Lead shots

Bullet

114

http://t.me/dr_pedagogy

Dr Pedagogy Constituentsofishotgun ortrldgë (trom base to top)

Forensic Traumatology

Constituents of iled gun-bullet (from base to top)

Theory Case Bullet

Lead

Shot

Bullet case

Wad e Gunpowder Power

charge Brass head

Primer

Primer p Rsson Chamber/Primer Cup/Detonator Cap

Cartridge The Brain of the . Rcoatains the priming mixture-Kahyilatble

The strike of firing pin on the primer cup ignites the priming

misture and burns ns it.

The fre flashes through the flash hole/vent and ignites the

Percussion cup

Smokeless gun powder

Single base: Nitrocellulose " Double base: Nitrocellulose + Nitroglycerine " Triple base: Nitrocellulose + Nitroglycerine + Nitroguanidine Explosive power: Most effective explosive with minimal smoke

"

Each grain produces 800-900 cc of gas.

gunpowder.

. The priming mixture contains lead peroxide, lead styphnate, tetrazene, barium nitrate, antimony sulhde and potassium

Semi- Smokeless gunpowder: 80% black and 20% smokeless gun powder.

chlorate, etc

MNEHONIC Primer constituents

Wad " Made up of soft material, like felt, cardboard, plastic, cork or straw.

It separates the gunpowder and lead shots.

LAST

-Barium nitrate

Functions of wad:

S-fLead) Styphnate I-Tetrazene?

" Acts like a piston " Seals the gas in the bore effectively (Obturation) and thereby allows optimum pressure to develop

A-Antimony

" Helps in lubrication

-lead peraride

" Prevents the escape of gas from the breech end

Gunpowder FFFFa

Black gun powder

Potassiun nitrate(75%) K

Working Mechanism of Firearm PULLING THE TRIGGER

harcoal (15%)

PROPULSION OF

"Sutfur (10%)S

" More smoke produced ‘ hre Lias

BULLETSHOTS

HAMMER RELEASE

" Desoibed as FG, FFG, FFFG, FFFFG depending on the fineness of the grain.

Ihe fner grains have more number of 'F

PERCUSSION PIN HITS

GAS

PERCUSSION CUP

PRODUCTION

Erplosive power: tach grarm of black gun powder produces 3000- 4000 cc of

gas

Each grain produces 200-250 cc of gas.

IGNITION OF

PRIMER MIXTURE

FLAME

EXPLOSION OF

PRODUCTION

GUN POWDER

115

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy Due to the deposition of lubricants, gun oll or lead

Theory Abrasion Collar/Ring

bullet.

surrounding Arim of reddish-brown zone ofabraded epidermis,

the entrance wound.

"

In rifled gun entrance wounds. collar. If contusion also present, contusion Abrasion collar Quls Absent abrasion collar: Entry wound on palms and soles Ricochet bullet.

Dirt collar/G, QDA0 Wla Bullot entry hole

-Abrasi on col Dit coler -Bullel entry

Abrasion collar surrounds the dirt collar,

Mechanlsm to the spinning The skin around the entry wound is abraded due action of bullet.

.

Dirt collar rim is more prominent in clothing- "bullet wi Abrasion and dirt collars are proof of an entry wound

Effects of Discharges ofa Gun

Importance

Round Abrasion collar: If the bullet hits at right angle to the skin surface.

Oval abrasion collar: If the bullet hits at oblique angle to the

skin surface

gives the Diameter of the entry wound + abrasion collar

approximate diameter of the bullet.

Fire/Flame-’ Burning at entrance wound along with

burning or singeing of hairs.Jehuss Smoke -’ Blackening effect or smudging e kwiped b

Hot gases -’ Scorching effect Unburnt gun powder-> Tattoolng effect, peppering or

stippling effect Felt wad-’

Grease Collar (Bullet Wipe) the entrance wound. A black/grey colored ring is seen lining

Minor abraslon and bruise.

Metallcfoulíng

Blackening

Tattooing

soot or smoke solling/smudging)

Due to embedding of unburnt or partially burnt powder particles in the skin. a Tattoolng cannot be wiped away with

Iwith abrasion collar.

. Bullet/Pellet - Puncture woung

Deposition of smoke produced by

expelled by " Due to fragmnents of metal

combustion of gunpowder. It can be easily removed with a wet

the discharge. Cannot be wiped off from the skin,

cotton.

wet cotton.

Antemortem phenomenon and alive. indicates that the indivldual was

Shotgun

cm

15 cm

Flame/singeing

30-em

45um

Blackening/smoke

|Tattooing/unburnt powder

Revolver/Plstoll

60-90 cm

30 cm

60-90 cm

Rifle

15 cmS

30 cm 60-90 cm

2m Card

2m

Wad

WOUND BALLISTICS

Rifled Gun lnjuries

tight contact with skin. Contact shot: Muzzle end of the gun is in Close shot: Victim lies within the range of flame

of flame but within the Near shot: Victim lies outside the range

range of gunpowder Distant shot: Outside the range of gunpowder.

Specific appearances of contact shot Muzzle/recoll imprint mark: power of the Patterned abrasion caused by the expansive muzzle. gases lifting the skin forclbly up against the This is a slgn of a contact shot. Back spatter: in the barrel may sun " In a contact shot, negative pressure blood, hair, tissue fragments back Into the barrel.

Blowback phenomenon or blast effect: especlaly" Cruclate, stellate or ragged laceration is seen, there isa bone under the skin (skull)

116

http://t.me/dr_pedagogy

Dr PedagogyForensic Traumatology Appearanceof

Woundof Rifled Firearm in Different Ranges

cONTACT(Pointblack)

CLOSE SHOr

NEAR RANGE

(ränge of tlame)

(range of gunpowder)

"

I, Muzzleimpression

wound

Present

margins blackening & Burns, powder tattooing seen

" Burning/blackening

Blackening- Present

ofthe

Tattooing. Present

Abrasion collar-Present

than the " Circular wound smaller diameter of the bullet

" Burning, blackening, tattooing Absent

Absent

" Tattooing-Present

along the track in skin wound (not seen

LONG RANGE

" Circular entrance

Burns &Singeing

, Stellate"orcruciate

l

Circular entrance wound

Theory (beyond the range of gunpowder)

" Abrasion collar - Present

Abrasion collar Present

|externally

cONTACT SHOT TON nta

CLOSE SHOT

Stellate/iregular shaped

"Bullet hole, Abrasion collar

"Buns, Blackening

"Bums, Blackening, tatlooing inside the track of the wound

Tattooing

Tattooing / Abrasion collar

NEAR SHOT "Bullet hole "Abrasion collar

DISTANT SHOT

"Bullet hole

"Abrasion collar

"Tattooing

Burns

Blackening Bullet hole

Appearonce of Wound of Shotgun Firearm in

Important points to remember:

Different Ranges

.

Wound is cruciate/stellate in contact shot.

In shot gun, there is dispersion of lead shots.

" Burns, blackening and tattooing around entrance wound till 90

ln contact shot, cruciate or stellate appearance is noted due to blast efect. Efects of flame, smoke, tattooing are noted within 1 m. (beyond

" Between I and 2 m, lead shots are about to disperse (but has not

cm approx.1 m).

As the distance increases, the dispersion increases.

Im, only lead shot injuries seen) Beginning of lead shots dispersion is seen at 2 n

begun to disperse) making the wound rat - hole appearance. . All the lead shots enter the skin as single mass till 2 m. " After 2m, lead shots begin to disperse and individual pellet holes

can be found in addition to central big hole. " At 4 m, there is complete dispersion of lead shots and only

" Complete dispersion is seen at 4 m

individual pellet holes are seen.

Deinitlon of ranges in shot gun:

Contact range: Muzle end of gun is in tight contact with skin.

Close range: Less than 1 m Near range: 1-2 m

Intermediate range: 2-4 m

Distant ange: More than 4 m

Appearance of Wound of Shot Gun in Different Ranges

Contact Shot

Close range (slm)

Single entrance wound Stellate or cruciate WOund

Burms/ ckenialong ng/ tattooingblaseen the track of

wound

Muzie impression

present

Near range

Intermediate range

Distant range

(1-2 m)

(2-4 m)

(>4 m) " Individual

Single circular

SIngle entrance

entrance wound

wOund

Central hole due to shot mass surrounded

by individual pellet hole

Present

Irregular margins -

Blackening

Rot hole

increases from

appearance/

2-4 m, the slze of

Cookie cutter

central hole decreases

Burns/singeing Present

Tattooing- Present

appearance

" As the distance

and the pellet

http://t.me/dr_pedagogy dispersion increases

pellet holes due to complete

dispersion

117

Dr Pedagogy

Forensic Medicine

DISTANT

INTERMEDIATE

Theory

cONTACT

CLOSE

NEAR

2 m

Extra Edge Thumb Rule Determination of range:

The extent of dispersion wll approximately indicate the range of firing.

Unchoked Gun: Range in yards is given by 2/3 x spread in inches.

" Fully choked gun: Range in yards is given by 4/3 xspread in inches.

" Half choked gun: Range in yards is given by the spread in inches.

" For example, a pellet spread of 6 Inches in a wound.

Range in Unchoked/cylinder bore gun= 6x2/3= 4 yards (range is 4 yards) " Range In fully choked gun = 4/3 x6 = 8 yards (range is 8 yards) " Range in half choked gun =6 yards (range is 6 yards) The plastic cup wad may contain lead shots; the wad may open between 30-60 cm in the form of petals.

(30 to 60 cm)

>90 cm

The four petals stick out, and a circular entrance wound is produced with a

The air resistance folds back the petals and a single hole of entrance will be produced.

Maltese cross pattern of abrasion encircling it Abrasion

Cross-ke abrasion

Entry Wound vs Exit Wounds Character

Entry wound | Smaller than the dlameter of the bullet

Size

Edges

Inverted

Abrasion collar &grease collar PJrr Scorching, smudging &tattoolng Bleeding 118

Fat extrusion

Cherry red color

Present May be present Less

Absent

May be present

Exit wound

Larger

Everted

Absent Absent More

|May be present

http://t.me/dr_pedagogy Absent

Dr Pedagogy Forensic Traumatology Shoredexitwound

Souvenir Bullets

Iftheskinat the exitt wound is supported by firm objects or tight garments, c,g. belt, waist band, bra or tie, or body is leaning

" Retained bullet inside the body for a long time. Dense fibrous tissue surrounds the bullet.

gainsrta wall, the exit wound |skin gets crushed as the bullet is resistance. coming out with

Due to absorption of lead from the bullet into the body fluids,

chronic lead poisoning may occur. Plubihm

eeit wound is surrounded by a margin of abrasion resembling

an entry wound.

Frangible Bullet /fded loet

ATYPICAL BULLETS bllouch

Dum -Dum Bullet iAlraded bule n The nose oftheebullet is not covered by jacket and exposed.

" These bullets are designed to fragment and disintegrate on

impact. Usually made up of powdered copper, iron or lead.

Incendiary Bullets

" Incendiary bullets contain phosphorus®, -4olade on imta

ernands or mushrooms on striking the target, producing a large hole and more damage.

" Type of army bullet used to cause fire in the target.

Tandem Bullet (Piggyback Bullet) Cause: Old unused gun or faulty ammunition.:

When an unused gun is fhired, the fhrst bullet gets struck in the barrel.

Tracer Bullet

" It leaves a víaible mark or trace while in flight, so that the

path of bullet can be seen. n sdo in the ar in dayk

When it is fired again, the second bullet carries the first bullet

and comes out.

Two bullets come out of the muzzle end.

Efects of flame, smoke and gun powder are absent and the wound appears as long-range fire. First bullet gets stuck in the barrel

Frst firnng

Theory

Plastic Bullets or Baton Round It is made up of polyvinyl chloride. "

Can be fatal, if hit from near distance.

Poisoned Bullets They are usually 0.177 caliber bullets containing curare, ricin or aflatoxin.

Second fiing

Second bullet comes out with the first bullet

Non-toxic or Green Bullet

" Lead-free bullet. Duplex Bullet or Cartridge Some military rifles contain two bullets.

Ricochet Bullet " Aricochet bullet is one which before striking the victim, strikes

some intervening object first, and then after ricocheting, hits

Both the bullets enter the target at different points, when it is fired.

the victim.

" Base of the first bullet is notched, where the second bullets fts.

" The path of aricochet is completely unexpected. Yawming Bullet Abullet traveling in an irregular fashion instead of travelling nose onis called ayawning bulle.

May cause key hole entry wound., - t oolise

Tumbling Bullet Abullet that rotates end-onend during its nnotion

" Cause: Inferior firearms and low velocity bullets

Wound Appearance in External Ricocheting The bullet may be deformed. Entrance wound is large, irregularly oval, or cruciate wound with irregular margins. " Abrasion collar is absent, as the bullet loses its spinning motion.

Yawning bullet

"

Burning, blackening and tattooing are also not seen.

" Depending on the surface hit, paint may be found adhering to the bullet.

Kennedy Phenomenon Tunbing bullet

Aht

Mutk wound

Iatrogenic surgical alteration of the entrance wound.

. The evaluation of whether the wound is entrance or exit becomes

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

How to find out whether the recovered

ATYPICAL APPEARANCES IN SHOTGUN Theory

been fired from the alleged firearm?

WOUNDS

Primary Marking/Class Characteristics

Billiard Ball Ricochet Effect they strike each At cose range. while the lead shots are bunched., through the pass as they pattern other, and soroad out in a wide

"

As the bullet passes throughthe barrel, the rifling

suggest a Such arperance of wide dispersion of lead shots may ire) Jong rang fire (even though actually it is close range Intermediate

grooves pr

" Primary markings are used to identifythe make and guns invohed.

model ofs,

Secondary Markings or lndividuallAccidental

Skin

Characteristics "

Erratic

BAard bal ricochet

Every gun model has speciic rifling pattern.

markings on the buller (macroscopic).

hxty.

object

bullet ha

Each gun has some imperfections in the barrel which a. unique to that gun.

dispersion

" Imperfections may be produced accidentally durina. manufacturing process or may be due to sticking of lead na to the bore when shots are fired (Metallic Fouling).

Markings produced on bullet surface by such imperfection

called secondary markings (bullet fingerprint).

" They are useful in identifying the specific gun which was fired

Balling or Welding of Shot

PRIMARY MARKINGs: Macroscopic Rifling grooves of the

" Ballingof shotgun pellets results in the conversion of some lead

SECONDARY MARKINGS: Microscopic striations/

barrel.

shots into acompact mass. Remaining lead shots alone disperse.

Imperfetions of the barrel

" Itresults in asingle wound (due to balled shots) aFd surrounding ho The technique of study of markings on crime fingerorinins bullet and test dispersion (remaining dispersed lead shots)

or more lib Cause: Faulty manufacture, old ammunition

microscope - Bullet but builet under comparison

or melting of shots due to excessive heat

" anBecause of effect, the actual distance shot wound may look like intermediate range wound or may be 2 firearms are used.

Gunshot ResidueTests -Lubitaken fan hond o hanlk Dermal Nitrate test or

Paraffin test Harrison and Gilroy test

analysis

" Qualitative chemical test.

soil, glass pieces, paints. AAS is useful

Atomic absorption

spectroscopy (AAS) and Flameless atomic

absorption spectro

Detects nitrates and nitrites

elements in GSR, hair, nails,

NA

To analyze the holes in clothing and tissues. To find whether or not a

photometry (FAAS)

person has fired a gun.

Scannlng electron

Most sophisticated tool

microscope-energy

Minute traces of GSR can be

dispersive

found.

kray spectrometry |(SEM-EDX) nt

rifled.

" Helixometer: Instrument to examine the interior of the barrel

Bullet slap/graze: When the bullet strikes at an angle, it

from the suspect's hand.

Also to identify traces of

Neutron activation

Extra Edge Paradox guns: If the barrel is partly smooth bored and party

cannot penetrate the skin but elliptical or triangular abrasion is produced. Kronlein shot:

" Rare type of skull injury due to high velocity bullet. loe

" Bursting of skull and laceration of dura with complete e evisceration of brain. A Cyt won

Rayalaseema phenomenon: "

It is an artifact.

. Abullet is implanted in a stab injury to fake a firearm injury

It is done to mislead the investigations.

Such cases were reported at Rayalaseema district in Andhrd Pradesh.

Bullet emboli/Wandering bullet: Vascular embolization of bullet.

" Associated with small caliber, low velocity bullet . Usually involves the arterial system.

120

http://t.me/dr_pedagogy

Dr PedagogyForensic Traumatology Puppes Rule

Gunshot Wounds on Skull

Eor skull injuries due to multiple impacts°. (gunshotu/blunt inpact)

impacts ccan be established. stquence of the.

The

Principle

Theory

Skull has outer table and inner table.

When the bullet enters the skull, bevelling occurs in the second

layer.

not ede

" In entry wound, the beveling is present in inner table of skull In exit wound, the beveling is present in the outer table of skull Entrance wound

Skull outer table Skull inner table

Outer table

Exit wound

Clean cut hole

Bevelled opening

Bevelled opening

Clean cut hole

Inner table

Inner table Outer table

-Bevelled

.When there are two tracture lines in the skull, the second fracture

vil always be stopped by the preexisting fracture line.

margins/

Bevelled

margins

Cotey

Potnkcat'sn-fH

1211

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Theory

Chapter at a Glance BLUNT INJURIES

ABRASION

SHARP INJURIEs

cONTUSION

LACERATION

Destruction of layers ofBlood accumulation skin

Fothelial tag at tall end

Dd: Ant bite m

Margins irregular and

under skin Skin normal

Graze-most common Ks

pressure sores

INCISED Maro ins and

bruised

Tissue bridges+

Extravasation of blood+

crushed

raltway ine he "Ectopic bruise: black

Bleeding less

eye

"Dd: postmortem stalning

PoiDepthntedmoteweaprs

CUt

Single-edged r. wedge-shaen ole edge

vessels cut

Bleeding more

Do

Tailing+

knife

Split type-incised

- oval-shaped

Flaying present in

Penetrating only entry

Avulsion type

HESITATION AL CUTS:

Perforating -entry and ert

HARAKIRI:

DEFENSE INJURY: HOMICIDAL

SUICIDAL STAB INJURY

CIDAL

regular

Halr bulbs,

Hair bulbs, vessels

" Irregular margins

STAR

BULLETS USED

RIFLED GUN INJURIES

RIFLING IN BARREL

SPINNING OF BULLET CLOSE

cONTACT

NEAR

(Range of flame) Muzzle impression+ " Stellate margins+

Burns, blackening and track ot

aiong the

wOund

DISTANT

(Outside flame.

(Outside gun

within gunpowder)

Circular entrance wound

-Circular entrance

Burns and Singeing+

woUnd

-Blackening+

Tattooing+ Abrasion collar+

Tattooing Abrasion collar

powder)

Circular entrance Abraslon collar+

CALIBER: DISTANCE BETWEEN OPPOSITE

- Smoke: Blackening

LANI

" Flame: Burns and Singeing

SunpOWder: Tattooing

rasion collar and Bullet hole

SHOT GUN INJURIES)

" in shot gun, there Is dispersion of lead shots . The more the distance, more the

dispersion

CONTACT

CLOSE

NEAR

(2m)

(>4m)

Single entrance

entrance wound

Central hole due

WOund

Burns/singeing

Irreqular marglns -

to shot mass

Pretent ening present Tattooing present

Rat hole appearance

DISTANT

Burrounded by

Individual pellet hole.

Individual pellet holes due to Complete

dispersion

PHERICAL BALLS FROM CALIBER: NO. DF SPHER

POUND OF

EAD

122

http://t.me/dr_pedagogy

Dr PedagogyForensic Traumatology Frequently Asked

Concepts-Last-Minute Tidbits

abrasionsare usually simple hurt except corneal All most common type of fabrasion is Graze (brush abrasion. . The abrasion). e noted in tail end of abrasion. are tags Epithelial In contusion, thesskin is normal, whereas the underlying vessels ruptured. etavasation of blood noted in contusion

Theory

line bruise anddttire marks are the examples of patterned bruise ArtibcialI contusion producedlby the juice of Semecarpus

Toceration: Margins irregular, hair bulbs &vessels crushed

anacardium (Marking nut).

bridges: Present in laceration; absent in incised wound

more in incised wound Hemorrhage Less in laceration; laceration avulsion of feature Eaving is ike laceration/Split laceration appear like an incised wound at scalp, elbow, shin, etc. Tailingis noted in incisedI wound, swallow tails in lacerated wound, fish tailing in stab wound. Beeling of incised wound is homicidal in nature

Cenitalia incised wound is homicidal in nature Lesitational/intentional/ tentative cuts are suicidal in nature

Chop wounds overhead are homicidal, wide gaping, bevelled. Harakiri/seppuku is suicidal stab injury abdomen. Sed fracture skull is called signature fracture, as the pattern of the weapon can be determined.

Dctatic fractures involve sutures and are common in sagittal suture.

Ponds fracture are common in obstetric forceps delivery and among children.

Gutter fracture skull is due oblique bullet injury .ing fracture is fracture line around foramen magnum and due fall from height

Hinge fracture is also called motorcyclist fracture. Fracture line noted in MCF Contrecoup impact lesion is present at a site opposite to impact, common in mobile head. Ertradural hemorrhage commonly occurs from rupture of Middle meningeal artery.

. Subdural hemorrhage is due to the rupture of bridging veins. Lucid interval seen in EDH.

Whiplash is due to Hyperflexion and Hyperextension, seen in occupants of the car. " Paradoxical hypothermia is seen in hypothermia. Frostbite (dry cold injury) is very common in Nose; Trench foot is due to moist cold injury.

" Joule burn is an endogenous burn/due to contact with low voltage current " Arborescent burns/Lichtenberg burns/Filigree burn/Ferning is due to lightning. Tire marks and avulsion laceration are characteristics of run n over accident.

" " " "

Rifling is done in rifled gun and choking is done in smooth bored gun. Presence of spiral grooves in the barrel of agun is rifling; terminal constriction of barrel in smooth bored gun is choking Paradox gurm is basically ashotgun, in which the muzle end is rifled. Wad is present in shotgun cartridge; Wad acts like apiston and helps in lubrication in shot gun.

" Max dispersion is seen in unchoked gun and least dispersion of pellets is seen in fl choked shot gun. o Caliber is the distance between two opposite lands in rifed gun. " Abrasion collar (due to gyroscopic action of bullet) and Grease collar (due to deposition of dirt/grease) are associated with riled Firearm injury:.

Grease collar is also known as bullet wipe.

nagunshot injury, burns are due to the flame; Blackening seen is due to Smoke.

latooBng is due to the deposition of unburnt gun powder. Puppes Rule is related with determination of Sequence of bullets. Kennedy phenomenon is iatrogenic alteration of gunshot wounds. "

mary marking is due to rifling pattern on the gun, secondary marking is due to irregularities.

Secondary narkings are moree specific and individualistic. SEM-EDX is the specifc test for detection of Gunshot residue.

Injuries caused by the blast wave: Primary blast injury. Injuries caused by the fving obiects: Secondary blast injury

,uies caused by the wind/victim displacement: Tertiary blast injury

Injuries ccaused by theemiscellaneous factors: Quaternary blast injury.

http://t.me/dr_pedagogy

123

DrIMAGE-BASED Pedagogy QUESTIONS

Forensic Medicine

Imáge-Based Questions

(Recent Question 2021)

4. Identify the sign.

1. ldentify the injury.

a. Battle sign

a. Incised looking laceration

b. Raccoon sign

b. Incision

G. Ring fracture

d.

d. Anterior cranial fossa fracture

c. Laceration looking incision Laceration

image. 2. Identify the skull fracture as shown in the

5. What is the cause of injury in this person?

(INI-CET N

(INI-CET 2020)

a. Comminuted

b. Depressed

c. Ring

d. Sutural

e.

(Recenl uei

Linear fissured

3. ldentify the postmortem finding. (EMGE Dec 2021)

a. Electrocution

b. Lightning

c. Hot liquid injury d. Mechanical injury

6. Identify the phenomenon.

a. Tattooing

24

b. Abrasion collar

a. Left lung missing

c.

Cardiac tamponade

b. Fat necrosis d. Pulmonary embolism

c. Electrical injury d. Shot gun wound

http://t.me/dr_pedagogy

(INI-CET Nor X

Dr PedagogyForensic Traumatology 7.

Identify the injury shown in

image.

(INI-CET 2020)

10. Comment on the range of the shotgun entry wound.

Image-Based Questions

a Contact wound

b. Close range wound c. Near range wound 1 Incised wound

b. Lacerated wound

c Abrasion

d. Contusion

& ldentify the image.

d. Distant range wound 11. The injury shown in the figure is:

(AIIMS Nov 2018)

a. Stab wound

b. Wound of firearm entry c. Wound of firearm exit a Abrasion

b. Laceration

c Imprint

d. Graze

9. ldentify the fracture.

d. Penetrating wound 12. ldentify the type of skull fracture.

(AIIMS Nov 2018)

a. Fissure fracture

b. Diastatic fracture L Hinge fracture

C Depressed fracture

b. Ring fracture d. Comminuted fracture

c Depressed fracture d. Comminuted fracture

125

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

13. True statement about this injury is: Questions Image-Based

16. The source of bleeding in this hemorrhae.

a. Bridging veins a. Blood is present in vessel and can be washed away easily b. Extravasation of blood occurs

c. Produced by pointed object

b.

Aneurysms

c. Middle meningeal artery d.

Diploic veins

17. True about this firearmn injury:

d. Postmortem pooling of blood in venules 14. The type of injury shown in image is:

a. Scratch abrasion

a. Entry wound due to bullet entering the skin perpent

b. Patterned abrasion

larly b. Entry wound due to bullet entering the skin oblique

Graze abrasion d

15.

Pressure abrasion

True about stab wounds:

Rifled firearm exit wound d. Shotgun exit wound

18. Comment on the range of the entry wound.

a. Depth is greater than breadth b. Breadth is greater than depth

c. Length is greater than breadth d. t has wound of entry and exit

a.

Contact wound

C. Near range wound

126

http://t.me/dr_pedagogy

b. Close range wound

d. Distant range wound

Dr Pedagogy type 19. The

offlaceration

shown a in the

image is:

Forensic Traumatology

22. The skull fracture seen in the picture is caused by:

Image-Based Questions FORAMEN MAGNUM -FRACTURE

LINE

a. Strike by harnmer

a Stretch laceration c Split laceration

b. Avulsion laceration d. Cut laceration

20. The following injury is:

b. Strike by bullet

C. Fall from height landing on feet d. Strike by iron rod in neck 23. Tissue bridges are seen in the image:

a Primary impact injury

b. Secondary impact injury G Tertiary impact injury

B

d Secondary injury

21. The critical impact angle in external ricocheting is:

& 30-degree C 60-degree

b. 45-degree

d. 90-degree

a. Injury A

b. Injury B

c. Both Injury A &B

d. Neither A nor B

24. Identify the injury in scalp.

a. Incised injury c. Laceration

b. Stab injury d. Chop injury

127

http://t.me/dr_pedagogy

Forensic Medicine

Dr Pedagogy

25. The range of this rifled firearm injury in the chest is: Image-Based Questions

a.

Contact shot

b. Close shot

c.

Near shot

d. Distant shot

28. Identify the type of injury.

26. This type of fracture is produced by: a. Whiplash injury

h

Punch drunk svnd;

c. Secondary injury d. Coup injury 29. Pick out the correct pair:

A

a Heavy weapon with small striking surface

b. Heavy weapon with large striking surface

a. Entry wound-A; Exit wound - B

c Light weapon with small striking surface

b. Entry wound- B; Exit wound- A c. Entry wound - A & B

d. Light weapon with large striking surface 27. Identify the injury.

d. Exit wound - A & B

30. The injuries produced by blast wave are: Blast Wave

a Penetrating injury c. Chop injury

a. Primary blast injury b. Secondary blast injury

b. Perforating injury

c.

d. Defense injury

d.

Tertiary blast injury Miscellaneous blast injury

128

http://t.me/dr_pedagogy

Dr PedagogyForensic Traumatology 1. True regarding

these lines jis:

34.

ldentify this method

of

torture:

Image-Based Questions

a Picana

b. Parrot's perch

.These are the pattern of dermal collagen and elastic fibers.

c Chepuwa

h They do not correspond to the creases of the body surface

d. Saw horse

Astab wound with long axis at right angles to the cleavage

lines of Langer, will gape lesser A. Astab that runs parallel to these lines will gape more

e. Bastinado

35. The most common intracranial hemorrhage associated in this scenario is:

12 The injury seen in the RTA victim is due to:

a Extradural hemorrhage b. Subdural hemorrhage

a Whiplash Injury

c. Subarachnoid hemorrhage

b. Windshjeld C Acceleration -deceleration

d Intracerebral hemorrhage

d. Seat belt 33.

Identify this torture method:

&Chepuwa c Parrot perch

b. Bastinado d. Saw horse

http://t.me/dr_pedagogy

129

Forensic Medicine

Questions

Dr Pedagogy

ANSWERS WITH EXPLANATIONS TO IMAGE-BASED QUESTIONS

1. Ans. a. incised looking laceration The photograph shows incised looking laceration in the scalp.

" Incised looking laceration is a type of split laceration.

Image-Based

Commonly seen in bony prominences

on the skull vault

. The image

3. Ans. c. Cardiac tamponade to The photograph shows blood in the pericardial Hemopericardium (cardiac tamponade). Explanations

cavity

Cardiac tamponade

This results in compression of

with

cardiac chambers.

Answers

" Most common type 9. Ans. a. Hinge fracture

"Most common type of skull fracture

pressure.

photograph shows graze abrasion Graze/Brusk

gravel rash.

shows thin, linear fissure fracture line is seen

Rapid accumulation offluid or blood in the pericardial space causing increase in the intrapericardial

8. Ans. d. Graze

. The

2. Ans. e. Linear fissure fracture

The photo

" Profuse hemorrhage is seen

" Length >Breadth >Depth of the wound

shows the fracture line in the middle cr fossa extending from one side to the other - Hinge fr or motor cyclist fracture.

10. Ans. d. Distant range wound

The photograph s

Beck's triad

Hypotension

Muffled heart sounds Raised jugular venous pressure

Decreased venous return

individual pellet injuries.

" Complete dispersion of lead shots is seen in distant re (4 m).

11. Ans. b. Wound of firearm entry

The photograph shows beveling of inner table of skull

" In entry wound, the beveling is present in inner tahle skull

" In exít wound, the beveling is present in the outer table df skull

Decreased cardiac output " Most common cause is trauma

12. Ans. d. Comminuted fracture . Ans, a. Battle sign

" Two or more fracture lines intersecting and dividing th

bone into three or more fragments. Mastoid ecchymosis

Battle

sign

Middle cranial fossa #

13. Ans. b. Extravasation of blood occurs

" The injury displayed is contusion.

" Extravasation in blood is the characteristic feature Contusion.

Raccoon

Periorbital

sign

ecchymosis

14. Ans. d. Pressure abrasion

Basal skull #

" The picture shows ligature mark, which is an example d pressure abrasion.

It cannot be patterned abrasion, as the pattern of the ligatur is not reflected in this mark.

15. Ans. a. Depth is greater than breadth " In stabinjury, depth is the maximum dimension

5. Ans. b. Lightning

Filigree burn/Lichtenberg flowers - Lightning.

Lichtenberg flowers are pathognomonic of lightning strike. Superficial thin irregular tortuous markings on sl

resembling

branches of a tree. Found over shoulders or flanks.

6. Ans, d. Shotgun wound

" The photograph shows multiple pellet wound suggestive of shotgun wound. 7. Ans. a. Incised wound The photograph shows incised wound in the fingers. Features: " Margins are clean, cut & regular

130 A

" Structures at the floor of the wound [vessels, nerves, hair bulb, eic.J

" In incised wound, length is the maximum dimension. 16. Ans. c. Middle meningeal artery " The photograph shows the hematoma above the dura mat - extradural hematoma.

. EDH is due to rupture of middle meningeal artery. 17. Ans. a. Entry wound due to bullet entering the skin

perpendicularly " The photograph shows the bullet wound with circu abrasion collar.

When the bullet enters the skin perpendicularly, abrasio

collar is circular.

" When the bullet enters the skin obliquely, abrasion co is oval.

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology T

Ans. C. Near

range wound

.The photograph shows s circular wound along with tattooing

it.

around of gunpowderrifled entrance injuries

Appearance of Cuciate or Stellate wound- Contact range Circular bullet ywOund with singeing, blackening &tattooing "

nd the wound - Close range (within the range of flame)

" Circular bullet hole around the wound

with abrasion collar

& tattooing

- Near range (within the range of

gunpowder.

" Circular bullet hole with abrasion collar - Distant range

(outside the range of gunpowder) laceration 19. Ans C. Split

The photograph shows incised looking laceration in the scalp.

Incdised looking laceration is a type of split laceration.

. Avulsion laceration shows flaying,.

injury 20. Ans. a. Primary impact . Bumper injury is a primary impact injury. . Primary impact injury

Due to 1" impact of vehicle on the

yictim.

. Secondary impact injury - Due to 2nd impact of same vehicle on the victim.

. Secondary injury - Due to victim thrown on the ground.

26. Ans. a. Heavy Weapon with small striking surface " The

photograph shows depressed fracture in the skull.

Answers

by heavy weapon with " Depressed fracture is smaller striking surface like hammer. " It reflects the pattern of the weapon and termed signature fracture.

with

27. Ans. a. Penetrating injury

Penetrating wounds: The weapon enters into the body/cavities without producing any wound of eexit.

Explanations

Perforating wounds: When the weapon enters the body

through a cavity and exits, thus producing two surface wounds (Entry wound and Exit wound). 28. Ans. a. Whiplash injury

" Whiplash injury is seen in occupant of car. " It results from hyperflexion and hyperextension movements

29. Ans. a. Entry wound- A: Exit wound-B The photograph shows abrasion collar in the wound A

to

Image-Based

suggestive of entry wound and everted wound with more

bleeding in woundB suggestive of exit wound.

30. Ans. a. Primary blast injury

"Primary blast injury-Blast wave Secondary blast wave - Flying projectiles Tertiary blast injury - Victim displacement

Questions

" Quaternary blast injury - Burns, building collapse

21. Ans. a. 30 degrees

"Critical angle of external ricocheting of bullet is 30 degrees. . The bullet before striking the victim, strikes some

intervening object first, and then after ricocheting, hits the victim.

31. Ans. a. These are the patterns of dermal collagen and elastic fibers

" The patterns of collagen fiber arrangement are the lines of cleavage of the skin and their linear representations on the

" The bullet may be deformed. 22. Ans, c. Fall from height landing on feet Ring fracture in the base of skull seen in fall from height

landing on feet or buttocks 23. Ans. a Injury " Injury Ais laceration, while injury B is incised wound.

skin are known as "Langer's line of cleavage" " A stab wound with long axis at right angles to the cleavage

es of Langer, will 8P

" A stab injury that runs paral

tohese lines will gape less.

32. Ans. b. Windshield

" The picture shows sparrow foot marks, which is due to broken windshield.

T

" Tissue bridges are characteristic of laceration.

33. Ans. d. Saw horse

4 Ans, c.Laceration

" Photograph shows incised looking laceration.

34. Ans. b. Parrot's perch

Common in scalp, forehead, shin, iliac crest, etc. 35. Ans, b. Subdural hemorrhage

25. Ans, d. Distant shot

ne Photograph shows bullet hole with abrasion collar and

Dence of blackening, tattooing and burns

" The photograph shows shaken baby syndrome. " The most common intracranial haemorrhage associated with shaking is sub dural haemorrhage.

131

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

NEXT/CLINICAL CASE-BASED QUESTIONS

NEXT/CIinical Case-Based Questions

7

CBQ

A-49-year-old male is brought to

inverted margins, AGunshot bullet wound showing tattooing, (FMGE Dec 2020) The range is:

no signs of burns/charring. Contact

c.

Near

d. Close

emergency& bomb explosion. He has multiple abrasions injuries at right side chest & abdomen.

lacera

Which following is responsible for proximity of these injuries:

Distant

(INI-CET Nov n

a. Explosion burns

CBQ

2

A Cricket player was hit in the head & becomes unconscious. After sometimes, he becomes conscious. After the match, he lost his consciousness & was taken to the hospital. The

diagnosis could be:

af

b. C.

d. Building collapse 8

(FMGE Dec 2020)

Extradural hemorhage

Flying missiles Blast etfect

A 28-year-old man was involved in a bomb blast exolos

Subdural hemorrhage Subarachnoid hemorrhage

Which of the following is not true?

d. Intracerebral hemorrhage

CBQ Apatient presented to OPD, with burns of soddened skin, with

dear line of demarcation, lines of vesicles running down the

(IN-CET Nov 2021)

body. The probable cause is due to: a

Chemical burn

c.

Burn due to dry heat

d.

Burn due to mnoist heat

a.

Lightening

b. Force of explosion decrease rapidly

Injuries due to burns or air blast Force of explosion is directional

Abrasion, bruise and fracture are triad of explosion

CBÌ

4

Aperson is brought to emergency department, with laceration on the forehead and back ofhead. Mechanism of such laceration (INI-CET Nov 2021) on forehead is by: a Skin crushed between 2 hard objects

9

CE

A 25-year-old victim has been brought for autopsy. Multige

abrasions were present over right upper limbs & right le

Fracture was present in the both the bones of right leg. :

b. Shearing force

examination of the abrasion, the age of this abrasion is:

c. Semi sharp objects d.

Overstretching

CBQ

5

A person under police custody is made to lie on a prone

position and his ankle and wrist are tied behind. What is the

(INI-CET July 2021)

name of this torture method? a.

Choke

b.

Falaka

C.

Hog tying

d.

Bansdola

CBQ

6

A man was working in field, collapsed in a hot summer afernoon. Which of the following symptoms is least likely to (Recent Question 2021)

be seen?

Bradycardia Hot skin

132

d

Hypotension

Temperature 105.2°F

b.

12-24 hours

c. 4-5 days

2-3 days

d.

http://t.me/dr_pedagogy

5-7 days

Dr PedagogyForensic Traumatology CBQ

10 of fall from bike has come to 15-pearoldwith alleged history noted in his left forearm. The type of A OPD. Abrasion

T sustained is: sbrasion

CBQ

14

A 35-year-old married woman had arrivedNEXT/Clinical at the police by her husband. The of abuse complaining domestic station

investigating medical officer noticed bruises on the forearm,

shoulder and back on examination, She also had blackening with swelling and puffiness around her left eye, which made it

difficult for her to open her eye. The blackening around the eyes is caused by: a. b.

G. Penny bruise Questions d Ectopic bruise Case-Based

Friction abrasion Patterned abrasion

CBQ During autopsy of a 35-year-old man found dead in his house, approximately a wound over the right parietal area that waswas found. The circular sbaped and 5 x5 cm by dimension 15

C. Contact d. Imprint

Seratch

h Graze

CBÌ

a hammer forensic expert safely assumed the weapon to befound in the fracture of be the type would probably. What

most

skull?

ale dead body has brought for autopsy. The injuries are as

Rem in thbe image. The manner of injury shown in the image

c. Ring fracture

Gutter fracture

d. Sutural separation

b. Depressed fracture

CBQ

16

revealed Examination of the victim of the road traffic accident

multiple shallow, punctate wounds that had a bizarre pattern these

on the face and

findings as Sparrow

The forensic doctor documents

tmarks. What could most probably be

the cause of such an injury?

Motor cyclist's fracture b. Under-running or tail gating G. Steering wheel impact

d. Windscreen impact C.

& Accidental b Suicidal

Four members of the same family were burnt to death when their

hut had caught fire, allegedly from embers that had been blown around from the bonfire they had lit earlier that evening to warm CBQ

12

Arular bullet wound, erythema seen around the margin,

bbdtening &tattooing present. What is(Recent the range? Question 2019) 4 Contact shot entry b. Qose shot entry wound wound Cose shot exit wound

& Near shot

CBQ

17

Homicidal

d None of the above

themselves. The bodies were seen with their hips flexed at the hip

and lnees. Their hands were held in a defensive pose and with

denched fists. This posture in burn victims is because of:

Coagulation of proteins and present in ante-mortem burn b. Coagulation of proteins and present in post-mortem burn C. Coagulation of proteins and present in both ante-mortem and post-mortem burn

d.

None of the above

entry wound

13

CBQ

lame burn over face, both Tvogarlisbs,-ol4 froatchildof sstained abdomen and chest. Percentage of burns

hed

(AIIMS 2016) b. 54% d. 40%

CBQ 18 A30-year-old pedestrian is hit by a car and sustained injuries. He is noted to have tiblal fracture on the left leg and contusion

over the scalp on the right side. The tibial fracture in this patient isa result of:

a. Primary impact injury

b. Secondary impact injury

G Tertiaryy impact injury d. Quaternary impact injury

http://t.me/dr_pedagogy

133

Forensic Medicine

Questions

Dr Pedagogy

ANSWERS TO NEXT/CLINICAL CASE-BASED QUESTIONS 11. Ans. c. Homicidal

1. Ans. b. Near shot

The injuries on the victim are defense homicide.

The wound showing absence of burning (out of the range of flame) and presence of tattooing Case-Based gunpowder) indicates the near shot.

(inside the range of

2. Ans. a Extradural hemorrhage The period of consciousness between two unconsciousness

is called lucid interval. It is primarily seen in extradural hemorrhage.

12. Ans. b. Close shot entry wound The circular wound with erythema seen around the

blackening &tattooing is suggestive ot close shot entry

13. Ans. b. 54%

NEXT/Clinical 3. Ans. c. Burns due to moist heat

According to Rule of nine: Face = 18%

The burns showing soddened skin, with clear line of

Both upper limbs =9+9%

demarcation, lines of vesicles running down the body indicate scalds. Typical features of scalds " No charring &No singeing of hair

Front of chest =9%

" Soddening of the skin to " Signs of splashing Answers" Lines of blisters

Front of abdomen = 9% Total surface area of burns: 54 % 14.

Ans. d. Ectopic bruise

Blackening with swelling and puffiness around her lef o following a trauma indicates black eye, a type of ectopic br

" Clothes are wet & intact

4. Ans. a Skin crushed between two hard objects

injuries,

15. Ans. b. Depressed fracture. " Depressed fracture is due to local deformation of skull

The laceration in the forehead &back of head is split laceration.

. The fractured segment resembles the pattern of the strikt

Split laceration is produced by skin crushing between bone &

surface of the weapon

" It is also called 'fracture ala signature (signature fractur)

Weapon.

5. Ans. cHogtying It is the torture method, where the victim's ankle & wrist are

tied in a prone position. 6. Ans. &. Bradycardia In heat stroke, tachycardia is seen (not bradycardia)

7. Ans. b. Flying missiles

16

Ans, d. Windscreen impact

The description of the injury suggests sparrow foot markx T

sparrow foot marks are due to broken windshield.

17. Ans. c. Coagulation of proteins and present in both unt

mortem and post-mnortem burm

The posture is suggestive of pugilistic attitude or defos attitude.

The pugilistic attitude is due to coagulation of muscle ptes

explosion 8. Ans. dAbrasion, bruise and fracture are triad of multiple abrasions In a bomb blast victim, the presence of & abdomen are & lacerations injuries at right side chest

to flying missiles) suggestive of secondary blast injuries (due Laceration are scen & Marshal's triad = Abrasion, Contusion on sarne side of the body (due to flying missiles).

9. Ans. b. 2-3 days

It is a nonspecific sign, seen in ante-mortem burns postmortem burns also.

18. Ans. a. Primary impact injury The tibial fracture on the left leg of a RTA victim is de

the bumper impact tof the vehicde.

The injury due to the first impact with vehicle (bun impact) is known as primary impact injury

10. Ans. b. Graze

The image showing reddish brown scabbed abraslon, Indicating 2-3 days.

134

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology MULTIPLE CHOICE QUESTIONS I.

with correct palr (INI-CET Nov 2020) Match the following Injury

Weapon 1,

Incised wound

a

Lathl

Chop wound

Road traffic accident

3, 4, Surglcal blade

d

Graze abraslon

3(d), 4 (c) &. I (6), 2 (a), 3(b), 4 (c) 4 (a)

(FMGE June 2021)

Sharpobject

b. Blunt object

d. IJV ante-Imortem death due to burns: of sign conclusive 11. Most

(AIIMS 2016)

(AIIMS Nov 2019)

term is 3. Bullet wipe

Gutter fracture of skull b. Blackening d. Dirt from barrel c. Tattooing can be determined by the spread of shot AAsertion: Range

of pellets Reason: Shotgun cartridge contains pellets

(AIIMS May 2019) true and the 2 Both assertion and reasons are independently assertion the reason is the correct explanation for the assertion and reason are independently true but Both b. assertion reason is not the correct explanation of the reason is inde c. Assertion in independently true but the

pendently false

the reason is inde d. Assertion in independently a false but pendently true

e. Both assertion and reasons are independently false

occurs due to 5. Paradoxical undressing cause of death

(AIIMS May 2019)

2 Immersion syndrome b. Hypothermia d. All of the above c Dhatura poisoning Question 2016) 6. Scalp laceration may resemble? (Recent 1 Incised wound

b. Abrasion

. Gunshot wound

d.

Contusion

7. 7.In an incised wound. all of the following are true, excep

(Recent Question 2014, 15)

a t has

cdean-cut margins D. Bleeding is generally les than in lacerations C Tailing is often present Length of injury docs not correspond with length of blade

(Recent Question 2016) (AIIMS 2014) & Subbing heart b. Cutting the genitalia . Shooting in Stabbing in abdomen d. mouth Frimary lmpact iniury ls commonly scen in:

Hara kiri mean:

(Recent Question 2015)

c Pedestraininjury Injury

a. Heat hyperemia b.

Heat fracture

c. Presence of carboxyhemoglobin

b. Motor cycle injury d. Burns

(Recent Question 2015)

Antemortem burn

b. Postmortem burn

C. Asphyxia d. Carbon mono oxide poisoning

antemortem and post 13. Not a differentiating feature of (Recent Question 2015) mortem burn?

d. Bullet

c Fall from height used for:

Gun shot

Questions Multiple Choice

b. SVC

C. Descending aorta

a.

d. 1(c), 2 (a), 3(d), associated with , Cutter fracture of skull is

L

Carotid arteries

d. Absence of line of redness 12. Soot in trachea is a sign of:

3(d), c. I(b), 2 (c), 4 (b)

8.

(Recent Question 2015)

Ladder tears seen in:

Tram tack brulse

2. Axe

b. 1(d), 2 (a),

10,

a. Laceration on medial aspect of thigh b. Cheery red muscle

C. Soot in respiratory passage d. Cyanide in the blood

(Recent Question 2016)

14. Molst burn refers to: a. Simple burns

b. Scalds

C. Electric burns

d.

Thermal burns

of: 15. Bone pearl's or wax drippings is pathogonomic a. Burns

c. Lightening

b. Scalds d.

Electrocution

(AIIMS Nov 2018)

16. Bullet fingerprinting is: a. Human fingerprints on bullet

b. Primary marking c. Secondary marking

d.

Distorted bullet

produce maximum 17. Which type of chocking in short gun (Recent Question 2016) dispersion of pellets? a. Fully chocked C. Quarter

b. Half d.

Unchoked

18, Smokeless gunpowder contains:

(Recent Question 2016)

a. Nitrocellulose

b. Charcoal

c.

d. Sulphur

Potassium

by: 19. Gunpowder remnant can be visualized (Recent Question 2016) UV rays c. Infrared rays

a.

b. X-rays d. CT scan

is called: 20. Bullet which is left inside the body for long a. Souvenir bullet

c. Tracer bullet 21. Tandem bullet is:

b. Tumbling bullet

d.

Tandem bullet

a. Bullet which left for long in the body b. Bullet not released on first fire but comes out with second bullet on secondd shot

C. Bullet that leaves a visible mark in path that a person can d. Bullet deviated from is path

http://t.me/dr_pedagogy

135

Forensic Medicine

Dr Pedagogy

Answers with Explanations

ANSWERS WITH EXPLANATIONS

1. Ans. c.l (b), 2 (c), 3(d),4 (a)

6.

(Ref Review of Forensic Medicine

Ans, a. Incised wound

Taxicology:

IRef Revicw of Forensic Medicine

Gautam Biswvas; 2nd etition; P- 196]

" Tram line Bruise (aka Railway line bruise)

longitudinal weapon like stick, cane, lathi can

oroduce t sbruise

This bruise looks like Tram-line/Railway-line.

2. Ans. d. Bullet (refer to earlier discussion)

bullet/glancing bullet, tangentially

Essentials of Forensic Medicine & Toxicology,

33rd Ed, P 230]

Grease Collar (Bullet Wipe) " Ablack/grey colored ring is seen lining the entrance wound. " Due to the deposition of lubricants, gun oil or lead from the bullet.

" Abrasion collar surrounds the dirt collar. " Dirt collar rim is more prominent in dothing- 'bullet wipe. " Abrasion and dirt collars are proof of an entry wound. 4. Ans. b. Both

assertion and reason are independently true but the reason is not the correct explanation of the assertion.

(Ref: Review of Forensic Medicine + Toxicology, Gautam Biswas, 3rd edition, P 212]

" Shotgun cartridge contains lead pellets. Range of shot gun can be determined by the spread of

(margjns

differentiated from incised wound by examination with magnifying lens.

7. Ans. b. Bleeding is generally less than laceration

pellets.

Incised wound/cut/slash/slice

Gaping present &eversion of margins

Points to Remember:

Characters

Laceration

Incised wound

Margins

Irregular, edges

Clean cut, regular

contused Tissue bridges

Present

Tailing

Absent

Present

Bleeding

Less (due to

More (due to

The extent of dispersion will approximately indicate the range of firing. " Unchoked gun: Range in yards = 2/3 spread in inches. " Fully choked gun: Range in yards =4/3 in inches. " Half choked gun: Range in yards = spread in inches. 5. Ans. b. Hypothermia (Ref: Review of Forensic Medicine & Taxicolog, Gautam Biswas,

3rd edition, P 264)

Paradorical undressing:

LACERATION

" In such case, there may be suspicion of sexual offence.

" The manner of death is usually accidental.,

Terminal burrowing or Hide and Die Syndrome:

Seen in severe

Absent

crushing of vessels)cutting of vessel INCISED WOUND

" This may occur in severe hypothermia; the body is found partially or fully undressed. " During termínal hypothermia, the victim becomes himself. disoriented &confused, and may undress u

i

2nd cdition, Pg- 1

" Tailing is present, suggesting the direction. " Bevelling is seen if the blade cuts obliquely.

Determination of range:

byptions.

"Due to terminal

"Victim is often found under bed or bench, behind wardrobe, on a shelf.

" This may also lead to the assurmption of a homicide or

robbery.

Toxicology: Gautam

" Margins clean cut ®ular . Blood vessels are clean cut, profuse bleeding presere

Thumb Rule

136

2nd edithon, P-i

Laceration looking like an incised wound to be regular &clean cut) ag Sites: Shin9, scalp", eyebrows, cheek bones, iliac creut & perineum.

IRef Review of Forensic Medicine

3. Ans. d. Dirt from Barrel

[Ref KSN Reddy,

"

Can be

Gutter fracture:

" Caused by oblique travelling to the skull

Incised looking laceration:

Toxicology, Ga tam

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Traumatology abdomen 8. Ans. d. Stabbing in IRef Review of Forensic Medicine c Toxicology; Gautam Biswas: 2nd edition; Pg- 199)

. Hara-kiri (seppuku) is a form of Japanese ritual suicide by disembowelment. . Stab injury in the abdomen, causing instantaneous

evisceration of bowel loops. . It results in circulatory collapse and death Suicldal manner Hesitational cuts

14. Ans. b. Scalds

(Ref Parikh 6th/e p. 4I151) Local effects of heat & cold:

" Dry heat: Flame burns

Explanations Answers with

" Moist cold: Immersion

" Moist heat: Scalds

foot

" Dry cold: Frost bite

15. Ans. d. Electrocution (Ref: Review of Forensic Medicine & Toxicology; Gautam Biswas; 2nd edition; Pg- 275)

"

Hara-kiri@

Joule burn

Homicidal manner

Defense injuries

flash or spark burn

Chop injury over head Stab Injuries over back

Incised wounds on

SKIN

edile fash crocodile

Bevelling injuries

0enitolio

burn

arc eye bun

9. Ans. c. Pedestrian injury Ref Reddys 29thle p. 249-52; Parikh 6th/e p. 4.132-4.135;

MUSCLE

ELECTRIC INJURIES

Zenker's degeneration Bone pearls

BONE

Forensic Medicine by Guharaj 2nd/e p. 166, 167, 168;

Micro fractures

(Zig Zag fracture)

Rao (1999)/ep. 207, 208, 209)

Pedestrian injuries: " Primary impact injuries: Injuries caused due to the first

impact of the vehicle with the victim. " Secondary impact injuries: Injuries caused due to the second impact of the vehicle with the victim, .Secondary injuries: Injuries caused due to victim falling on

the ground. Ref Essentials of Forensic Medicine d Toxicology, KSN Reddy, 33rd Ed., P 280

282)

" Ladder tears: Multiple parallel horizontal tears of the

aortic intima that occur in deceleration injuries.

Aorta injury in Road traffic injuries: " In sudden deceleration forces, complete or partial transection of aorta results. descend " The most comnon site of complete transection is the arteriosum. ligarnentum of attachment to the aortadistal ing

tears

" Io partial transection, multiple, semicircular ¶llel tears. occur in the intima of aorta known as ladder-rung

11. Ans. c. Presence of carboxyhemoglobin

Primary Marking/Class Characteristics: " Produced by rifling grooves Primary markings are used to identify the make and model of the guns i Secondary markings or individual/accidental characteristics

" Produced by imperfections of barrel are called secondary markings.

" They are useful in identifying the specific gun which was

fired- Bullet finger printing 17. Ans, d. Unchoked 18. Ans. a. Nitrocellulose

Ref Review of Forensic Medicineó Toxicology: Gautam Biswas; 2nd edition; Pg - 215)

BLACK unpowder: Potassium nitrate (75%), Charcoal (15%) &Sulfur (10%)

" SMOKELESS gunpowder:

SEMISMOKELESS gunpowder: 80% black &20% smokeless

12. Ans, a Antemortem burn

gunpowder.

13, Ans, a. Laceration on medial aspect of thig

(Ref.: Parikh 6the p. 4.I52-4.156) Soot particles In airway

Carboxyhaemoglobin In blood

Blisters wilh alburnin

ANTEMORTEM BURNS

LNON-SPECIFIC SIGNS

(Ref Reddy 31stle p. 217: Parikh 6th/e p. 437-39, Apurwa Nandy 2ndlep. 48]

involved.

10, Ans. c. Descending aorta

SPECIFIC SIGNS OF

16. Ans. c. Secondary marking

chlorlde

Line of redness Heallng slgns

19. Ans. c. Infrared rays (refer discussion) 20. Ans, a. Souvenir bullet

21. Ans, b. Bullet not released on first fire but comes out with second bullet on second shot

(Ref KSN Reddy, Bsentials of Forensic Medicine + Taxicolog. 33rd Ed, P 230]

Infectlon

Souvenir Bullets:

Pugillstlc attude

" Retained buller inslde the body for along time.

Heal haemalorma Hesl fracture Heat rupture

4. I52-4.156] 6th/e p.33d (Ref Parikh R KSN Raddy, Essertials of fForensic Medicine &Toxicology. Ed PJ25)

Dense fAbrous tissue surrounds the bullet.

" Due to absorption of lead from the bullet into the body

fluids, chronic lead poisontng may occur. Tandem bullet (Plggyback bullet): . Two bullets come out of the muzzle end.

http://t.me/dr_pedagogy

137

http://t.me/dr_pedagogy Nolke -Tim

Kad"

y

Work Doesn't

Salent

When Jalent

Beato

work "Havd

Forensic

Dr Pedagogy

Dr Pedagogy

Forensic Medicine

Theory CLASSIFICATION OF POISONS Let's Know the Basics

cORROsIVES CALKAL!

INORGANIC ACID ULPHURIC ACID

NaOH KOH

.SUL

ORGANI C ACIDS CARBOLIC OXALIC

.NITE

TRIC ACID

HCL

IRRITANT

POISON

ACETIC

NEURAL ORGANICS

SOMNIFEROUs (SLEEP des N INDUCING): G): OPIODS

DELIRIANTS STIMULANT (CNS NTS): DATURA COCAINE, CANNABIS INEBRIANTS

SPINAL

NUX VOMICA

ABRUS PERIPHERAL NERVE SEMICARPUS CROTON POISON

CONIUM "CURARE

(UNTOXICANTS): ALCOHOL AR 99-enbri

ARSENNC "MERC

ANIMALS

.COPPER

"SNAKE

. 1RON

SCORPION

ONVETALLY. ..2CPNHOSPHP HLORNE

ACONITE

CARDIAC

1.CANORGANE, METALL

RICINUS

" IODINE

IGITALIS Sear NERIUM CERBERA THEVETIA NICOTINE

.CCAPR YANIDE

ASPHYXIANTS

HYOON MONOXIDE

OGEN SULPHIDE

" CARBON DIOXIDE

AGRIGULTURR

-b

ldeal homicidal poison . Cheap and Easily

Colorless, odorless,available and tasteless

Can be mixed with food easily

Symptoms should resemble notural diseasea

No antidote

NoOpostmortem changes

Should not

be by chemical tests detected and must be rapidly body, e.g,destroyed Fluorine,from

vthallium) Arsenic, aconite (commonly

MISCELLANEOUS INSECTICIDES "FOOD POISONING

RolkncUeleAneeo

ldeal suicidal poison Cheap and easily available

Police intimation

Pleasant taste

39 Cr.P.C

Ea_ily taken with food

should be done by a

Not informing the

doctor under

police is

Giving false information is punishable under 176 IPC punishable under 177 IPC If there is any suspected of food, article should be stomach wash by to preservepreserved the doctor. Intentional omission

Highly toxic

Painless deoth

Highly toxic

used)

-

VGyonide fideal)

Others are Opium, barbiturates OPC and endrin (commonly used)

amounts to destruction of evidence and punishable under 201 IPC Intentional omission to inform police about the

offence s Dunishable under 202 IPC Intentionally giving false information about the offence s

punishable under 203 IPC Negllgent conduct with respect to poison is

under 284 IPC "

punishable

Causing hurt by means of potson, with offence is punishable under 328 IPC intent to commita

140

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Toxicology GENERAL LINES OF TREATMENT ncantamination:

Emesis. Gastric lavage,

INORGANIC ÁCIDS Catharsis, Activated

Whole bowel| irrigation

huras!

eectivee avageis very

within 1hour of poison ingestion. Gastric sitting position or position Oin lefA lateral Boustube,

for gastric

Rylestube

lavage: Lavacualor (Best), Ewald's tube,

Theory

Nitricacid

Brown to black streak from

GastricLavage

TubesusedI

Sulfurlcacid

ISObacion: "Xanthoproteic

angle of mouth

Yellow discoloration

Black tongue Aaolen

of tissues (picric acid formation 47tooo

Chalky white teeth"dermi lack stomach wall or black charred stomacha Blotting paper stomach

Yellow teeth Brown stomach mucosa

Vitriolage (Throwing Acid Over Face -Adadork to Disfigure) carbolicacid, caustic " Sulfuricacid (most common9), Nitric acid, or calotropis. nut juice soda, caustic potash, iodine, marking A IPC? " Voluntarily causing grievous hurt by acids - Sec. 326

32c rc (10 years/life imprisonment) " Attempt of vitriolage-Sec. 326 BIPC (5-7 years)

1

ExtraE d g e Na. .a rale Costraindications: Comatose patients, corrosive (except

henol), esophageal varices, volatile poisons, convulsant poisons.

Activated Charcoal Mechanical antidote Contains small, low volume pores for adsorption of poisons

Magenstrasse (Street of the Stomach)

" The pathway corrosive agents follow in food-filled stomach

" It is along the lesser curvature (Location of greatest damage) half " In case of empty stomach, damage is seen in lower

(fundus spared)

Acivated charcoal does not adsorb: Corrosives

Heavy metals/Hydrocarbons

"Iron

" Pesticides Solvents

(Magenstrasse)

Maemonic: CHIPS)

CORROSIVES Arid

Alkalis

USes coagulative necrosisCauses Liquefactiveenecrosis ne Alkalis

Acids

noranic acid | Primarily shows

ocal acton only as there

hno Systemic

Absorption

Organic acid It has systemic Eg. 1. NaOH absorption 2. Potasslum Hence, shows Local action +systemic action hydroxide

" Carbolic acid (Phenol)

2HNO.

"

3. HCL

" Acetic acid

"hyloaoicacid causes

Oxalic acid

Boric acid

a

3. Sodium carbonate Potassium

carbonate 5. Ammonla

Hydrofluoric Acid AUardtoh. N lee

tmei

It is a unique acid as it can cause both Coagulative necrosis (by ions) &Liquefactive necrosis (by Fluoride ions)

Mechanlsm of Toxicity Liquefactive necrosis Decalcification +intense destruction of the bone

When it comes in contlact with calcium/magnesium, it forms

Laekkrtinsoluble salts, Thus, results in hypocalcemia &hypomagnesemia. liquefactive necrosis.-

http://t.me/dr_pedagogy

141

Dr Pedagogy

ForensicMedicine

Systemiceffects

Phenolic Polsoning

of entry, Irrespective of the route are:seen systemic effects following Hypocalcemica

Local exposure/effects

heory

Skin

Causes deep burns

severe excruciative pain

[predominantly]

primarily in subungual

Hypomagnesemla " Hyperkalemia Cardlac arrhythmias

h hale 1mahsn co

Cs) ys - Hya h,fcale pua (7 1. Carbolisma 2. Carboluria (green color urine)

Constriction of pupils -Mi 3.4. Corneal deposition 5. Cartilage deposition

(PCT) 6. Convoluted tubule damage

." Metabolic acidosis

7. CNS depresslon", Lony lusws

Treattent

ifavailable calcium gluconate, 2.5% apply of 10% calcium Topically burns SC injection

Acute Poisoning (Carbolism) Miosis

and numbness due to Skin: Burning skin. white eschar on

deep/large In cases of gluconate is given Correct Electrolyte imbalance

nerve

PCT necrosis, hemoglobinuria.

oxidation of Green color urine due to the

IVCalcium gluconate

endings de

metabolites

at

Chronic Poisoning (Phenolic Marasmus)

ORGANIC ACIDS

and systemic effects systemic absorption - both local

have (They present)tdiahue-

weight loss " Anorexia, Progressive pigmentationnof skin and sclera Dark urine, and

Cesl,Rer'h

(ochrosa

Other Features

Carbolic Acid (Phenol)

White/brown leathery stomach is seen Gastric lavage can be done (Gastric lavage contraindi other corrosives)

as an antiseptic or disinfectant. " Phenol is usedHisoy odoY dokne

Didr Metabolism

Putrefaction is delayed

and pyrocatecho " Phenol gets converted into hydroquinone metabolites on further oxidation

Land excreted in the urine the- carboluriaQ, produces green color urine

sof Phen ol, Properesoa,Phead

odtcauses tingling

Ak., ligaments (Ochronosis°)

tat

Oxalic acid is used in ink remover solution (used to e

Used in calico printing and as bleaching agent.

Spinach and cabbage I Attentlon

When ina question of a case of poisoning, history of ink remover solution is given, Oxalic acid should be considered.

LvshgReay muwsa

OXALIC ACID (ABSORBED INTO BLOODSTREAM

TETANY HYPOCALCEMIA

cOMBINES WITH)

(CHVOSTEKWEISS SIGN) (ACCOUCHEUR'S

HANDITROUSSEAU's SIGN)

CALCIUM IN

BLOODSTREAM

CALCIUM OXALATE CRYSTALS

OXALURIA: EXCRETION OXAL ATON OF CALCIUM

E CRYSTAL s IN URINE

TUBULAR NECROSIS AND

142

e

writing in attempts at forgery)isn tain omoe

" It danmages the sensory nerve endings (initially sensation, later numbness and fnally anesthesia) in cornea, cartilage and " Phenol and metabolites get deposited

Mechanism of Toxicity

sugas salt d

Oxalic Acid Aud

RENAL FAILURE (UREMIA)

http://t.me/dr_pedagogy

Dr Pedagogy Forensic Toxicology

al'sen) groundvomitus" is seen

Coñee Theatment:Calkiumgluconalee(antidote). parathyroid stomachisseen in postnlortem

.Blackcolor

CAed Himdialys.

Exta

RoledLobsterSyndrome t there Inboricacidpoisoning,

MNEMONIC

extract

aree massive areas of erythema,

and exfoliation (loOking like aboilled lobster) desquamation, seencommonly on tthe palms, soles and buttocks.

Theory METAL M-Minamata disease,Mernbranous colitis", S - S Membranous glomerulonephritis E -Erethism" (Mad hatter")

T-Tremor" (Hatters shakes) Glassblowers' shakes

A -Acrodynla

L -Lentis (Mercurla lentis)

rashesare

The

MINAMATA DISEASE

" Disease due to organic mercury"

Chronlc organic mercury intoxication caused by eating

contaminated fish and shellfish

coordination, gait " Symptoms include disturbances in hand

and speech, tremors, rigidity, selzures.

ERETHISM " Mad hatter syndrome

Neuropsychiotric symptoms

Personality change da

nid

Irritability, shyness, dementia, insomnla

industry workers " Common among gloss industry and hat Intention Tremors (Danbury Tremors/Shaking Palsy)

Predisposed Occupation: Workers of hat industries (hatter's shakes)

IRRITANTS:METALS

shakes") and glass blowing industries (glass blower's

Type of tremors: Coarse tremors Site: First in the hands’ lips’ tongue’ arms and legs. Features: Worsening of handwriting (early feature)’ Slurring of speech’ ataxia ’ concussion mercurialis (most severe

Mercury (Quick Silver) Todc Forms of Mercury Elemental mercury

form of tremors).

toxic Not absorbed in the GIT & Inhaled vapors are toxic.

Organic mercury

Acrodynia (Pink Disease)/Swift-Feer disease/Calomel's disease

o

Incudes Methyl mercury, Ethyl mercury, etc.

Inorganic mercury mercurous " Indudes 2 types of salts. They are mercuric salts &

ldiosyncrotic hypersensitlvity teaction Due to mercurous chloride (calomel) Age group: Children Features

salts

Mercuric chloride (most toxic salt)

Mercurous chloride (calomel) Mercuric sulfide

Mercuric cyanide onicity: Organic mercury >Mercuric salts >mercurous salts)

HdiSm ares of Chronic Mercury Poisoning Sate grey mucosa in stomach1 Excessive salivation, gingivitis, loosening of teeth, blue lines on 6ums

Minamata disease

hatter syndrone) Erethism- -Neuropsychiatric features ((Mad(Danberry tremors/

Tremorshakes/Glass s- Coarse blowers shakes") Hatters intentional tremors

Acrodyni a (pink disease) Lens

deposition- Mercuria lentis -

1 Hunter--Russell syndrome

Pink discoloration in the hands and feet Pink Puffy

Painful

Paresthetic Peripheries Assoclated with Dental fillings, teething powders

http://t.me/dr_pedagogy

143

Forensic Medicine

Dr Pedagogy

Iheory Mercurialentis Toxicity: Exposure to mercury vapor Mechanism: Brownish deposition of mercury in anterior lens

copsule Site: Anterior lens capsule, Bilateral

Slit lamp examination: Malt brown reflex Visual acuity: Normal (No effect on visual acuity)

THE

Hunter Russell Syndrome

INHERITOR'S

Due to the toxicity of Methyl-mercury visd dak sped sdf

POWDER

" Classically, patients present with paresthesia, dysarthria, sensory

ATale ef

deficits, deafnes, cerebellar ataxia, and progressive constriction

ARSENIC

of visual felds

A

Jlustvative

On April 21, 1956, a 5-year-old girl was examined at the Chisso Corporation's Factory Hospital in Minamata city, Japan. The

doctors were surprised by her symptoms: unable to walk, speak and convulsions. Two days later, her younger sister also began to exhibit the same symptoms and she was also hospitalized. The

girls' mother informed doctors that her neighbor's daughter was also experiencing similar problems. On May 1, it was reported as "epidemic of an unknown disease of the central

nervous system", marking the official discovery of Minamata

falade100-2Sng Clinical Features Acute Poisoning

" Causes hemorrhagic gastritis Gastroenteritis like cholera In postmortem, pink velvety stomach mucosa or strawba stomach seen.

d

disease.

Chronic Pojsoning

Researchers found that the victims, were often members of the same family, clustering in fishing hamlets along the

. Metallic taste, excessive salivation, and garlic odor of breat

shore of Minamata Bay. Cats also began exhibiting bizarre

movements and strange walking that the people said the cats were "dancing". It was even noted that some cats fell

and sweat. ka

Alopecia,l

Aseics as

Skin.

into sea and drowned, which the residents referred to as cat

Arash resembling fading measles rash

suicides'.

Rain drop pigmentation

It was shocking to find that large quantities of methyl mercury

were detected in fish, shellfish, and sludge from the bay. The

Brown pigmentation over skin flexures, temples, shoulders, palm, eyelids and neck

Leucomelanosis: Ncp\es

SCHCC

Chisso factory was identified as the source of contamination as Mercury contaminated waste water from Chisso factory spilled into the bay. The Organic Mercury travelled from microorganisms inhabiting the bay, and then up the food chain to fish and shellfish, and then finaly to the cats or humans

" Hyperkeratosis of the palms and soles bilaterally.

which ate the fish and shellfish.

Black Foot Disease"

" Macular areas of depigmentation (earliest sign") Aldrich Mees line: White bands of opacity in the nalls of fingers and toes.

Chronic exposure also causes vasospasm and peripheral vascular insufficiency ' h b i a 40N WN

Arsenic (Metalloid)

. Dry gangrene and spontaneous amputations of affected

Toxic Compounds of Arsenic

extremities

The toxicity of arsenic compounds can vary greatly. In general,

Peripheral Neuropathy

arsenic compounds can be ranked from highest to lowest toxicity:

"Peripheral mixed neuropathy with tÉngling, numbness of

" Arsine gas (Most 1oxic form)

" Inorganic arsenic (e.g. Arsenic trioxide - most toxic salt) inheritance powder Organic arsenic Elemental arsenic.

144

MURDER

hands and feet (glove and stocking distribution")

Hematological Signs

" Bone marrow suppression, mlcrocytic hypochromic anemia, thrombocytopenia and leukemia. anyshe

Noes- Poyantheitate halygkn pai tting

http://t.me/dr_pedagogy

Dr Pedagogy

ANs

(ls

ol)

CDTA

kof Arsenic Toxicity

Jllustrative

L9. Blood samplea polsoning: than te sarmpleis moreereliable the blood sample.

Mrs Vidya, 32-year-old, thin-bult staff nurse, had come Theory with

Uninay

detailed examination, she was found to be having raindrop

DMS

Oagnoss

Urine arsenic levels of >50 arsenie

ug/244 hours

is an

history of repeated infections and generalised weakness. On

indication

eposureto (Dimethvl lor like DMA e

Forensic Toxicology

Arsenic Acid), MMA Acld] noted. Arsenic Methyl BoneQ Hair, Nall and nnk posoning: are taken, as arsenlc has the tiseuee nail samples

plgmentation, palmar hyperkeratosis, and hypertension and

Metabolites

Guillain-Barré lke peripheral neuropathy. Blood tests revealed

neutropenia, microcytic hypochromic anemia. She raised the susplcion of belng poisoned for property affairs by her husband,

who is a blochemistry lecturer. On further questloning, she had

depositng in keratin noerty of morereliableesample than the Scalp halr, as scalp blc hairis chancessof. external contamination with the

also glven the history of intermittent episodes of diarrhea.

The arsenic concentrations in blood and urlne were found too

hasnmore irhas

hlgh, beyond normal level, Her husband was arrested and he

enionment

confessed of adding small doses of arsenic salt to her food

Tests:

every day.

test Reinsch° test Morsh AOmic absorphon spectroscopy -AAS

Dlsadvantages of Arsenlc Usage asHomlcidal Poison

t

It delays putrefaction

be detected in completely decomposed bodies, keldeaesa Can Can be found in bones, hairs and nails for several years

MNEHONIC

S - a s dei nnoyhas Car

ASenic Poisoning

iynewsethy

BonaparteARSEN

Senember Napoleon Bonaparte died of arsenic) -

Back foot disease

Lead poisoning is the most common chronic heavy metal

poisoning.

-Neoplastic(Skin, lung, Bladder)NAA

" Most common route of occupational exposure is inhalational'

- wmleh

-Alopecia

Lead "

toxic) 0-Oude (arsenic trioxide most

be detected in charred bones or ashes

p

Toxle Salts of Lead

Anemia

P-Peripheral neuropathy

A-Atrich Mees' line, Asophg -Raindrop pigmentation Rgor mortis longer

(tlele

Lead tetroxide (Vermillion)

teyt,R

Retards Putrefacton , Rin

-Teratogen

-Enugtions on skin (hyperkeratosis) Enteritis (cholera)

Lead acetate ugar of lead

| Lead acetate

Lead sulphlde Used es ume

ety

Most common source of lead

poisoning |Used as Sindoor mot

Ay.

Tetraethyl lead

Antiknock in petrol

Lead sulfide

Least toxic form

Lead carbonate

Palnts

Tetraethyl lead

Lead encephalopothy Ai o

Lead tetroxlde

Load carbonata

Commonly ueed ae vemilllon/sindoor

used in paints

qf-muge akeswyis 145

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine Taxic Actions Theory

group and interferes with Lead combines with sulthvdrd

"

tohondrial oxidative Inhibit heme synthesisphosphre mito

ALA

ayprporphringn axidase, Frnhelatas)

MNEHO

Plumbism Features ABCDEFGHI

delydratase,

A-Anemia

8-Burtonian line/Basophilic stippling, Bone lines C-Colic, Constipation (dry belly ache)

sheaths and causes lead CNS atfets nerve cells and myelin

encephalopathy in children JUric acid excretion- f Blood urates - Saturnine gout

D- Drop (wrist/foot drop)-Lead palsy

d

m

E-Encephalopathy

F-Facial pallor (earliest sign) r

Plumbism (Saturnism)

sis

G-Gout (saturnine gout)

" Chronic lead poisoning is called Plumbism (saturnism) " Lead is a cumulative poison. In chronic exposure, lead deposits

H-Hypertension |-impotence

in Aones (904, liver and kidneys.

DiarsiA

ALA

Anemia - Microcytic Hypochromic anemia

Mechanism: Inhibition of ALA dehydratase, coproporphyrin oxidase and Ferrochelotase

Elevated levels of ALA, Coproporphyrins, free erythrocyte protoporphyrin Punctate Basophilia/Basophilic Stippling in RBCS

Lead

Pyrimidine 5 nucleotidase Ribasomes aggregate as dark blue spots in RBC cytoplasm?

|Colic(saturnine colic)

Burtonian line

" Nocturnal

Blue line along

Late synptom

gums

Opposite to caries tooth Deposition of leod

sutfide (lead +H,S

Lead enCephalopathy

Lead palsy " Late symptom Common in adults

Spasmodic

abdominal pain

Degeneration of nerves and

lasting for few

muscular atrophy

minutesm bhae

by bacteria)

Pain relieved by

1 week of exposure

pressure

Lead osteopathy/lead ine

Present in all cases

" Among children!

of plumbism Due to tetraethyl

. Deposition of lead

lead

Wrist drop and foot drop

in growing ends of

bones

In children Irritability, laasra

Radiopaque bands along metophysi

restlessness,

of long bones and iliac crest morgins.

hyperkinetic, delirium, hallu

" Width of lines

cinations and coma

implies the durotiot

Brain damage is

of exposure

Irreversible and

" Minimum 4 week

permanent Green color vomitus

"

Blood picture Bloodd picture in plumbism Polycythemia

Microcytic hypochromic anemia

Anisocytosis , Poikilocytosis j Cabot's ring Ring shaped inclusion bodies seen RBC

Basophilic stippling

"

copper chemical compounds may cause green hair

discolorat

Extra Edge

Thallum Poisoning -Rkatde

YMees' lines presentin to

Copper Polsoning- Vital Points "

disease Chronic contact with swimming pool water containing a

iNdeal homicidal poison features (poisoner's poison)

Copper 146

In postmortem, bluish green stomach mucosa present.

" Copper deposits in tissues-chalcosis l " Chronic inhalation of Copper Sulfate- Vinevard sprayers

Pseudomotor neuropathyA-pRh huNud r

Features resemble Guillain Barré syndrome

Metalic taste

Ptyalism (increased salivation) in chronic poisoning

het

. Triad of alopecio with madarosis, neuropathy ond dioi

http://t.me/dr_pedagogy

d

Dr PedagogyForensic Toxicology Phosphorus Poisoning 4P MNEMONIC Chronic (Phossy Jaw/Glass Jaw/Lucifer's Jaw)

ThalliumPoisoning - AND Anemghhiecs: ,Aopeca

weekness changespanc so-petheic

Phstlmnea Theory

Nail

Neuropathy& damne

.Oarrhea a

ExtraEdge

******

Poisoning

rotoxicity

Golden-yellowstaining of

Neph

teethRstula

Ouch Diseasea

disease") disease= "it hurts-it hurts and water by mining effluents with food of Contamin ation admiuminJapan. cadmium poisoning are bone pain ands maineffects of The ritlebones.Bre weaken resulting in multiple Osteomalac cia - Bones athological bone fractures

Waddlinggait

Due to inhalation of fumes over years. - v o b o the jaw, loosen Toothache (earliest symptom9), swelling of Sequestration of jaw, lower of Necrosis ing of the teeth,

NON-METALLIC IRRITANTS

bone in the mandible, multiple sinuses discharging foul-smelling

pus. Ostnyts d a d b e , t e s

Fhosphorus PAe nhosphorus (yellow phosphorus)

Red phosphorus

Diwali Poisons

Nontoxic

uminous in dark

(phosphorescence)

Phosphorus and Mercury

Nonluminous

aricodor rfanmable (unstable, should be kept

Odorless

Noninflammable

ORGANIC IRRITANTS

No smoke

Plant Irritants

der water) fnis smpke

Accidental poisoning cases with fire crackers (Diwali poison) sdrat killers.

Todturtps patçerohd

Dear friends, please Note:

" In general, plant irritants on ingestion cause burning pain from the mouth to stomach, salivation, vomiting, purging and bloody

stools, followed by circulatory collapse and death.

Sgns and Symptoms Gurlicky odor Laminous vomit and stoolPbecause of the presence ofphosphorus

Fumes emanate from the stools (smoking or smoky stool

mdrome). A b a

Atle poisoning causes liver cell necrosis, fatty liver and acute

relow atrophy

On injection into skin, inflammation, edema and necrosis at puncture site.

On contact with skin, burning, redness and vesication " Plant irritants do not have antidotes, except Abrin

(antiabrin-antidote)

" Symptomatic management only

lame of poison

Major active principle and toxicity

Special points

ds comnunis (Castor)

Active Principle: Rlcin,Rini Quo

(category B) inhh

Entire plant is poisonous

Ricin is a Biological warfare agent

Rilhone

Castor oil nonpoisonous

ns Precatorius unchi Ratb/rosary beadl

óan iquorice)

Unbroken seeds are not poisonous when a se Swallowed or cooked.

Active Principle: Abrin mpo Abraline

Others: Abrine, abric acid and

Entire plant is poisonous spot at Seeds are bright scarlet red with a black one pole

Similar to VIper snake venom

Used asSUl needles? Amew ion,ak si

Anti abrin° (antidote)

http://t.me/dr_pedagogy

Contd..

147

Dr Pedagogy

Forensic Medicine

Major active principle and toxlcity

Name of poison Theory

Special polnts

Active Principle: Crotin

Croton tiglium

Others: crotonic acid &crotonoside Entire plant is polsonous

Tamel Gte,Jama bisn,Ctn Kes

Seeds resemble castor

Active Principle: Semecarpol and Bhilawanol " Seeds are black heart-shaped with a rough

Semlcarpus anacordium

(Marking Nut)-bla

projection at the base.

Irritant Julce is brownish and acrid, but turn

black on exposure to air.

Calotroplssgliganteo

p

edoAk3

Applied to the skin. i

irritation, itching andla painful serum and eruptions of the with aer The lesion resembles a bruise.surrounding h

blister

Uscharin, calotoxin and calotropin lachin, Skin: Bister oycd- G17 irg tab'n Whoeplerd Giqenha

Eye: Conjunctivitis and blindness

Ingestion: Vomiting and diarrhea

Calotropis root - highly poisonous to cobras and other poisonous snakes.

Copsicum onnum

L

Hulan's hand; Contact dermatitis to chill

Capsicin &capsalcin

Medicolegal Importance ~wi- A deitak obytort Ricinus communis

Croton

Semecarpus anacardium Abrus precatorius

Accidental poisoning

Accidental poisoning

To produce artificial

Accidental poisoning

Abortifacient

Biological warfare

Abortifacient.

Juice may be introduced

ldeal cattle poison?

Infanticide (mixed win

brulse/conjunctivitis

Into the vagina, as a

weapon

Arrow poison

Calotropis

milk)

punishment for infidelity. For criminal abortion,

Powdered seeds -

juice is applied to the

conjunctivitis.

Cattle poison by ming with fodder or insertrg

cervix by means of

a cloth smeared with t

abortion stick.

juice inside the rectum of the animal

Seeds-abortifacient and

To produce artificial

arrow polson

bruise

A-1se2d

Arrow poison

Sui Needles " Powdered abrus seeds mixed with dhatura and opium are made

into paste with spirit and water. Small sharp needles are made from this paste and dried under Sun.

The needles are inserted into wooden logs and cattle are struck

with great force which drives the needle into the flesh (s0 as to

resemble snakebite). " Painful swelling develops at the site of injection, with inlammation and necrosis, sepsis and death.

Abrus is thus commonly used as cattle poison in Indian villages and is called ldeal cattle poison

Ricinus communis

" The poisoning resembles viperine snake bite, Toxalbumin " Proteins that inhibit protein synthesis

" Agglutination of RBCs and Hemolysis of RBCs 48

Phytotoxn (Plant toxalbumin) L. Ricin 2. Crotin

Anlmal toxalbumin 1.

Snale venom

2.

Scorpion venom

3.

Abrln

http://t.me/dr_pedagogy

Abrus seeds

Dr Pedagogy

Forensic Toxicology

Extra Edge Hunan Hand 5yndrome

Theory

Paintul contact dermatitis to capsaicin (the active principle ot

capsicum)

Hrequently presents in cooks and chili pepper workers after

preparing or handling chili peppers.

Contact with other body parts gives ri_e - "Hunan nose"

"Hunan eye", and "Chili Willie".

Capsaicin binds with pain receptors causing the sensation of

intense heat or burning.

ANIMAL IRRITANTS: SNAKES Appearance

Venomous snakes

Non-venomous

snakes

Croton seeds Habit Head scales

Nocturnal

Not specific

Usually smalla

Usually large

3 exceptions

(Poisonous snakes with large head scales) "

Cobra

"

Krait

Cobra: 3rd labial largest,

touches eye and nasal shields

Kralt: 4 infralabials scales

below mouth and 4th being largest

Semecarpus anacardium seeds

Belly scales Tal

Fangs

Mouth Bite mark

Large and cover the entire

Small

breadth of bellyA

Compresseda Flatinse aky Not compressed Long and canalized, like Short or small hypodermic needle

grooved teeth

Two fang marks

Small teeth

Calotropis plant

marks

149

http://t.me/dr_pedagogy

Dr Pedagogy

Forensic Medicine

Theory Snout f

Elliptical pupil

-Round pupil

Fangs Teeth

Anal plate scales Venomous

Non-venomous

Head scales

Venomous

Belly scales

Nonvenomous

SNAKES IN INDIA

Smal head scales scales

Large head scales

" Large belly

Singie row of anal scale

Compressed tait " Long fangs.

FAMILY: ELAPIDAE King cobra Common cobra Krait

NEUROTOXIC VENOM

POISONOUS SNAKES WITH

LARGE HEAD SCALES

POISONOUsNON-POISONOUS

bely

sCascale

Uncompressed tal Small teeth

FAMILY: VIPERIDAE

FAMILY: HYDROPHIDAE

"Saw scaled viper Munge

MYOT DTOXIC VENOM

"Russell's viper

Shake

"Pit viper

VASCULOTOXIC (HEMOTOXIC) VENOM

Fatal dose

Sra Brd Supralabial Scale largest

COBRA

Common cobra- 15 mg

King cobra- 12 mg 5g Krait -2.5-6 mg

PiA inhd 4th Infralabial

KRAIT

scale largest

"Russell's viper -40 mg " Saw scaled viper- 8 mg

Ophiology: Study of snakes; Ophitoxemia Circulation of

snake venom in blood. hroke bik

haa

Four venomous snake species are responsible for most of the human snake bite cases in India. They are referred to as the blg four.

1. Indian cobra, Naja naja? 2. Common krait, Bungarus caeruleu 3. Rusell's viper, Dabola russeliQ russ

.

Cobra

Krait

" Russell's viper

" Saw scaled viper

" Elapidae envenomation: Neuroparalytic manifestaton " Vlperidae anvenomatlon: Bleeding tendencies

The big four:

150

Indlan Antisnake venom is effective agalnstb

Sea snake envenomatlon: Rhabdomyolyss and renal fallure

"Mamba snake: Cardiotoxlcity

Saw-Bcaled viper, Echis carinatus

http://t.me/dr_pedagogy

Dr Pedagogy S in

Ah

ofensícToxicology

Clinical Features

pan

Snake bite

whyhnia

Fright (M.c) Non venomous bite

(70%)

Venoumous bite (30%)

Dry brte

(no symptorns) 20%

Envenomation (ophitoxenia) Progressive paintul

Neuroparalytic

Swelling

Viperb

Cobra kraitz

Local necrosis Ecchymosis

"Diplopia

Dysarthria

" Painful swelling

Dysphonia Dyspnea

Compartment

A

syndrome

Russell's viper

Flat tailed

saw scale viper

Plosis

"Blistening

Myotoxic

Vasculotoxíc

sea snake

"Bleeding-saras- Muscle ache ran),ule2rras " DIC

"Muscle swelling

" Shock Acute

" Involuntary contractions

of muscles

kidney injury

Dysphagia

Compartment

r3Ave Paralysis

syndrome

Neurotoxic features (seen in elapid bites)

localsymptoms

!no loal Syn-kra " Ptosis, followed by descending paralysis resulting in respiratory necrosis. Pin,Swelling, blisters, Bleedingfronbiite site is the most important feature, as it indicates sioers bite &is an important sign to start ASV immediately. Resional lymphadenopathy: It is also an important sign for

rting ASV Lehn ragine

paralysis.

Vasculotoxic/Hemotoxic features (seen in viper bites) " Disseminated Intravascular Coagulation is the most important

complication of viper bites.

(ordistiShk Haboein,nyn

Extra Edge Dry bite

no venom is released. Adry bite is a bite by a venomous snake in which

The rate of dry bite differs between snake species.

MMinute Whole Blood Clotting Test (20 WBCT) B d e eyt The most reliable test of venom-induced defibrinogenationand kept aside for 20 minutes. blood is put in a clean test tube Afew millliters of venous tis then tilted to see if it has clotted or not.

hcoagulability indicates systemic envenomation by Vipers.

Whole blood clotting test (WBCT) Draw 2ml of venous blood and transfer Dectly into a clean and dry glass tube.

e t upright, open undisturbed for 20

d/or 30 minutes

at

test indicates normal coagulation.

indicates a coagulopathy.

room temp.

Snale VWenom Ophthalmla From spitting cobra. tthe venom exposed to

douing

breaks down quickly upon inversion After exactly 20 minutes, pick up the tube If clot the of the tube or fails to coagulate, the test and invert it. If a solid clot is retained,

of vision and

burning, stinging pain, eyes, intense

temporary

wateringBof the eyes with congested conjunctivae, followed by profuse

blindness.

http://t.me/dr_pedagogy

151

Forensic Medicine

Dr Pedagogy

Theory

Jluotratiue

A5-year-old boy, who was sleeping along with his parents,

It is not done in viper bites, due to thee

risk of

syndrome. Antisnake venom:

(compartmen

developed sudden abdominal pain, weakness of his hands and mild difficulty in breathing. The chlld was reported to the

" It is effective against Common cobra, Krait, Russell's scaled viper (big 4) asair kig

hospital and on examination, he was drowsy with bilateral ptosis, complete ophthalmoplegia and paresis of the limbs. I

Source of ASV is hyper-immunized horse serum.

seemed like a rapid progression to descending paralysis and shallow respiration. The boy was immediately intubated and mechanically ventilated. An erythematous papule (3 mm by 2

No need of test dose. IV Route of administration (1-2 ml/min)

mm) was noted on his right forearm.

Adetailed history revealed that the family was residing in a village near Kanchipuram, Tamil Nadu and that they were sleeping on the floor that night. The boy was completely well till 2:00 AM and suddenly developed the symptoms in the early hours of the morning. He denied history of any food consumption outside, which could have caused botullsm, NeurotOxlc envenomation due to snake bite was suspected

as an important possibility and anti-snake venom was

vipet,

Can be given only when signs of envenomation preset Itis available in the form of frozen, dried powder; whjch d.. be mixed with diluent.

" Time: Very effective, if we start ASV within 4-6 hrs

" Dosé: 10 vials [irrespective of age &sex]

In case of neuroparalytic envenomation, ASV should be rene till the clinical improvement occurs.

In case of vasculotoxic venom, ASV should be continued nil

clotting becomes normal (repeat the 20 min clotting test. nil becomes normal)]

administered.

Respiratory failure was completely reversed after 36 hours

MNEHONI

of administration of ASV and he was extubated. No residual

neurological deficit was detected and he was discharged after 7

days of hospital stay.

The cardinal symptom of krait bite, which is abdominal pain,

can precede neurological symptoms by several hours and the

paucity of local tissue reaction is a typical feature of Krait bites I wish to reiterate that rapldly progressing descending paralysis in the absence of local tissue reaction could be an early feature of krait bite. They are commonly reported in the early A morning and those sleeping on the floor are at a greater risk. of administration high index of suspicion is reguired, as timely

ASV is effective against Cool Shah Rukh Khan (0r) . C-Common Cobra

CSK Rocks C-Common Cobra

" S-Saw scaled viper

S-Saw scaled viper

" R-Russell's viper

K-Kraít

K- Krait

. R-Russel's viper

Interesting Facts about Krait-the 'KILLER'

ASV is critical for a favorable outcome.

Management of Snake Bite Specific treatment

First aid approach CARRY NO RIGHT

Carry - Carry the pt'

No= No ligation/tourniquet/

Indian Polyvalent Ant snake venom

suction/Cautery/electric shock/Neostigmine +atropine coffee/alcohol/'euS R- Reassurance

-Immobilization (pressure Immobilization) GH- Get to the Hospital

(to reverse the neuroparalysis in cobra

bite) Neostigmine is not so effective In kralt bite

immediately -Tell the doctor, systemicC

signs of envenomaton Pressure Immobillzation:

" Apply crepe bandage/Sutherlands wrap &immobilize the entire limb

Objective: To occlude the lymphatics. For upper limb, pressure up to 40-70 mm Hg For lower limb, pressure up to 55-70 mm Hg

Belongs to Elapidae and thus, neurotoxic. . More dangerous than Cobra

. Nocturnal (comes out only during night time)

the bite site; Krait bite is dangerous as there ls no paln at

the victim is unaware of the bite

" Kralt is neurotoxlc. " Venom Is loaded with presynaptic toxins and is 16 times

more powerful than cobra " Causes Immediate paralysis of muscles. " Ineffectve treatment and No response to anticholinesterases.

" Fatality is 70-80%

http://t.me/dr_pedagogy

Dr Pedagogy AnForensicToxiçology

Alho hogey Cantharides(Spanish Fiy)/ utiveprinciple:CantharidinQ

" This is followed by depression of vital centers of medulla

1y

-o,2 r

producing coma and death.

" Three stages of alcoholism: Stage of influence, stage of Theory

150-)5EgOrdination and stage of coma725ea 5b-159 " Pupils are dilated in the initial two stages, constricted in

Tnordoth

comatose state.

Macewen Sign .

Seen in alcoholic coma,

" Pupils are contracted, but on stimulation of the person, e.g., by Lcalapplicationonskin: Vesicle orbblister formation

pinching or slapping pupils dilate with slow return o Lota " This diferentiates alcohotic comafromcoma due to other cause-phie

Opingestion:

Aloodstained vomiting and diarrhea.

in painand nephrotoxicity ( ail) urine Frank blood in Prapism,^ido (elndsia)

Extra Edge

abat..50

Statutory limit for driving in India: 30 mg%° (Sec. 185 of

MVA Motor Vehicles Act)

dAlh0

si

Widmark's formula: a =prc(blood); a =3/4 prq (urine)

CNS DEPRESSANTS NEURAL

Public nuisance under the influence of alcohol is punishable

Te GRIANTS

Alcohol clearance rate: 15-20 mg/hr

under Sec. 510 1PC

Alcohol Taridty: Isopropyl alcohol >Methyl alcohol>Ethyl alcohol

Abrupt excess or stoppage of alcohol can cause delirium

tremens (Mania a Potu)-Coh'ndain Any crime committed by a person suffering from delirium tremens, is not punishable under 84 IPC.

Absolute

Rectified

alcohol

spirit

99.95%

90-95% ethanol +

alcohol

5-10%

Methylated spirit

Surgical'spirít

99% alcohol

90-95% ethanol + 5-10% methanol

+5% wood naphtha

methanol traces of castor oil

Samples used to estimate alcohol levels in the body

Bloodsample - NaF +(k oxalate esevhe Note: While withdrawing the blood, never use rectified spirit for disinfection; as it may give false positives Urine sample Naf

Alveolar air(breath analyzer) Al conde-based sn eN

Vitreous humor

%of alcohol

Beverage Beer

4-86o7

|Wine, champagne

t0-15-2ol

" Itis specifically useful during autopsy of decomposed bodies. Ratio of blood alcohol with different body.fiuids

Blood: Urine =1:1.33 Bloso tohol

Port, shery

20

Blood: Exhaled air (breath) =1:2300

Whisky, gin, brandy em, liquor

40-4505D7.

Blood: Saliva = 1:12.

50-604

Vodka

60-65-50-60%

Action lead

Blood: CSF = 1:1.17 Blood: vitreous = 1:1.2

Methods to find blood and urne alcohol levels

" Kozelka and Hine test

iially ethanol acts as a depressant of cortical centers for ngconduct and judgment with release of inhibitory tone,

lma

stth

Gas chromatography (most speciic) Qonat " Cavett test uolahe

unrestrained behavior.

l04 MVA

Lab test (an be

dsne in Hosta

http://t.me/dr_pedagogy

153

Forensic Medicine

Dr Pedagogy

Methanol (Wood Alcohol) Theory Formaldehyde 33 times more toxic than methonol, ic Acid 6 times more toxic than methanol

METHANOL

Formic

ALCOHOL

Treatment:

Ethanol- Competitive inhibitor for Alcohol

DEHYDROGENASE

SEVERE METABOLIC

dehydrogenase

FORMALDEHYDE

sBicarbonate -for corecting metabolic

Foneioe

ACIDOSIS

Due to accumuiation o

formic acid in body

acidosis 4-Methyl pyrazole-Competitive inhibitor

for Alcohol dehydrogenase

Folinic acid- formic acid elimination

ALDEHYDE DEHYDROGENASE

"Hemodialysis- Treatment of cholce in severe poisoning

BLINDNESS Retinal damage

FORMIC ACID

Toxic metabolites:

Optic nenve damage Biurred vision Scotoma

Formic acid, Formaldehyde

Papiloedema

SNMNICROUS

Marquis test: To detect opLore lora sn Rihi

Opium/Afim/Chandu/Madak Opium is derived from the juice of Papaver somiferum capsule.

Antidote: Nalaxone sodium Na

Treatment for morphine withdrawal:

Methadone

to be nrer Along with routine viscera, brain, blood and bile

Mobrire os Heroin (Di-acetylmorphine) din bood Brown sugar/junk/smack/dope

" Semisynthetic derivative of opium

Routes of Administration of Heroin It can be taken by snorting, smoking or intravenocs (mainlining) and subcutaneously (skin popping).

Toic part: Uaripe fruit capsule, latex juice.

It is dried to " The juice is obtained by cutting the unripe capsule.

abrown residue. ()', ~\I(. ~ Ahl> I OJ210 difYS)

~units/mL - ~1C/~, ~ ~- f.-2...,~ \._ A,alut of >100 ~aasky umts _wi~hlwithoui motile sperms , ~rthalejaculationoccurrcdw1thin 12hoursoftxaminalion. (t¥ds II' not related to sperm co1111t : : Id is useful even in the absence of sperm

,..Jloef/llOSPholdna" Test

1

CPl is .high in seminal fluid,.and can be dnectcd even in 6-!llldh·old stains.

>,"otC~-..

• ~ )I\

"1 t\"~itM I

•

~" \t -..II() ,.. 11

Guys do rtmember that: • During fetal autopsy. abdominal cavity should be opened first. ½

.., I,() 1 \j / .,,. L

,_,,.,,,, Molybdate Tat

~,~v~"""~ I.

,.,_Sptd6cAntigen or Glymprottin PJO Test ISAJound in seminal plasma, male wine and blood, and has not Im 6JWMI ill any female body tissue. • plO CIA be detected in dried and old stains

Chest

1

~:.b~tb~~ -~y~t'°' \.,,~, ~5-\tb

IIIIS~ 11: HIGHLY RELIABLE FOR SEMEN ~~~~Ji ,;~ft(j ~I.. 0$~ ~\.\l~I)-.) 1' -IUIIWUOn of Species Origin

•fllcipiin~I

I

~ iloenzyme

pal1ern (Human pattern is dilfmnt from

t\)~ iri'-

llillalpcma) I..'\- - ~~OI"" A.\?llv~ ~ U)~ Dilution of Y ~ spermatozoa ~ (wblch is not seen

il..:-L)

-

· \} b~Qie.L"" -~ l

~.,,,.,_

"

u

~MrNc-QJ l ~ ~,ll4.

• I.I I...L.

._;: ~ spemia retain full

• le

mollllty In ¥lplll h nd 12boura. tallll rema1n motile In the uterine cavity for 3-7 daya. of IBOlile apen1111o1oa from ¥1p111 II a lip or

'"'°'U- ~~~"iQq- ~"~1 •,. \ "'1.)

i~ U.~

hlr4:." C,,~~o. ",~l"'t

:l..i J; a;~ ,) ~~ ....

Examination of Live Born Baby

~W'l\ ,~rq.;~1. .\.-,',,...,l"(\qn

IJtl«ISlbephosphorus.

~

• Viable child

I

u-'"

¼~~ ~

J.1 1. it < 1wt d"- ( ~•,I.Or tl1J,: ! '),,.,. ma1ur11y at which I f, I ' ·II bl y I CXlstcnceafterblrlh c us a c 10 lead a Jepatalc ,,:,, • Asperl h . ..; ., ~ /,~JI .,.. -1..,.r,.:t -/ •·. • V . aw, ac lld Ii viable In 21 odays (7 months) • ~.I../ 1 1 ag1t115 u1e · . R , .,,_,.. -'d b nnus. csplratson (cry) of the feius while In the wom after the rupture of membranes !. Vagltui vaglnaJbQ· R · , ' ' i.~. . 1t . . . 1l •• ,,~~ti?~'w"i ' the head u In 1he vagina

-\1..¾\.\~

~~ l'°to (r~m scmil:lal vesicle. ~10 diO

:t

'
11nt ,IJjgOI Iodine test To dltecl vaginal

J )

• Sign: Semen in genilalia of animal • Groond for divorce

l

__j

' • • • •

INCEST Seit Within blood 191aliona Not an ol'lence lo India Eleclnl complex Phareoh complex Oedipus comp!ex

~ l cal•

B\JCCAl COO\JS (Sin of Gomorroh) • Oral coitus • Sign: Semen In lhe oral cavily • Ground for divorce LESBIANISM (Trlb1dlam) • Female homoseXU8lily • ~ (active) or Femme (J>8$$ive) • Ground for cfrvorce

------------;=~:;=========--===-=-------------~ f SE.XUAL PARAPHIL.IAS

l I

I

ACHIEVING SEXUAL GRATIFICATION BY ACTS OTtlER THAN INTERCOURSE

l

J. ! 'Infliction of pain or physical cruelty on lhe partner: Sadism • Having sex wtth the dead body: Necrophill• • Ealing the dead body: Necrophagla Receiving painful sllmulu1 from lhe partner tor 11xual pleasure: Masochism • Wearing the dress of opposite sex: 1 Transvestism • Exposure of genllalia In a public pface to obtain iexual pleasure: Exhibitionism • Sexual arousal resulting from objects: ~

· I

I

Fetishism

' Rubbing lhe private parts of a woman in a public CfOWded place: Frotteurlsm

--

• Observing unsuspecting people undress or na~ed, laking bath: Voyeurism/Peeping tom • Sell-stlmUlation whlch eflects sexual arousal: Masturbation • Female amputates penis of her male pa,tner. Bobbit syndrome • Inducing hi& wife lo have sexual lntercoU11e with another man and by observing the same: Troilism • Sight of others engaged In sexual lntercourw: Mlxoscopla • Sexual actMly involving enemas: Kllsmaphllla • sexual arousal by u~g Obscene languege over phone: Telephone S~lologia

----

/

http://t.me/dr_pedagogy

Dr Pedagogy ,~ ;------------------------------------------------------------Forensic Medicine

t1

r·

>-

~

1.. -

J

0

CV

INFANT DEATH S enUclde· killing lnf•nt• -

,--- -- - '' LIVE BORN

f

I

t DEAD BOR N Penod o1 vralnllty· 210 d• y• • Rl{I PI mor111 ' - - - - - - - ••• Mocornllon • Mummmcallon

.C

I-

Jf

l•

• Viable child (>210 day•) • Wea expanded lungs • Inflammatory redon In umbllcal cord • Pr11Mnce of m ilk In •tomach

TESTS OF LIVE BIRTH

,---:-:====;;-:;=----. X-RAY SIGNS OF MACERATION Spaldlng sing • Ovarl11pptng of cranial bones Robert's sign: • Appooranc• of 9,u shadow" In heart • HyfM!r1lexlon ot spine • Crowding of lhe ribs

MACERATION (Aseptic autolysls) , Oeed child lnsldo ulerue for about 3,4 days • Llqor emlnll No air Earll.,.1 sign: skin sllppage Jolnta aro hypermoblla sweetish dlaagreeable odor

http://t.me/dr_pedagogy

....

J ',

STILLBIRTH • Born nner 28 we~k•. or progn•ney. and bnby dfa not breothe or 1t,a w 11ny •lgn, of llfa Boby dlod during lobor -

MUMMIFICATION 1, lnloct membrane, 2 Scanty liquor emnll 3. ,'lbsenl blood supply • Fetui dlea In 2 weeks

SIGNS OF LIVE BIRTH

• Hydrostatic; Respired lungs will float In -!er • Foder•••: Weight of lung• double■ • Plocquelrs: Rallo of lung weight l o body weight (from 1/70 to 1/35) • Wredln's: Presence of a ir In middle ear I• Bn19lsu's a■c:ond Ille: P,e■ence of swallowed air In stomach

-...._.... ..... .....

r .------------~

1

/

)1/

i1

Frequ~• ·~·' · ·-··- - --· "' JJu;-Last-Minute Tidbits 3

]led dcfloration.

,r•I"''l),is ' n tc~r ln sclClla11nlcrcoune Ia po&tcrolatcral (•·• 0,c1o,,.,. - 7 0-o,,"~ ~U>c-4. f-1-· • ·-• -

j

..

"0!1 . ....

tMIMllo!u

~··.

.

.,

.,_, notii:r': List of offences which ore considered as . . . .ainduct. llllmmgO: Notice of toution by SMC to a doctor guilty of Info• J!!l"I ~ not to npeat the offence.

PROFESSIONAL MISCONDUCT/INFAMOUS ~DUCT - ...,~+k; ;,p \ :

a\l

~ llnd dishonorable act by the doctors. by 0 1ficrtloc.ton4 ofgood rrpuu .

'-ming Notice • '•tberu,

1

'llit11ot1a o/11e.b ""-ldi are considaed infamaw conducts. bicom,Pletc, updated by SMC periodically.

•

B

C

Bribery Covering

A:Multery A: Abortion (criminal) A: Alcohol A: Advertisement A: Association A: Addiction

t - l, \¼ ('"o}:jci - ,...,, , ); .• \.,.\,\,

,A•!)'"'°'·""'M~

• Simple Negligent act of the doctor, causing damage to the patient. • Damage Is such, which can be compensated b)I poylng ll'IOM)'

Types of Negligence • • • • • •

Civil negligence Criminal negligence Contrib utory negligence Corporate n~ligen ce Ethical negligence Compo sile negligence

L's\·,,- ..-~ 4~~y~ ':>'!;b WL :. , .- '- \> TT "-rrt c,·idcn~

; -.:.t.._h ,-.. '-" '''W"°'

.

u 'l\ot nttded

as

Calculated Risk Doctrine •

An important drft nu to an,, doclor.

• •

'!be docirinc Is th11t. injury may occur. even though reasonable care has been taken. \:.,~.., 1 ~ -' \ l°'N)\-\- ~ ~ \. 6.wry ac«pled method of lrtalmmt has cert11in percentage of

•

lf the Froduct deficiency ll proved, thr 11111111,fatturtr btcomti rr,tpo•~•iblt'l for r/,c i11J11r')' or de111l1.

•

11,c bunlcrr of proof about the safety lits with the m11nuf11cturcrO.

Doctrine of Respondent Superior/ Vicarious Liability ':.->~~ ~~-~; bl.L t..... r,,..'..~~ L.4. I:, • 'Let the master answer°' V' 1

lnjury ordtolh ohhepatien1 is due to unlnlrntlonal/11111d,·ute111 act by doctor4. Misadvenrutt is ,nisd1anct, acddcrrt or disaster. • Hypmensitivity ~~ctions caused by penicillin, tetr.tcydinc or aspirin. • Trawmtic- rupiutt of rtctum or chemical peritonitis during barium enema. • Thyroid cancer with 1-131 therapy. • Fatal compliations from hemolytic reactions with blood

rvenlng N t .i

•

The chlcf doctor b.comes responsible for any neg\Jgence of his assistants When two doctors practice as partners, cnch is liable for ncgligtnce or the other

•

A hospital, as an employer, is responsible for negligence or Its employees who are acting under its supervision and control A physician.is responsible for the acts of the interns and residents, cnrried out under his dlrect supervision and control

\i'-liv...

ows Actus lnterveniens = Unrelated Action 0

Circumstances

•

transfusion. \)a~ ',, f'I-J...,_

•

t\..t ~~-"i~4l

An ramlattd or unaptdtd inle,.,.tning ,wt which breaks the be said to be an e,;pected complication. Doctor is responsible for the negligent act of leaving of swabs in the abdomen In accidents and assault cases. cominuity of events and cannot

~.,\+-, ,..:'>.,'lq+tJ. ½'-~ ~ -, ~ -,dw-\ Res Judlcata ('the Things have been Decided')

Wbrn the case is completed between two parties in the court, it cannot be tried again bdWffll the same parties. • EDmplc: If a patient sues a hospital for any negligentt and the lhlnp m dccided,Jic cannot subsequently sue the doctor again separately Cur the 11111e negligence.

•

'Borrowed Servant Doctrine;.,_ •

Umltcrclon Period

The nurse unploycd by a hospttal to assist in surgeries willbe th~ ~ " L 'borrowed servant' of the operating surgeon during the surgery. and the servant of the hospital for all other purposes.

Normally, Professional negligence of a doctor must be proved In the court by expert evidence of another doctor. Expert evidence is not needed In: • Res ipsa loquitu~ ,o Doctrine of common knowledge

•

'Ihe Ptlient lhould fik die aut against the doctor within

/rOfrl dietlote ofalltgu M~grnu.

2 years0

~,

~\"~ iii ~~~;lk wi ~(\~~~ O\u ct Mu'(C.h-,

Burden of proof I ies on patient

Res lndicata

o°

An employd~ is rcsporulbl~ not only for his own negligent act, but also for t.he ncgllgmr net of 1,1$ cmployus If three conditions are satis:fied: • There must be an employer-employee rdatlonshlp • The employee's conduct must occur within the scope of his employment • Incident must occur while on the job.

• •

• Enmplrs:

•

•

l

1).-:,~""

~~ ~~ ~ Therapeutic Misadventure •

•

1t is leg•rding mnuers of

•common knowledgt.

unavoidablt risks.

The injuryorrfo,ul, of rlrt p,1tlr11t during m,atmcnt Is due to the d~fin,nr or f1111tty physiwl 11gmtut y diw:hu sed 1CCOrdlng 10 prev hge na. t :). I.. ~ ~ ixg y P,111ten1 w» gwlty o ( con trib utor '-. ~ "- • =-.,. ~ ,.>, '),"° < '."» 1 Thm1~" 11C m1UM/w nt11,t'J.

0 •'~ )

fJn • u(1udgmm1° the pall ffll l ofu tl'M d curu cnt fur tlw a.ct from ·.\> -~ ~ , -~ l, U# .,~ Ila Jud lUU "~- ,;,.. "'re,¼N'1 (rum tJw dak of allcg,td Lun kali oa: C - 6kd wr Z JN

Mslop-nc,c.

• (-.r :.~ • ~ ,

... ) . \ ••

C.. .,.M ar1 1 oiot• IIIGNI mitconduct II d1ff«111t. • Pfd eu• orll , m l ~ , """""1w IO IIW t-• Fo, a CNI.. of pr o/f lf•.. "' proft,ulonol molp,am ,,,_ ,,, 11 ,.., nw nfto l, wh ,n, In lh■ ,0,, n of CN ll-n uJ dlM p, tlomof, IO llw pan lnJuty, ,-n , dub tllty Of . . .,, II mhrociduct II 1aun • T h e ~ Ktl On nery acllOn ... .. , died -.u ndl, whet■n the dl1tlpl1

ffliltlr-•

...n..,,...,,,,,, ,,

far,,.,

br ._ ,tN -. for,-or 1d1natn,... .w1 1i .., .e.

Fea wre

Pro fess iona l mis con duc t

Pro fess ioul

Nat ure

Violatio n o f codl!! of medic.ii ethlcs'I

Ab se~ ofl ' T -

Dut yof care

Nee d not be pres ent

Should ~ pr~

O.m ace to the pat ten t

Nee d not be pre sen t

Should ~ ~

Tri.I by

Slate m~ lul council°

~

skill & are~

Waminc", Tem por a,v

Pun ishm ent

eruure or ~,, .• •rasut\'

Appe.aon befl led1 n

ToN MC

C1v,I or cnm>Ni CW-:-

-

lmposorvnen< or ~ To h11&hef coum:

CONSENT •

Cun1r..t A,t, Ill~! l~h r,al by ~- ll ul t1w lnJ wi ~ ~~ wiJ to .:onwnt wu ur mu, ,

I"''"""' .,,

• 1

"MG

1hr wnw lhtn . In 1hr wnw 1m w. .. , ~

.. 4 \

~

, • • •, ,..__

http://t.me/dr_pedagogy

\.'\ '!itt,,/

~..,._\'-\. t.\, 1'--.rr °':I ~~ri

tlenl

Emergency Conditions (Sec. 92 IPC)

•

~~Q.rJ-

Doctrine of Informed Refusal

Invalid Consent

•

u.- 0\

In un emergency inmMng children. when their parents or guudlJJIS ore not ovaibbk constnl am II0 ~ ~~,\.- · h L-... • What Is the punishment for not oblfginc SLA'nmon? 1)- '"'I 7 • A Summon must be obeyed. . • If the witness falls to attend the court w1:hout any valid Justification, then: ,._ot,' c.Q wQ).N~ r .,,,_'Mt,}/ i~h, I , In Civil cases: Liable to pay domog"l!s. \" -~ , In Criminal casM: Court may l.ssue arrest wurant'I. • Olsobeditnct to attend the court on receiving the summon Is punishable up 10 silt months' impr,sonment (ll4 IPCJ. a. What If summons from two courts are received for lht ""'•

I

~

~d.w\. ~\(

Assistant sessions judge

10 )'1tars0

Unllmlted0

Chief Judicial Mag,strate

7years0

Unllmlted0

I Cln s Judicial Moglstrote

3 years0

10000 rupees

II Class Judic;i;il Miglnrate

l year"

SOOO rupees

\._

I

HNEHDNIC " - " of crimilNI court: Numericals: 1, J, 1, 10 • Subsbtute this numencals from the lowest court. I • , 2.,. class M"&l5trate court, 1st class mag,rtrate, Chief Judicial maa1strate & ~ nt~ns • 2"" class mag,~tt-1 )'1tar • l" clan mas,.trate - 3 yHrs • Chief judlcial ma111trate- 7 vears • Assistant sess1o"s coun -10 years

SpKlal Courts

I

day? ),.,:•"'

One crimrnal court and Attend criminal court'I other civil court 1-0:::,:ne::::..low:::..:e:..:r::,o:.:u_rt:__ &_o_th :--e-r- -t:A:-:tt-:-e-n-:d--::h-;-lg--::h-e-,-co-u-rt'l-;:-- - l

!lo.J- -:,:i,.;

•

...,, Conduct Money (0 et •

Punishments In lnd;a, the cap"al punWunffll or death ~a1ty is by hanging'! by neck till death (Sec. 354(5) CrPCJ

•

5«416Crl'C

•

oney

\¼I.It

It Is the money/fee offered to a witnuslW11°-"'

Med ical Law and Ethics

.

g questions In direct examinarfon and re-exominarfon, leadin ore not ollow td. Bur If the witness Is declared hostile by the Judge, leading onon and qutsfio ns are even permi tted In direct exomin n. re-11xominono

Red Cross Emb lem

Fubn s ol_. ...m iNtl on r. • Examination of a witness by the opposite party lawye • Def.me lawyer in cases of criminal cases. • Leaclinf quntlanl - allowecf'I (Sec. 143 IEA). • Ctoss-euminallon has no time llmlt'I.

,_.., ,.. ol lle-txaftlnatlon llla-DINct Enmlnatlonl

• E.umlnltlon of a witness subsequent to the aoss• eaminatlon by the lawyer or the party wflo called him. • UOtfltlfl quatlons ar, nat allow d'I.

a..-a11tbJtlleJudte

Stale of • AJudp mi, ult llff't question to the wltntss at any s. lhe t,lalG to dear doubt • Ste. 165 IEAG

RECENT ADVANCES ,.......Rtfora«apllfltglftlhffl ...... ... CDIII ,.,.... ment for • M a• ~IIClllfled 1111 quantum of punish l flam fldllty tmtl or cash C,lfts, doctan 1a11pt1111 bribe . . . . C'Offlpll .....

• Gifts word! 1DINHCIOO: warn1111

Who can use 7 (As specified by the Geneva Connntions} • • • •

ln1mia11onal Red Cross Organizations ers l'acilitlts for rhe care or injured and sick armed forcts memb Armed forces mrdical pcrsonnd and cquipmcnl lM Misuu It puni.shable with a fine of 500 and forfci!Utt of goodJ or vehid a 011 which lht tmblr m has bc-rn laud

l • Gifts worth 5000-10000: Su~s lon from State Mediu Council for 3 months al • Gifts wonh 10000-soooo: Su~s lon from State Med.c Counclf for 6 months il • Gifts wonh >50000: Suspension from State Medlail Counc forl ,-

http://t.me/dr_pedagogy

.1

I

Dr Pedagogy NCE RECORDING OF EVIDE

~--- -----r ---

OATH (51 IPCJ

-~

• 12 years: Physkal e•amlnatfon (Sec. 19 IPC) • lnsanlly or inlo•icaled pe150n: Invalid consent (Sec, 90 IPC) • No consenl In emergency (Sec. 92 IPC)

I I

• Patient waives.

•Al delalla should be given aboUl his condition and

t

- -,- - - - - - - -,

be told

be Informed • Pallent& right lo refuse

• Oonatron of sperm • Any procedure hampers sexual act1Y1ty '--------~

CONSENT NOT REQUIRED IN

• Medlcolegal autopsy • Mass Immunization

ax--« lo be Informed

~'-L \'.).~, 5 ) -_ ~ ocJ

~ U-:~','!..t') \-Qh -,,. -y...:i~~\.., ~~ ~~ \,. )-..).~_,\~ °'-(!ul'-h~ j.__ ~ r:..-

-S •..r.~~.J,·..,,_

\. ~ ~\)~O:.~ ~U

v-e.N ~ "'"I

~"° Y½~' w \A-...._ I

'-L

~ ;:> W. j

C..b~ ' ,\\~ ~

l t 1.\: t>™ ~-.1!. vd m ~ 1)t-M.k -\- 2 ~1:>~~ I

> ➔ £Vi

''

..

\ .,--,,.e...,\t_

A.M~.Nr-l

\..I °!'\ '¼ , ,

~ ~ .d"6 dJ..), \..::>-.;,.\.. r->,..ll.; r,o. ,C'(")Jl' u,,_" \...,\..:.. ,,~ .....,,,..._, ,, .._,, J J ~ , ~ ,.,,~ ~ N .. , ~ -. ... \)en, ,rs or ntra mo / Gtlling commlsslon tor or for mv.M.; .\-; ICld1rs

C~( 1,I--

-11

d.9~1\(..

n ~\o,

~()~l\, \1\,, 1 '

o ~"..>,li>"

\ltlJ

/' 1 0

Iii\

t ~l'l

◄-'i.i:.

•i

'\, I '

\i

------------------------····>.\.i····----------------------t~~~a,1' Qr\.,t \1,Q\ d~lt. L.,1\~ >..h,~, c1·,0311~;t> ~ ;;,,._: ..\.. .._.. ..,,,, Mh cl,,,-.d:\11I 1"'-\ -'n\4 LET\ KNOW THE TERMS FIRST

-

\ffll;j

i·•·~

,11, \; • Fofensk P1VChl1try: It duls with the appllcollon or knowled8C or psychlo1ry In tho odmlnlw1t1on or )Jsllco, Iii rei menial • Mentally Ill person: Any person who Is In need of treatment by ronson of any mcn1ol disorder othar Ihon 4'd1tt1>11, • Dellrlum1Lick of orientation In tarms of Uma, plnco o~d parson, • Delusion: Persistent false belief • HaUudnat1on: False perception or stimulus, which Is not prosant. \. 11 ,/\b°'\&..o. .l ,,., .w,-H~ fv, " ) • Illusion:False Interpretation of stimulus, which Is present. object. or stimulus particular of• fear Irrational or Elltesslw • Phobia: • 1mpul11: Sudden Irresistible force compaUlns e parson to the conscious performance of on action without monve or lore lhD(,Cft • Lud d Interval! Period of sanity between two periods of Insanity. • Mens rt1: Criminal mind or Criminal thou8ht. h....MlA,, • Adus m :Crlmlnal act. • Holo1raphk wlll: Awlll which Is written by the testator.In his/her own handwrftfn8, • ~cept!on ord•r: The order Issued by the court for admission and detention or n mentally III person In a psychiatric hosp/1:ar

.

~- ~~

• COmpos mentfs: Sound mind

• Somnanlbullsm: Sleep w1lkl11g • Somnollntll (Sltep,,drunanness): State or confusion when the person Is aroused from deep sleep. During this st.11e. h, 111~ commit some crime. • Somnlloquy (S1Np-t1lkln1): Patient talks during this state, but does not remember about It In the morning on awakening,

• ~I.ii-

,._··~;'~ {-~~ ·:li''~o-ji·_;;······,t~·~"~ ;:J''~'i.'" '~---\t,.i;.;;;.···0·;·.,~~ .. x.;;·;:,;:;;~~:f•~,,,.

~ \.-JJ 0. ~J~~~

wv\~

~~ ~...J ~~~

•

Individual diould be kepi under observation for 10 day,0 , which an be extended up to a mulmum of 30 days "1th the pcrmwlon ol nag!stratc. Cvtifica:e should be Issued after a minimum of 3 namlnatlona.

Motive

~rspos1111 facton

. ".

5lcnsand ' symptOms

Manag1mMt ofProp1rty and Affairs •

Absent

Consent givtn by an lruane person b 1 01 a valid consci110.\u. \ ~-. Contract: Any contract signed by an insane person Is no1 nJld Contract algned by an Insane person during the pmodo/lllCil lntcnal lava1lcl. ll\'l~ ~ Vt.'J>O.- d..., Marrlog1 ~.,,,.,..,i ,,,,,,! when ht is (,,, ~ Ifany of the couple Is proved 10 be Insane;t tlie time ofIIWlilf. obserwcj(l then U1e murl1ge can be declared os Null and Vold0 Frequently If any one of the parme.rs becomes inruie after.\ marriqr. lh.,1 '..!IN;/1 J, ';1 , .u r t ~ u .o....: .~ ~ - . ..f\'\V"I ta , > J' .. r \ 11 .)• 1 ,, ,.,. • · r, '>,. ,. ·~ ·· , '-"' !JI('\ ~11 } .,' ''\~UF Pedagogy . Q.I\ qt:"~ ... Dr ~ N \,v ~~ N ' u"' i:u ,--J ,,, , vi , t ct rd 6t ya docto r. uJdb eO I ' "-._, forc.e. undue Influenc

~ . , JI shO .should b( 'fh tlt

r m Jrcprc1cn .

no

¥b0n1lblllty "''" 1nt1ne CAN Defend

, (tllOD of facts.

~ j(III

r .

~ U ,~ " .,, •)

J

1, ;

sane Person ,responslblllty of an In

•

I: lrr uln 1ble Impulse

~I

• C· Currtn'srut,

fl Ruf,

10 tt,. ,c, ~) 0/ -U l I ' ~ ~ ga t res g wron n Is dealt b bU1ty of Insane perso ns1 po rt.s l ina y im Cr ia, , r.nd

~r

te ~I I At American Law Institu lt ru 's ten gh • N; M'Ha • 0; Dtrrham'srult I

, Ill . n14 JpCO

nslbillty of a person. ~ & rht crunlnal rtSJ>O lble If II Is proved t criminally re.iponJ , , r, ,caiscd ptrson is no ng the crime he wu suffc . ,ro lul nng nomt , •411 1tht timt of comm d' did he t tha , rom uc uc of mind , pdt I citied of reason o~ ing do u w he t tha t ac ality of i,oW (be na111re and qu

,

di•'•

odl!.~_,,I.Jt,,, \ I

~ ~ iu Jt

I

c;antJI~ rwt

1

1

Tu .~

1'..\

0\b .- ~ i' t 1., ~ e Jc~u ~ D: i~J~ \a oi.;,, ~o ,.V , ~ ~

~

...,,,U 11 ~. ,1)- a " Gt,n1t1 M'Nillh d ...~ had suf ck the blc k of IW l O"I ed, plstol, whlCh wuOfd ~luSIOfl1 and w u 1CQ1i ,t1 ~ on 1~ fir ten lfr Na M' . lhGt Ille secretary M ~ n fm h on onwn.tv in t.red from pl( III

,_,

!) ),. )~ ..-,

4

of=~ e-:~..~.,,,r:,,,,r,.,,..~......... ....

hit'(bltshtd chit M'N,thtffl wt

e~

lhe House

tlfY

6,.d UOM J ,w.~

i ... ~, ht .). Jr .., \ V .). .."

w uhroom, ht 1 ' " talking, '" ' ro,wty. WIien "- wow up to vi e !h t _,_ -" . wl!llffl ht 11111111 p« ~ ..~ . )'L , -~

.. .,

•

•• t

• '- • ot

• bo ut t"- - . _ _ __ _. • r1c,1 q~mon, __ ,. ,.. _, L iv.. = ,, .... ,, • series of hypotht ol L- QIW, .,. i.. i,.. al , »4 ..tao _.. ., u ... , ,.., ,... ..... ..,, ..._ tl u es " ,,. ... , _ . . lnel ,-sponslb11ity ,,... 111 cled S days laoft«LoItnffwas .~ -'- > ud v" framed tor a lm ._ j, . , ~

.. .. .. to t h

.. .

u

'. \ .,. \ff'."""' .M ,. ~It ~ .Lal,·

http://t.me/dr_pedagogy

~ •~ .

~~\,a.c-J,:;cJ (V'\IY')&0i ~ \\;,~~ 1'r-.I,.

I

H,podJondrlacal D1lu1ion°

1

'111/dJ~C.~0,y,.

• Pmisknt fw or bdlef of having • s~ium/1 (like cancer)

based on the patient's own unrralistic Interpretations of phr,siCi31 , sigmand~ptoms. ~12 \.e.. "'4i --~ ~ ~-1- · Iii... ..,,, 'fl'.11:~ "

http://t.me/dr_pedagogy

.·1 · .

. Forensic Medicine

Dr Pedagogy

-- - - -- - - -- - - - - - - -- - - - - • - - • •

r

------------------- --- --- --- - - --- --- ....

Erotomoniao (dt Clirom boult's Syndrom,) ~,,,, ""

Nihilistic Dtlusion

PerSon holds a delusional bd,ef thlll a11otl1c, Ptr lug/,tr socwl s111111 s. rs"' love w,rl, l1imlhefl.. • ~4l~ Cf~ • The erotomanic tncs to get close 10 the ~rso n throU calls, e-moll~. Jctrcrs, gifts and vlsils. gh ltlcpi.~ • It is more commo11 in ,.-om w than in men. • It is seen during psychosis. t.~ ~N '- di., c.n ~w •~

io~..,

•

Snlman Kh Lo•·c wllbmr • •

The p3tknt d~ not bdie,·e 111 his crls1cnce or the exls1encc of earthly m~ll m. -~\ ii Commonly seen in dep~sslon L \\

e~ ~

-~ ~...,... l,.v ~

Dtlusion of Mis1dtntification

•

~

r-- :,\'~

Copgral' ,s a rart syndrome in which 1he patient believ es that a friend, parcn~ spouse or any family member has been replaced by an idcnt,cal looking impostor.

Jf£U6f;,/,alitJi. ✓.:; Eroto m1ni1

Frtgo/1SyndrorM •

F"fo m sy,,drorn~O is a disorder in which a person holds a dehuional belief that dl1feren1 people are In fact a single person who changes his or her appearance or is In disgu ise.

lT

Ms V, a 23•year-old woman was brought by the pol,ce alt!I being arrested for uespassing on Mr J's house . Ms V stated that she was simply entering her husband's home and was adamantly declarlng that Mr J was her husband. She described that it was a love marriage and also gave detai ls about tio-they met and how the marriage happened . On inveSligation. it was found that Mr J was her boss, a few years ago. tie had fired her because of her inappropriate romantic advances.~ V was unmarried and was staying in Chennai then. She denied these allexations, staring th~t peop le around her were plo!Mi against and cheating her. She was also in a false belief that sill may get killed by some unknown persons. Ms Vwas diagnol'O with delusional disorder, erotomanic type and persecution ai,d was started on risperidone. Othello syndrome A 29-yeu-male patient, Mr K was forcefully brou&ht by his siblings, with complaints of Insomnia and persis ' "',ifOIi tent aruie, . further quutlonlng, he said that his wile was havin& an a a, with his neigh bor, which was very dlstres.slng to him and du~ which ht used to rema in anxious the whole day. TheY clan to him that she was not havln11 an affair with their nei&hbO'· Despite eiq,lllnln&, his belief was persistent. He was st,irted Ofl \ Tab. Rlsperldont.

http://t.me/dr_pedagogy

r

---- ------------

,,,---

I

1,;011

lli,eltl 1100 • t!l1'pel0~

,i

Vi&oal halluO Nlllon

pcrup uon° without nny exter,ra/ ob•1crr or I5 false

d .,.,,,iO.•o.sa"""'' and in cond.ihons, like high fev•r • , rug

. 1 ~,··

c,d' ;o 1 and drug withdrawal. · • ,1t:.1Uo--" -

I ~10".

--::::::::;;;;;;::::;;;;:=,:;;;r;;;;;.__=- -,

/'"'L 'I" C>~O ;t-

1/16

~,o.\

c!, i ) l . ~

l",...i hallucination : False percc'f>1ion of sense of sight , usually : l,,Jitorf ba))udnation: False perce ption of sound

,.;us. /Tll.ing IJl!adO,Y balludnatlon : False perce ption primarily inv~v smdforodors-

1

False perce ption involv ing taste. l>-c..U' Tlfa pdrtl~11l,1r obJ«

http://t.me/dr_pedagogy

\

Dr Pedagogy

Forensic Medicine

e ~, G ~--~ ..

~

0

DI

.~

0 u"v, J.., Q,I ...Jcj, 1-r-e., :I.,. Cl•-'L ·-o'f ,_,. '•. ,- ~ I , ,. I Jls '-".>. , .....,. 1 .... : ' ~-' ~ ",i. !), ~-.i.,. , •. \ J.. w-\. mpu set_;:,,_ ~.I. - - '"V') ~ .,.,..,... "> '•-..r): • Suddm irrrs,,tiblf forcc0 cumpdlrni a per.ion 10 ' ·rt'0 · co111ciou~ly. w11h1>11t 11wtll'r 11111/ fmrt/w 11g),r c:::::::>- G>

0 \lc J •10 fV 1• II 1M, 1.• rf" ( ' 11\• 1(1 • 1, J'/ j, l

,h•

n -. • 1ITCu " II l n ' ,:i I ' I,.,. . .. v,., /od Fa tal Ptr

• •

, 1.

' ,,

',,1 " '

w,,, ~ri 10 l l d•y I/ 'lbln l wllhh11l,ff11K 0((11,,,11111d •• 11nly1l-f, wtrk•'' Wl lh IIJIIII 1loprlvnrl1,n 11( r,,,,cl (., •

,, .

Postmort•rn Ap p,a ran\ c,d-.. 1,,.,J.... .,qJP~ ~ \ cf\, €. q~11 ~.,, _ t wn nirnphy, cmp/y cl111111hr11• bro ull, Sm : rl • fica • f11111 ca: Streu frnc111ra• •

Oulll,hulJ cr: 1)1Ar enclcd

11 1..,;~"

http://t.me/dr_pedagogy

\;le., o,cl ~:~,.~ I~ l •~

•11

http://t.me/dr_pedagogy

_I_

& ■dlola

.

fypes:

symptom) • Olfac:IOfy • PaycllomoCor

• Tactile (Magnan•s

• Visual • Ouatatory

• Audltlxy

• Contract: Invalid • Marriage: N ull & void ~ : lnvalld

CIVtL : : : J

l

1

• lnHnity: Nol responsible (Sec. 114 IPC ) • Involuntary dNnkenne n: N ot responsibl e (Sec . 85 IPC ) • Voluntary dNnkenne ss : Refip onslble ( Sec. 86 IPC)

1

C RIM INAL

1

RESPONS IBILITIES Of AN INSANE PERS ON

c' -- 1

(

• Calmd Clalualon: One II• died • ~delu 9iona: Belief a l being followed , cheated , 11a11 irwd o, ca,....,e,ed against • ttwi,ocna,ldnacal delu9ion: BelW al having Nrious dise• Oalu■iDn of lntldelil,tO hlllo sylldrome: Belief Iha! the ■peaJN .. unfallhful

• DalualanClf,.,__, Eve,ytt,ing refenlny u,. penoon

-e,...,... ,.:,.,_ •thelalac l..,nlslnl ovewUh lhem

per90 n bellevea they ere much ~ - - they nlllllypder,l 1s 11rm1y convinced 1t1at • person ha

• Dllmlon d glWldllur. The

• Daaiand oannl: ....,_ bm contrvlll ng-'s ltloughla

1WN

lanol ■ fac:t

•Dlaardel 'clthought ....... belief In eomelhillQwhk:11

• Stimulus llbMnt • F■IM perception

8YIIPTOI IS OF MENTAL ILLNE.SS

S omnambu lism: N ol re spons,ble Automatis m : N ot responsib le

-

• Kleptoman ia: S leaUng sman value things • Pyroman ia: Setting fire • Oniomanla : Compulsi ve buying • Dipsoman ia • M utilomania

fypes:

• No mollve or Intent

• Consciou s acts

• Sudden Irresistible force

IMPULSE

,{.lo.nu .

Claustrop hobia Fea.- of he ights: Acrophobia • Fear of dal1uiess: Nyctopho bia • Fear o f dl tt: Mysophob la0 • Fea, of w a ter: Hydropho bia

• Fear of dosed spaces:

• Fear of o pen sp a ces: Agorapho bia

fypes:

• Irrational fear of a particular situation

.,

I

''

I

-"' I

I

QI

::,

QI

::,

0

:::!.

I I

I

"'

QI

' ·--•

'• 0.. •• a, 0 0 '' Q. • Vl ' • :,

'I

••

I

QI

'

-

V,

n·

::,

rt>

-n

0

,,•• "'O "< n ::r •,• 01· •' ~.... ,• V'I •• ....