Forensic medicine Seminar

1. Introduction and Death
Group (1)

2. Objectives
1) Introduction and Definition of Forensic Medicine
2) Medico-legal system in Saudi Arabia
3) Definitions of medico-legal autopsies
4) Preserve and dispatch specimens in medico-legal/post-
mortem cases.
5) Cause, manner, and mechanism of death
6) Writing death certificate.
7) Definition of death & Types of death
8) Post-mortem changes & their medico-legal importance
9) Writing the medico-legal reports.

3. 1) Introduction and
Definition of Forensic
Medicine
Suliman Sultan Abuhaimad
438011639

4. Forensic Medicine
• The term Forensic Medicine is the knowledge of all
the branches of medical sciences (including
laboratory examinations applied) for the administration
of law and justice.
• Forensic medicine influenced by a wide variety of
factors including culture, religion and politics.

5. Forensic sciences
Clinical Forensic
Medicine
• Involves an
interaction
among law,
judiciary, and
police officials,
generally
involving living
persons.
Forensic
Pathology
• Determining the
cause of death
by examination
of a corpse.
Forensic
Odontology
• Helps in identify
the cause of
death.
Forensic
Toxicology
• For biological
and non-
biological
samples.
Forensic DNA
• Biology,
matching
samples like
semen or saliva.
Forensic
Chemistry
• Scientists work
in forensic
laboratories,
examine paint,
fire source etc.
Forensic
Psychiatry
• Is the criminal
psychic and
unaware of his
crime
Forensic Nursing
• Abuse and
sexual causes

6. • The Doctors, because they have the professional skills,
experience and broad knowledge of medical facts, may be
required to give evidence about a criminal act in
court.
• • May have one of two roles, either as a professional or as
an expert witness, which can sometimes overlap.
• • A professional witness: is one who gives factual
evidence equivalent to a simple witness of an event, deals
solely with the relevant medical findings.
• • An expert witness: is one who expresses an opinion
about medical facts.

7. • • There are often situations of overlap between these
professional and expert witness roles.
• For example a forensic physician may have documented
a series of injuries having been asked by the police and
then express an opinion about causation.
• A forensic pathologist will produce a report on their
post-mortem examination (professional aspect) and
then form conclusions and interpretation based upon
their findings (expert aspect).

8. Role of forensic pathologist
1. Visit crime scenes
2. Postmortem examination (external examination and
autopsy) x ray to the whole body.
3. Document injuries, time of injury and how injuries occurred.
4. Identification of the dead person.
5. Collecting evidences from the body (fingerprint, knife, hair,
semen, blood, urine ,tissue.)
6. Cause of death.
7. Time of death (postmortem changes)
8. Forensic report

9. 2) Medico-legal system in
Saudi Arabia
Turki Ibrahim Alaudah
438011308

10. Medico-legal system in Saudi Arabia
Unique medico-legal system
Derived from Islamic judiciary and based on Shari'ah law.
Applied on Saudi citizens as well as foreigners.
The forensic medicine centers in Saudi Arabia are related administratively
to Ministry Of Health (MOH) and other ministries and governments.

11. Development of forensic medicine in
Saudi Arabia
• In June 1962, the forensic medicine centers were established in affiliation with
MOH, with its head office in Riyadh, and other branches across major cities in
KSA.
• The first view was: determination, estimation, and evaluation of aggression
against health and life of a human being to the Islamic Shari'ah judiciary
about the extent and level of aggression.
• Two main sections were included in each forensic medicine center:
1. Chemical labs.
2. X-ray section.

12. Staff members of forensic medicine in
Saudi Arabia
Forensic medical examiner.
Forensic medical nurse staff.
Radiology technician.
• Requirements ??

13. The roles of forensic medical examiners
Death investigation
Clinical forensic medicine

14. Cooperation with other MOH
departments
• The forensic chemistry laboratories:
 Examination and detection of clandestine drugs and other substances of abuse held by police
authorities.
 Clinical forensic toxicology screening.
 Drug monitoring and assessment in clinical departments in the MOH hospitals.
 Processing biological materials and tissue samples received from forensic medicine centers.
• The histopathology laboratories:
 Examination and reporting clinical cases from clinical departments in MOH hospitals.
 Examination and reporting of tissue samples received rom forensic medicine departments from
medico-legal autopsies.

15. Cooperation with laboratories of
Ministry Of Interior
Assisting laboratories such as DNA fingerprinting, counterfeiting and forgery units
are all related administervely to Ministry Of Interior (MOI), represented by
Administration of Criminal Evidence (ACE), assessed by the General Directorate of
Public Security in MOI.
Case reports are exchanged with confidentiality between ACE and forensic
medicine experts in MOH, to finalize reports independently or in a shared
committee including both parties.

16. 3) Definitions of medico-
legal autopsies
Turki Ibrahim Alaudah
438011308

17. Definitions of medico-legal autopsies
A medico-legal autopsy is an autopsy performed as part of an inquest
procedure.
Medico-legal autopsies should be performed by pathologists who have had the
necessary training and experience in forensic pathology.
Medicolegal autopsies differ from hospital autopsies in that they are under
jurisdiction of a local governmental death investigation office.

18. Aim of medico-legal autopsy
• identify the body • estimate the time of
death
• identify and document
the nature and number
of injuries
• interpret the significance
and effect of the injuries
• identify the presence of
any natural disease
• interpret the significance
and effect of the natural
disease present
• identify the presence of
poisons
• interpret the effect of
any medical or surgical
treatment.

19. 4) Preserve and dispatch
specimens in medico-
legal/post-mortem cases.
Tariq Saleh Dabil
438010122

20. Types of Evidence
• Physical
• Biological
• Trace
• Verbal

21. Collection of Forensic Evidences
Blood Urine Tissues
• Histopathology
• Toxicology
• Dna

22. General Procedures of Evidence
collection
• Perssonal Protective Equipment.
• Collection Basics.

23. General Procedures of Evidence
collection
• Drying
• Labelling
• Sealing
• processing
• Storage and security
Farwarding

24. Documintation
• Physical Examination
Types of Injury
Dimensions
Site
Number in order
• Body Diagram
• Photography:
• ID of the patient.
• Photo with scale.
• Different angle shots.
• Close range shot with scale.

25. 5) Cause, Manner, and
Mechanism of Death
Abdulmalik Sultan Alawam
438020478

26. Cause of Death
• The disease or injury that intiated the train of morbid events
leading directly to death or the cirumstances of the accident
or violence that produced the injury.
• Examples:
• Blunt force trauma
• Injury from gun shot
• Myocardial infarction
• COPD
• ِExternal examination + Internal examination +
Investigations (Imaging, toxicology, and histopathology)

27. Mechanism of Death
• The mechanism of death is the
physiological derangement that
results in the death.
• The main interest are the effects
on the Heart or the Brain.
• Example:
• electrocution and the electrical
distrurbances of the heart and central
nervous system
• exsanguination (extreme blood loss)
due to a gunshot wound.

28. Manner of Death
• Manner of death is the way to categorize death as
required by law, how the cause of death came about?
• The classifications are:
• Natural: aging/illness/disease
• Accident: unintentiontional
• Suicide: self-inflicted act of harm that caused death
• Homicide: harm that led to death due to another person
intentionaly
• Undetermined: when the infromation pointing toward one
manner of death is no more compelling than any others.

29. • Being ran over by a truck may CAUSE blunt force
trauma to the torso. The MECHANISM of death could
be cardiac and pulomanry contusions with rib
fracturers. The MANNER of death could be any except
Natural.

30. 6) How to write a Death
Certificate
Abdulmalik Sultan Alawam
438020478

31. Death Certificate
The death certificate is a
permanent legal record of
the fact of death, it
provides important
personal information about
the deceased and MOST
IMPORTANTLY about the
cause of death.

32. 1)Direct cause that led to the death:
• 1a) caused by or consequence of b
• Immediate cause  final
disease/condition that cuased death
• 1b) caused by or consequence of c
• 1c) last subsection is the primiary
pathological condition in the chain of
events leading to death.
• Underlying cause that intiated the
events leading to death
• 2) describes the other conditons not
related to those listed in part one
that may have contributed to the
death.

33. Case History Example:
• A 68-year-old male was admitted to the hospital
with progressive right lower quadrant pain of 3-
week duration. The patient had lost
approximately 20 Kg, with progressive weakness
and malaise. On physical examination, the
patient had an enlarged liver span that was four
finger breadths below the right costal margin.
Rectal examination was normal, and stool was
negative for occult blood. Routine laboratory
studies were within normal limits. A chest x ray
and barium enema were negative. CT scan
showed masses within both lobes of the liver. A
needle biopsy of the liver was diagnostic of
moderately differentiated hepatocellular
carcinoma, and the patient was started on
chemotherapy. Three months after the diagnosis,
the patient developed decrease in liver function
as well as a deep venous thrombosis on his left
thigh, and he was admitted to the hospital. On
his third day, the patient developed a pulmonary
embolism and died 30 minutes later.
• 1a) pulmonary embolism
• 1b) deep venous thrombosis in left thigh
• 1c) acute hepatic failure due to hepatocellular
carcinoma
• 2) no other signifcant conditions that
contrubuted to the death

34. 7) Definition of death &
Types of death
Saleh Hassan Alorainy
438020973

35. Definition of Death
• Cessation of life in a previously living organism.
• Medically and scientifically, death is not an event, it is a
process
• in which the more complex and more specialized
internal organs have different functions with different
cellular metabolic processes which cease to function at
different rates.

36. Types of Death: (Somatic death)
• The person irreversibly loses its sentient personality,
being unconscious, unable to be aware of (or to
communicate with) its environment.
• Unable to appreciate any sensory stimuli or to initiate
any voluntary movement.
• Neural reflexes may still be present after death.

37. Types of Death: (Cellular death)
• The cells no longer function or have metabolic activity, primarily
aerobic respiration.
• Anoxia Ischemia Autolysis Decay.
• The differences in cellular metabolism determine the rate with
which cells die and this can be very variable.
• Connective tissue can survive for many hours.
• On the other hand, cortical neurons die between 3-7 minutes
after oxygen deprivation.

39. Brain Death
• irreversible cessation of the function of the entire brain,
including the brain stem.
• Criteria for Diagnosis:
• Unresponsiveness
• Absence of cerebral and brain stem function
• Nature of coma must be known
• Rule out any other causes
• Persistence of brain dysfunction

40. Brain Death
Criteria for Diagnosis:
• Persistence of brain dysfunction:
• Six hours with a confirmatory
isoelectric EEG or electrocerebral
silence
• Twelve hours without a
confirmatory EEG
• Twenty-four hours for anoxic brain
injury without a confirmatory
isoelectric EEG

41. When to say that the patient is dead?
• The Uniform Determination of Death Act (UDDA) in
1980 established 2 criteria to determine death :
• Irreversible cessation of circulatory and respiratory functions.
• Irreversible cessation of all functions of the entire brain,
including the brain stem.

42. 8) Post-mortem changes &
their medico-legal
importance
Fahad Sulaiman Alhussainan
438021124

43. Medico-legal importance of PM changes
• To know the normal progression of decomposition and
not misunderstand those normal changes for un-natural
causes
• Ability to estimate for how long has the individual been
dead

44. Post-mortem changes
Late
changes
Rapid/Early
changes

45. Rapid/Early PM changes
• Initially, these changes can only be detected biochemically
due to alteration of metabolism in cells to autolytic pathways
• Immediate fall in BP  Pale skin, conjunctivae and mucous
membranes
• Oxygen supply to the cells ceases
• Loss of neuronal activity  Absent reflexes and breathing

46. Rapid/Early PM changes
• Eye changes
• Corneal reflex ceases
• Pupils stop reacting to light
• Break-up or fragmentation of retinal vessels
• Rapid flaccidity of muscles (primary flaccidity) and
mostly with complete loss of tone
• Regurgitation of gastric contents
• Voiding of urine
• Emission of semen

47. Late PM
changes
Cooling of the body
Hypostasis (lividity)
Rigor mortis
Putrefaction/Decomposition

48. Cooling of the body after death
• Many variables and factors also
affect the rate of cooling of a
body
• Temperature will fall gradually but not evenly, because each
body will lie in its own unique environment. Therefore, will cool
at a different speed

49. Cooling of the body after death
• A body tempressure can be used as an indicator of time
of death under three assumptions
• Body temperature was 37°C at the time of death
• One (or few) PM body temperature readings for a reliable
estimation
• That the body has lain in a thermally static environment
• Hence why the forensic pathologists don’t determine
the time of death based only on body temperature

50. PM hypostasis (lividity)
• Cessation of the circulation and the relaxation of the muscular
tone of the vascular bed allow simple fluid movement to occur
within the blood vessels
• With this movement, red blood cells will settle due to gravity in
blood vessels in the lowest areas of the body
• This process leads to the formation of a pink or bluish color to
these lowest areas, usually 4 hours after death
• Compression of skin in contact with a firm surface, prevents such
distension to BVs and results in areas of pallor

52. PM hypostasis (lividity)
• Cases where hypostasis may not be found or masked
• Clinically anemic individuals
• Those who have died from severe blood loss
• Dark skin colors
• Jaundice
• Dermatological conditions
• Color of hypostasis is variable and may indicate certain causes of
death
• Cherry-pink color  Carbon monoxide poisoning
• Dark red  Cyanide poisoning and C. perfringens infection
• Blue  Hypoxic conditions

53. PM hypostasis (lividity)
• Hypostasis can aid in determinig
• Cause of death
• Time of death
• Whether the body was moved or not

54. Rigor mortis
• It is a temperature-dependent physicochemical change that
occurs within muscle cells as a result of lack of oxygen
• Lack of oxygen will lead to diminished ATP production and
high acidity due to lactic acid formation, ultimately causing
the actin and myosin fibers to bind resulting in muscle
stiffness
• It is first detectable in the smaller muscle groups (around
the eyes and mouth, the jaw and the fingers), then advance
down the body from the head to the legs affecting larger
muscle groups

55. Rigor mortis
• It is temperature-dependent in that “the colder the environment the slower
the reactions and vice versa”
• When the post-mortem cooling of a body is extreme, the stiffening of may
result from the physical effects of cooling or freezing rather than rigor
• Rigor mortis can aid in determining the time of death
• Facial involvement  Approximately 1-4 hours
• Limbs involvement  approximately 3-6 hours and reach maximum within 18 hours
• Rigor will remain for up to approximately 50 hours after then muscles
become flaccid again

56. Putrefaction/Decomposition
• As post-mortem interval increase body
undergo more changes affecting tissues
and causing breakdown
• Appearance of early changes of
decomposition may confuse the police or
members of the public with the signs of
violence or trauma
• It results in liquefaction of the soft tissues
over a period of time

57. Putrefaction/Decomposition
• Similar to rigor mortis, temperature also affect the
process of decomposition
• the warmer, the earlier the process starts and progresses
• Usually, first visible to the naked eye at about 3–4
days as an area of green discoloration of the right iliac
fossa
• Early bacterial passage through superficial BVs leads
to decomposition of hemoglobin and causing a linear
branching patterns of discoloration “marbling“
• Also, can aid in determining the time of death

59. 9) Writing the medico-
legal reports.
Moath Abdullah Alkeaid
438009612

60. What is the medicolegal report?
• It is documents that are prepared by a medicolegal
practitoner on the request of legal authorities (police or
investigating agencies) in criminal cases, poisoning or
unexplained death.
• The reports contain all data related to the examined
case in the form of:
1. Facts observed on examination (subject)
2. Opinion drawen from the facts (conclusion)

61. How to write a medicolegal report
• It consist of three parts:
1. introduction (preamble)
2. Body (subject)
3. Results (conclusion)

62. Introduction:
• Name, job and address of both medicolegal
practitiones who writes the report and the authority
ordering the examination
• The number of sign, type, date and time
• A summary about the case must be mentioned

63. The body (subject):
• Police report (including death circumstance)
• Report of crime scene
• External examination (‫الظاهري‬ ‫)الكشف‬
• Internal examination (‫)التشريح‬
• Further investigation including (including x-ray,
toxicology, histopathology, urin sample and blood work)

64. Conclusion (results)
• This part contains:
• Discussion (opinon) cause of death (‫الشرعي‬ ‫الطبيب‬ ‫)رأي‬
• Name and signature of the examiner

65. Refrences
• SIMPSON’S FORENSIC MEDICINE
• KNIGHT’S Forensic Pathology
• Uniform Determination of Death Act.Available at:
http://www.law.upenn.edu/
• Al Madani OM, Kharoshah MA, Zaki MK, Galeb SS, Al
Moghannam SA, Moulana AA. Origin and development of
forensic medicine in the Kingdom of Saudi Arabia. Am J
Forensic Med Pathol. 2012 Jun;33(2):147-51. doi:
10.1097/PAF.0b013e318221b895. PMID: 21725228.
• https://www.crimemuseum.org/crime-library/forensic-
investigation/cause-mechanism-and-manner-of-death/

66. Questions?

67. Thank You!