1. Subsection C1

2.  1. Resuscitative artifacts  2. Autolysis / decomposition  3. Rough Handling During Exhumation  4. Transport and Autopsy  5. Body Changes Secondary to Exposure to Natural Elements, Animals / Insects

4.  injuries observed on the patient’s body during the initial scene investigation.  includes any and all resuscitative efforts by trained and untrained personnel, which may have caused injury to the body.  “IATROGENIC COMPLICATIONS”

5. ◦ Laryngeal abrasions from traumatic intubation ◦ Skin & soft tissue lesions, rib & sternum fractures from chest decompression

6.  Surgical stab wounds for insertion of tubes & drains  Laparotomy, tracheostomy, & thoracotomy incisions  Incisions for peritoneal lavage  Cutdowns of wrists, antecubital fossa, & ankles

7.  May be misinterpreted!  Therapeutic tubing (i.e. IV lining, respiratory tubes, catheters, tracheostomies) should never be removed prior to sending a body to the coroner  Chart should be reviewed prior to autopsy  Treating physicians should be consulted

8.  Physicians, Fire Personnel, and Law Enforcement ◦ resuscitative treatments often cause external or internal injuries to patients – documentation necessary ◦ resuscitative artifacts and any associated equipment visible on the body should be documented in the investigative report and photographed.  agency and contact name and number of the individual who attempted resuscitation should also be documented in the report for follow-up as necessary.

9.  Relatives, Neighbors, Good Samaritans the investigator needs to document resuscitative efforts by photographing any artifacts or injury visible on the patient. include the name and contact information of the individual who attempted resuscitation and their relationship to the patient.

11. Trauma Any visible trauma to the patient should be documented by the investigator and photographed for the pre-autopsy report to the pathologist. Poisoning or Intoxication Any suspected blockage of the patient’s respiratory tract from poisoning or intoxication should be investigated, collected, documented, and reported to the pathologist before autopsy. Any suspected poison or toxicant, including medication bottles with pills, cleaning agent bottles should be collected.

14.  AUTOLYSIS ◦ the breakdown of cells and organs through an aseptic chemical process caused by intracellular changes  PUTREFACTION ◦ post- mortem destruction of soft tissues of body due to action of bacteria & endogenous enzymes

15. Autolysis Putrefaction Black putrefaction Butyric fermentation Skeletonization/Dry decay

16.  first few days after death  no physical signs of decomposition yet, but homeostasis has stopped  cellular and soft tissue changes  body enters algor mortis  reduction in body temperature following death

17.  When the body’s cells reach the final stage of autolysis, an anaerobic environment is created allowing the body’s normal bacteria to break down the remaining carbohydrates, proteins, and lipids. The products from the breakdown create acids, gases, and other products which cause volatile organic compounds and putrefactive effects.

18.  Odor, color changes, and bloating of the body.  BACTERIA’S ROLE ◦ Activity in the cecum turn the lower part of the abdomen green ◦ break down hemoglobin into sulfhemoglobin which causes the green color change. ◦ enter the venous system causing blood to hemolyze (formation of red streaks in the vein)  formation of gases ◦ enters the abdomen which forces liquids and feces out of the body ◦ enter the neck and face, causing swelling of the mouth, lips, and tongue.

19.  skin also fragile, leading to skin slippage, making it difficult to move a body. Body hair comes off easily.  discoloration from green to brown  transition of the early stage of putrefaction to the advanced decompositional stages.

20.  the body cavity ruptures, the abdominal gases escape and the body darkens from its greenish color. ◦ These activities allow for a greater invasion of scavengers, and insect activity increases greatly.  ends as the bones become apparent, which can take anywhere from 10 to 20 days after death depending on region and temperature.  dependent on the degree to which the body is exposed.

21.  body begins to dry out  human carcass is first mummified, and then goes through adipocere formation ◦ Adipocere (grave wax) formation  loss of body odor and the formation of a cheesy appearance on the cadaver. ◦ Mummification  post-active stage because there is less definite distinction between changes and they are indicated by reduced skin, cartilage, and bone. It is also indicated when all of the internal organs are lost due to insect activity.

22.  Occurs when the last of the soft-tissue has been removed from the body  more highly dependent on soil type and pH, along with presence of groundwater.

23.  Greenish discoloration of the lower quadrants of the abdomen  Greenish discoloration of the head, neck, & shoulders  Swelling of the face due to bacterial gas formation; “marbling”  Bloating  Purge fluid

24.  Hemolysed blood leaks out into the tissues  Tissues and organs soften and degenerate into a mass of unrecognizable tissue  Adipocere ◦ firm greyish-white to brown wax-like material composed of oleic, palmitic and stearic acids

25. ROUGH HANDLING DURING EXHUMATION

26.  The uncovering or exposure through erosion of a former surface, landscape, or feature that had been buried by subsequent deposition.  authorized digging out the coffin of a dead person from his grave, in order to establish his cause of death, or to decide upon some other relevant fact

27.  Becomes necessary when; ◦ At the time of death, there were no suspicions and the body was buried without a post-mortem. Later on fresh facts may come to light, showing some foul play. ◦ when the first post-mortem was inadequate.

28.  Identification  Determine cause of death  Recovery of foreign bodies (e.g. bullets)  Recovery of organs or tissues  Transfer to other burial sites

29.  Time: usually done in broad daylight  Who should be present: ◦ basic exhumation team would consist; a. diggers, b. pathologist c. investigating officer d. photographer (serve in documentation) e. transport coordinator.  Identification of the grave: with help of the relatives and officer in charge of the graveyard

30.  If there are too many curious spectators, the area should be screened off.  Professional diggers are then requested to remove soil from the grave  When the coffin becomes visible, strong ropes are passed beneath the coffin, and it is lifted up

31.  Soil from above, below, and from all four sides of the coffin should be collected and preserved in separate glass jars, with identification tags.  In addition, at least two samples must be taken from some distance (25 to 30 yards) from the grave. This is very necessary in some poisoning cases.

32.  It is customary to open the lid of the coffin once it is brought out of the grave.  Allows foul gases to escape in open air (rather than be released in the mortuary later)  Enables the pathologist to make a quick examination of the remains

33.  Care must be taken in handling exhumed bodies  Fractures or mechanical trauma due to rough handling during the process of exhumation may be mistaken for pre-mortem injuries

34.  Examination in-situ is important to determine later on if changes were caused by exhumation or not. (quick examination of the body to identify the cadaver, taking photographs for documentation)

35. TRANSPORT AND AUTOPSY

36.  Means “see for yourself”  also known as a post-mortem examination, obduction, autopsia cadaverum  A special surgical operation on a dead body performed by specially-trained physicians called the forensic pathologists or other persons authorized by law.

37.  Determine or confirm the cause of death  Improve the diagnosis of specific disease  Advance medical and scientific knowledge  Aid in the evaluation of new techniques, procedures or medications  Aid in medical education  May absolve guilt and remove concern about possible genetic defects

38.  FORENSIC ◦ This is done for medical-legal purposes and is the one that is normally seen on television or in the news.  CLINICAL ◦ This is usually performed in hospitals to determine a cause of death for research and study purposes.  CORONER’S ◦ cases where no medical cause of death is readily available.

39.  The manner of death is classified as  Natural  Accident  Homicide  Suicide  Undetermined  Following an in-depth examination of all the evidence, a medical examiner or coroner will assign a cause of death as one of the five listed above.

40.  Body is received in a body bag or evidence sheet.  A brand new body bag is used for each body to ensure that only evidence from that body is contained within the bag.

41.  an alternate way to transport the body.  a sterile sheet that the body is covered in when it is moved.  If it is believed there may be any significant residue on the hands, for instance gunpowder, a separate paper sack is put around each hand and taped shut around the wrist.

42. 1.EXTERNAL EXAMINATION 2. INTERNAL EXAMINATION

43.  Ultraviolet light may also be used to search body surfaces for any evidence not easily visible to the naked eye.  Samples of hair, nails and the like are taken and the body may also be X-rayed.  The body is removed from the bag, undressed and any wounds present are examined.

44.  A large and deep Y-shaped incision is made from shoulder to shoulder meeting at the breastbone extending all the way down to the pubic bone and will make a slight deviation to the side to avoid the navel.  If the body is that of a woman, the incisions are made to go around the breasts so that the arms of the "Y" have a slightly curved appearance.

45.  A scalpel is utilized to remove any soft tissue that is still attached to the posterior side of the chest plate.  Now the lungs and the heart are exposed. The chest plate is set aside and will be eventually replaced at the end of the autopsy.

46.  The various organs are examined, weighed and tissue samples in the form of slices are taken.  Even major blood vessels are cut open and inspected at this stage.

47.  To examine the brain, a cut is made from behind one ear, across the forehead, to the other ear and around.  These incisions are made on the back of the head so that when the autopsy is completed, the incision can be neatly sewn up and is not noticed when the head is resting on a pillow in funeral where it is open casket

48.  The scalp is pulled away from the skull in two flaps with the front flap going over the face and the rear flap over the back of the neck.  The skull is then cut with an electric saw to create a "cap" that can be pulled off, exposing the brain. The dura remains attached to the "cap".

49.  The brain's connection to the spinal cord is severed, and the brain can then be easily lifted out of the skull for examination. If the brain needs to be preserved before being inspected, it is contained in a jar of formalin for at least two

50. BODY CHANGES SECONDARY TO EXPOSURE TO NATURAL ELEMENTS, ANIMALS/INSECTS

51.  Algor Mortis (Body Cooling)  Rigor Mortis  Livor Mortis (Hypostasis, Post Mortem Lividity, Post Mortem Suggillations)  Putrefaction (Decomposition)  Adipocere  Mummification

52.  Defined as reduction in body temperature following death.  “most useful single indicator of the time of death during the first 24 hours postmortem” by Pounder  However, use of body temperature estimations to assess time of death applies only to cool and temperate climates.

53.  Air movement accelerates cooling -cooling is more rapid in humid air (better conduction)  Immersion in water -cools more rapidly (twice as fast)  Clothing and coverings -insulate the body; slows cooling

54.  caused by a chemical change in the muscles after death, causing the limbs of the corpse to become stiff (Latin word:rigor means stiff) and difficult to move or manipulate.  When the body is found in a certain position, it cannot be assumed that the deceased necessarily died in that position.

55.  Aka post mortem lividity which means a purple discoloration of the skin resulting from the gravitational pooling of blood in the veins and the capillary beds of the dependent part of the body following cessation of circulation.

56.  Post mortem destruction of the soft tissues of the body by the action of bacteria and enzymes (both bacterial and endogenous)  Main changes: change in color, evolution of gas and liquefaction

57.  Air ◦ hasten decomposition  Moderate Moisture ◦ accelerate decomposition ◦ elaborate the growth and multiplication of bacteria  Condition of the air ◦ if contains septic bacteria--> hasten decomposition

58.  Earth ◦ Moist soil accelerates decomposition ◦ Dry soil retards decomposition  Water ◦ Decomposition faster in running and bacteria-laden water  Clothing ◦ initially hastens, later delays

59.  Temperature of the air ◦ optimum temp for is 70 F-100F ◦ Decomposition does not occur below 32F or above 212F  Light ◦ faster in the absence of light

60.  Aka saponification; modification of putrefaction characterized by the transformation of fatty tissues into a yellowish-white, greasy, (but friable when dry), wax like substance with a sweetish rancid odor.  Ordinarily, it will remain unchanged for years.

61. Causes:  hydrolysis of fat with the release of fatty acids  Putrefactive organisms, of which Clostridium welchii is most active, are important, and adipocere formation is facilitated by post mortem invasion of the tissues by endogenous bacteria  warm, moist, anaerobic environment thus favours adipocere formation  air-prolongs formation  clothes- adipocere formation is found under body clothings, especially if tight

62.  Modification of putrefaction characterised by dehydration or dessication of tissues.  Body shrivels and is converted to a leathery or parchment-like mass of skin and tendons  Skin shrinkage may produce large artefactual splits mimmicking injuries  Importance: preservation of tissues which aids in personal identification and the recognition of injuries

63.  Hastens in conditions of dry heat  usually occur in warm countries-->early evaporation of body fluid takes place earlier and faster than decomposition  New born infants more prone to mummification because of being small and sterile  dry soil-accelerates

64.  Flies  Reptiles  Rodents  Fish and crabs  Molds

65.  Common house flies ◦ LC larval-->pupal-->adult ◦ usual time the egg to be hatched into larva is 24 hrs  live fleas in the cloths of drowning cases ◦ A flea can survive for approx. 24 hrs submerged in water.