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Definiie
Hipoxemia
Scaderea ppO2 sanguin sub 60 mmHg SAU
Scaderea saturatiei in oxigen sub 90%
Ischemie/Hipoxemie
Hipoxie
Neviolente
Boala membranelor hialine
Neviolente
Cantitative: anemie feripriva, megaloblastica
Calitative: drepanocitoza, talasemii
Clasificarea deceselor prin mecanism
asfixic citotoxic
Violente
Intoxicatii (alterarerea
enzimelor lantului
respirator)
Hipotermie (scaderea
met bazal)
Neviolente
ICC
hipoproteinemie
390
Tablou morfologic
Color Atlas of Forensic Medicine and Pathology
0
macroscopic extern
Color Atlas of Forensic Medicine and Pathology
Petesii
- Hemoragii punctiforme determinate de
rupturi vasculare (de ob venule
postcapilare)
- Semn nespecific de stare hipoanoxica
- Clasic in asfixii descrise la nivel scleral si
conjunctival
- Pot sa apara postmortem in ariile declive
Lividitati intens, violaceu albastrui
Petechiael hemorrhages at theofsurface of the heart Strangulation.
Strangulation. Petechiaelwithin
hemorrhages within the
echiael
ociated Petesii: sclerale, conjunctivale, in mucoasa sinusului sfenoid, epicardice, in mucoasa laringotraheala
hemorrhages
associated
at the surface
with asphyxia
with asphyxia due to chest
the heart
due compression.
to chest compression. mucosa of the
Petechiael hemorrhages
mucosa of and
tracheal the laryngeal
tracheal cartilage.
the
and laryngeal cartilage.
Tablou morfologic
macroscopic intern
Sange necoagulabil
Congestie pulmonara+alte organe interne
Emfizem pulmonar (mai ales in obstruciile
endoluminale
Tanatochimic:
- Creste hipoxantina in UV
- Creste cantitatea de lipoproteine in lichidul alveolar
- Creste LDH (in sp V) in ser
Etapele asfixiei mecanice
faza preasfixica (de latenta): cca 1 min
Clinic: apnee, agitatie , frica, sete de aer, cianoz
faza convulsiva: 1-2 min
Clinic: pierderea constientei, convulsii generalizate,
dispnee inspiratorie (sete de aer), horcait, tahicardie,
HTA, descarcari catecolaminice
faza asfixica (cca 4 min)
Clinic: decompensare, reducerea functiilor vitale,
bradicardie, moarte clinica
faza finala
Clinic: stop cardiorespirator
Tablou morfologic
Brain swelling and cerebral oedema are the common reac-
tions of the brain to injury of whatever aetiology. A con-
sequence of this is the formation of various intracranial
Histologically, congestion of intracerebral vessels with
perivascular haemorrhages (Figure 9.1) may be seen
Diffuse brain
Whist these may be seen in conditions such as suffocation
microscopic
herniations. or overlying in an infant, as well as asphyxial deaths in
If these are severe the non-perfused (respirator) brain, adults, they should not be taken as diagnostic for these
or cellular oedema
where there is cessation of cerebral perfusion, may be the conditions (see also Chapter 11, p. 1301).
final outcome.
Metode:
cu mana, direct
manual, indirect, prin aplicarea unor obiecte moi (perna, fular)
introducerea capului intr-un mediu moale (nisip) sau lichid (apa)
acoperirea fetei cu un cearsaf/carpa umeda
fixarea de benzi adezive de orificiile respiratorii
introducerea capului intr-o punga de plastic urmata de etanseizarea
acesteia (cea mai frecventa metoda in SUA)
SUDI apasarea accidenala a fetei sugarului cu bratul sau sanul mamei
This individual was
Sufocarea
abducted, bound, and
had multiple superficial
stab wounds associated
with a sexual assault.
Her head was wrapped
in multiple layers of
plastic that covered her
mouth and nose.
Morfologic
Sinucidere victima a luat o
- tablou clinic sarac supradoza medicamentoasa
dupa care si-a infasurat
- Urme degete in jurul punga peste cap
nasului/gurii Jos omucidere prin
aplicarea de benzi adezive la
nivelul orificiilor bucal si
- Echimoze/plagi in nazal)
vestibulul bucal
This individual committed suicide by taking multiple
pills and tying a plastic bag tightly over her head. It is
- Leziuni de aparare
Spanzurarea
Definitie: comprimarea gatului - Atipica (nodul in orice alta
cu un lat actionat de greutatea zona)
corpului persoanei spanzurate
- Functie de pozitia corpului:
Juridic: sinucidere (de regula); - Completa corpul atarna
mai rar accidental, omucidere, complet
pedeapsa capitala - Incompleta corpul are cel
putin 1 punct de sprijin
Clasificare medico-legala
- Functie de circulara
- functie de mobilitatea nodului - Completa (doar in spanzurari
- Cu nod fix complete)
- Cu nod culisant - Incompleta (in sp complete sau
incomplete)
- Functie de pozitia nodului
- Tipica (nodul la ceafa)
Spanzurarea
Mecanisme tanatogeneratoare carotic poate duce la deces
Compresiune pe carotida chiar daca forta este mica
intrerupe fluxul sanguin catre fracturi cervicale in
creier anoxie cerebrala in executii, cu dilacerarea MS,
minute BR sau a jonctiunii bulbo-
poate fi luata in discutie ca medulare
element izolat in cazul in care
forta aplicata este mica
compresiune pe CRS
insuficienta respiratorie
acuta
necesita o forta ceva mai mare
mecanism reflex
comprimarea bulbului
Spanzurare examen
clinic
Santul de spanzurare
- 1/3 superioara a gatului (intre cartilajul tiroid si mandibula)
- Traiect oblic, ascendent spre nod
- Adancime maxima in zona nodului
- Poate pastra patternul latului de spanzurare
- Asociaza:
- Banda excoriata inferior (prin frecarea santului de tegument)
- Dunga echimotica superior (rupturi microvasc la interfata sant-tesut
normal)
- Linie argintie sub sant (comprimarea tesutului adipos subcutanat)
- Daca lipseste mec mai probabil reflex vagal
- Tesutul subcutanat sau muscular infiltrate hematice
The rope pattern on this neck is very distinct
e rope. The pattern on the neck is wider than
e the folds of skin partially surrounded the
- Hemoragii la nivelul anului -> apar cnd laul face mai multe circulare,
ntre care prinde pliuri cutanate
Internal findings
1. Fractures of the larynx and hyoid bone: numero
have been carried out on the frequency of these
with highly diverse results and inadequate com
(Brinkmann 2004). Firstly, the discrepancies are d
predominantly retrospective, and rarely prospecti
of the examinations. Secondly, the dissection te
were not consistent. Occasionally, fine dissection
formed after the autopsy. In some cases, distinct
made between complete and incomplete hangin
in others.
It is an undisputed fact that thorough disse
identify fractures to the superior cornua of th
cartilage in up to 55% of cases. By contrast, th
Figure 21.14 Extravasation in the skin ridge between two majora of the hyoid bone are only fractured in a m
ligature marks (incomplete hanging with an electric cable).
Hemoragii la nivelul anului. Se observ trei of 42%. The thyroid cartilage laminae and cricoid
circulare de cordon
Strangularea
Definitie: comprimarea gatului printr-un cordon tras pe o
directie orizontala sau relativ orizontala (sau perpendiculara pe
axul lung al organismului), ce formeaza o circulara in jurul
gatului
Morfologie:
Manual strangulation
Definition
Manual strangulation is a fatal com
by applying direct pressure of the h
Morfologic:
Urme de degete la gtul victimei
Fracturi ale hioidului (coarne mari) i ale scheletului
cartilaginos al laringelui
Sus sugrumare, mici zone
semilunare coresp ungiilor
Jos excoriaii liniare,
sugestive pentru sugrumare cu
reacie de autoaprare a
victimei
St sus infiltrate hemoragice m cervicali
anteriori; st jos fractur cartilaje laringe
Dr fractur corn mare hioid
Asfixia mecanic prin obstrucie
endoluminal cu corpi strini
ATENIE!!! MOARTE VIOLENT, CHIAR DAC
PACIENTUL A FOST RESUSCITAT I A DECEDAT
ULTERIOR PRIN COMPLICAII
Forme:
Obstrucie cu un coninut extrinsec (bol alimentar, clu)
obstrucia este de regul la nivel laringean sau faringean
ingerior
Obstrucia este complet
Dac obstrucia este cu bol alimentar coresponden cu
coninutul gastric
General snge necoagulabil i hiperemie acut a organelor
interne
Aspirarea de materiale biologice intrinseci (snge,
coninut gastric)
Este obligatorie interesarea bronhiolelor mici/alveolelor
n caz contrar fenomen agonal/postmortem
Differentiation between suicide, homicide,
accident and natural death
Suicide In principle, a bolus mechanism as a method of
suicide would appear to be possible. Forster and Schulz (1964)
documented a case of self-inflicted gagging by a schizophrenic
subject, which evidently triggered a bolus mechanism.
Definition
Asphyxiation due to obstruction of the trachea and/or bronchia
ure 21.27 Bolus death, showing compressed chyme with a is caused by aspiration of material originating in the body or a Figure
ce of meat in the larynx and in the lowest section of the Figure 21.28
foreign body.Foreign
Not only asbody aspiration
the cause due tois obstruction
of death, aspiration also of the
trachea of an infantas aby
vitalasign.
peanut. fractu
Obstrucia laringelui cu
rynx.
Aspirarea unei alune (copil), identificat imediat
of great relevance
aspira
bol alimentar (carne
homorphology superior
Forms de bifurcaia traheei pulmo
Aspiration of material originating in the body A particularly lung.
ernal findings Petechiae only occur very rarely in the con-
ctivae or not at all. significant role is played by the aspiration of chyme and blood.
Only in cases where at least the small bronchi on both sides are
rnal findings obstructed by the aspirate up to the periphery is the evaluation
of aspiration of chyme or blood as the cause of death justified.
Site of the bolus: this is located in the larynx and/or in the
Some of these cases are accompanied by the development of
is a re
lowest section of the pharynx (Fig. 21.27). The laryngeal
inlet is usually completely obstructed. Bolus death is evi- areas of chyme and blood aspiration. An acute pulmonary Sudde
denced by the presence of the foreign body. It should be emphysema may frequently be observed. If aspirated material
noted that the bolus material may have been removed is only found in the trachea and the primary bronchia, and this varicea
as a result of resuscitation measures or shifted during section of the airways is not completely obstructed, death by sis, ul
intubation. asphyxiation may not be assumed. These findings may be inter-
Stomach contents: in approximately two-thirds of cases, preted as agonal aspiration with another underlying cause of Howev
Aspirarea de snge secundar unei fracturi craniene. Se observ snge la nivelul
bronhiilor principale dar i pe suprafaa de seciune i subpleural, asociat cu
Figure 21.30 Aspiration of blood following a craniofacial
aspecte de emfizem acut al unui plmn anemic
fracture. Blood is present in the right primary bronchus; blood
Aspirare de coninut gastric la un heroinoman (arii verzui maronii, evidente dup
compresia
Figure 21.29plmnului)
Chyme aspiration areas in the case of heroin
Culoarea este dat de digestia parial a parenchimului pulmonar de coninutul acid
intoxication.
gastric The
(sindromul areas exhibit greenish-brown discoloration.
Mendelson)
Inecarea
Definitie: asfixie mecanica determinata de inlocuirea coloanei de
aer din CR cu o coloana de lichide
Etape fiziopatologice:
!
g. 15.17 (a) Foam at the mouth and nostrils in a case of death by drowning. (b) Aspiration of chyme particles
e St ciuperca
upper inecatului
half of the spum
trachea and extrem content
watery/foamy de fin,innecesit dg dig cu spuma din EPA/boli
the airways
cardiace, etc situaie n care bulele sunt mult mai mari (vezi dr jos)
Dr sus fragment pulmonar pe care se exteriorizeaza o spuma albicioasa (sursa pentru
able 15.5 The
ciuperca inecatului Freshwater Saltwater Near drowning
athophysiological
Dr jos seciune la nivelulHypotonic
ATB cu spum rozat, cu bule mari (secundar unui aspirat
Hypertonic gastric)
Adipocere is a waxy decomposition product formed from
bacterial hydrolysis and hydrogenation of fat tissue, which
occurs in bodies under water or in moist soil, in a warm
and anaerobic environment. Adipocere biochemistry has been
extensively investigated (Takatori 2001). Adipocere appear
usually after approximately 3 months postmortem, but som
case studies have shown its early formation within 34 weeks
Late decomposition is influenced by factors such as wate
temperature and bacterial content, and the victims injuries
Algal colonisation gives soft tissues a green or black discolora
tion. Body colonisation by marine scavengers can start befor
the onset of putrefactive changes. Later scavengers cause post
mortem artefacts, which can modify existing injuries and
mimic antemortem lesions, and quicken the course of th
bodys skeletonisation. The corpses movement in the wate
(a)
(c) limbs disarticulate first distall
enhances joint disarticulation:
due to the higher torsion forces and sinovial joints such as th
Figure areSkin
21.32
shoulder macerationbefore
disconnected of thefibrous
hands injoints
drowning
suchvictims.
as interver
The chronology
tebral of these 1993).
ones (Haglund changes depends upon different factors,
primarily the temperature of the water in which the corpse in
Site of death
submerged. Postmortem submersion times in these cases were:
(a)
The3 days (water
site of temperature
death can be close56C), (b) 6place
to the days,where
(waterthe body i
temperature 56C)aquatic
Mna
found, a remote and
de(c)spltoreas:
9 days (water
setting, temperature
or, in the 67C).
case of the cadaver
disposal ina-3
water, dry land. Awareness concerning the behav
zile
iour of human bodies in water is crucial for the assessment o
B-6 zile
the site of death.
C-9 zile
Cadaver buoyancy
15.1.3
St Diagnosing Death
corp gsit n ap cu
by Drowning
numeroase arii de descuamare i
alge verzi pe suprafa
The external finding of cyanosis of the face,
and Dr leziuni
shoulders is postmortem
occasionally produse
made after
de fauna
postmortem acvaticahowever, these are as u
intervals;
cific as goose flesh, shrinking of the pe
nipples, excretion, or biting of the tongue.
heart dilatation, the absence of postmortem
coagulation, and anemic spleen are seen at au
in the case of death by drowning. Linear subf
hemorrhage in the superficial neck and ches
251
Plmni hiperinflai
Fig. 15.10 Emphysema aquosum with(umflai
sharply overex- cu pompa,
panded lungs that overlap at the body midline
emphysema aquosum) - nec n ap dulce Aort de culoare
rou intens, datorat
hemolizei sngelui
din circulaia mare
(dg dif cu autoliza
vezi fig). Pulmonara
are un spect normal
Elasticitate sczut
Fig. 15.11 Distinct emphysema aquosuma parenchimului
with residual pulmonar n
emphysema aquosum se vede urma lsat prin
imprints following blunt pressure (arrows)
digitopresiune
hemorrhage (Paltaufs spots), foamy content in the
Peteii mari, de tip Paltauf; produse prin
microrupturi la nivelul septurilor alveolare
False positives
The main critique of the diatom method is the finding of
diatoms in non-drowned corpses. Due to the ubiquity of
diatoms, false positives can be related to antemortem penetra-
tion, postmortem penetration during submersion or contami-
nation during sample collection and preparation.
Gastroenteric absorption may, in principle, occur as a result
Figure 21.37 A diatom (Thalassiosiria baltica) on the external of ingestion of diatom-laden beverages or food such as vegeta-
surface of the pleura in a cadaver with advanced postmortem bles and shellfish. Investigations performed during the 1960s
changes (experimental conditions, SEM 2000).
on gastroenteric absorption of diatoms using animals fed with
diatom suspensions have revealed some diatoms in internal
organs. Conversely, if a corpse is submerged after death, diatoms, organs, but others studies yielded negative results. Antemortem
due to the lack of cardiac activity, will not be transported to contamination may also, in principle, be due to diatom inhala-
closed organs. SEM and TEM studies have demonstrated the tion, which may involve aerophilic species, or be a consequence
penetration of diatoms from the alveoli into the blood stream of repeated swallowing or aspiration of water by divers or
during experimental drowning (Lunetta et al. 1998). swimmers.
Diatoms are eukaryotic unicellular or colonial algae, which Postmortem diatom penetration may occur during post-
are detectable in water, air and soil. The diatoms cell wall con- mortem submersion at high hydrostatic pressure, and through
tains a high quantity of silica and comprises two interconnected antemortem wound and postmortem artefacts. Experimental
units (valves). Diatom sizes range from 2 m to over 500 m, studies suggest the possibility of contamination, related to the
but those passing from the lungs into the blood stream gener- postmortem submersion time and depth as well as during post-
ally have a size <60 m. The valve structure represents the basis mortem submersion of isolated bones. Data on humans are
for taxonomic classification. It has either a pattern of radial much scantier than for animals due to the lack of systematic
symmetry or an elongated one, which provides the first distinc- studies on bodies submersed after death where the death
tion between centric and pinnate diatoms. Quantitative analysis occurred on land.
and taxonomic comparison of diatoms in the putative drown- Quantitative data on diatoms in organs of the non-drowned
ing media and the victims organs can assist in the diagnosis are contradictory. Most studies report few diatoms in the
of drowning, in differentiating between fresh- and saltwater peripheral organs of the non-drowned and studies performed
drowning, in estimating the site of drowning and in excluding with protocols aiming to avoid postmortem contamination
sources of contamination. found no diatoms in control cases (Auer and Mttnen 1988;
Ludes et al. 1994). A study from Denmark, published in the
1980s, reported in non-drowned bodies up to 194 valves/cm3
diameter of pulmonary artery) in drown
Fig. 6 a, b Distention of stom- (Fig. 2), whereas in the control group a
ach. a Swallowed water in a
distended stomach with an air average of 1.04 was measured (Table
fluid level (arrowhead) and was confirmed histologically (Fig. 3): t
alimentary leavings swimming
close to the top (arrow). Note had a significantly lower coefficient (0.
the hypodense liver indicating group (0.97); P=0.02 (Wilcoxon-test).
fatty liver as an additional find-
ing (31 HU). b Autopsy image The posterior distance between the
of the stomach fluid content show any significant difference betwee
A mosaic pattern of hypo- and hyper
was present in 60% of the drowning ca
and MSCT (Fig. 2), but only in 10% o
Heart failure
St sus lichid n bronhiile principale
(sgei),
spots in special sequences. Further CTRcu
The studies on nivel
did this show
not hidroaeric
issue a significant (vrf
The stomach dif
are necessary. sgeat) i aspect mozaicat al pl,on
interestingly,
drowning
Otherwise we found all thecaracteristic groupsigns
typical forensic (0.47) and the showed
victims control
pentru of aspiratul hidric
30%
wet drowning in MSCT, suchintrapulmonarof drowning
as aspiration, emphysema cases showed
non-drowning anc
(zonele albicioase
aquosum, mosaic pulmonary edema, MSCT; 40% at autopsy. The size of th
=ap)stomach swallowed fluid
and distented
hiperdense
and duodenum. Additionally we increased in 60% ofand
could document the cases,
in the the size io
stomach
St jos n zonele hipodense lumentul
directly measure bronchospasm,inwater40%, in were 40%rather
the paranasal
values and 20%, denseresp
co
vascular are diametrul mai
or showed mare
sinuses and haemodilution whichIniscomparison,
rather complicated
(sgeat) dect
the
n
control
zonele
groupanshowe
hiperdense
aver
impossible at the classical autopsy. content of stoma
The pathophysiological hypo-
atrium
(vrf
in
andsgeat)
70%.
hyperperfused areas Although the
in the lung (mosaic pattern)Drwith The left heart
narrow or dilated
hiperinflaie side was
hidricspecific,increased
gastric those
cu c
pulmonary arteries is much betterdrowning
nivelvisualised
ininMSCT
hidroaeric the (one
axial
(vrfuri
case). emphys
airways,
sgeat)
The inferior
images of the MSCT than during classical autopsy.caval vein lungwasin a enlarg
victim
drowning
The bronchial-arterial coefficient as well asde-
is significantly the control cases.
highly suspiciou
creased in the drowning cases in MSCT and histology; it is of these findings