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Postmortem artefcts

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Postmortem artefcts

  1. 1. Dr Sujeet Kumar Samadder RMO 1st year
  2. 2. POINTS TO BE COVERED  Literature regarding “ARTEFACT”  Definition  Classification  Description  Medico-legal Importance  Take home message
  3. 3.  British variant of ‘artifact’.  First used in 1821.  Origin – Latin.  Meaning by dissection of word ‘artefact’-  ‘arte’ – skill  ‘fact’ from ‘factum’ from ‘facere’ – something made. Cont.
  4. 4.  2 meanings:  A simple object created by humans, from a particular period in past for any practical purpose which have cultural or historical interest, so usually used by historians. (a favorite word among them)  A product of artificial characters, usually due to extraneous agency. or Something observed or evident that is not naturally present but occurs as a result of outside source or procedure. (a non-favorite word among doctors)
  5. 5. Definition  Artefacts means anything which is not real but something artificial.  It is a change or feature which was not physiologically or even pathologically present in the body tissues before death in natural course of events, but which have been caused or introduced into the body after death, often leading to much confusion about its nature and causative effect and often resulting in misinterpretation of medico- legally significant findings.
  6. 6. Classification  Four types 1. Due to resuscitative or therapeutic measures 2. Between death and autopsy 3. Due to injuries or lesions of organs before death 4. During post-mortem examination
  7. 7. Due to resuscitative or therapeutic measures 1. From the very outset, I want to state that HISTORY OF PATIENT is of utmost importance in every branch of medical science, either clinical or non-clinical, so is applied to Forensic Medicine. 2. Marks of injection & defibrillator on chest 3. CPR – fracture of ribs & sternum a) Can cause haemothorax & haemopneumothorax b) Fat embolism from fractured ribs or sternum c) Laceration of spleen, liver and diaphragm 4. Positive pressure ventilation – emphysema, sub-pleural air blebs, tension pneumothorax. Cont.
  8. 8. DEFIBRILATOR MARKS SIMULATING ANTEMORTEM ABRASION OVER CHEST
  9. 9. 5. Counter irritation Chinese style on neck – extravasation of blood under skin – suspicion of throttling. 6. Endo-tracheal intubation – inexperienced hands – injury to larynx and adjacent tissue – suspicion of foul play. 7. Carotid Angiography – neck muscle bruise – suspicion of throttling. 8. Antemortem surgeon’s intervention on wounds may mislead autopsy findings.
  10. 10. Between death and autopsy 1. Agonal artefact – ‘agonal’ the struggle that precedes death. a. Common agonal artefact is REGURGITATION & ASPIRATION b. Vascular collapse or shock before death May prevent any significant bleeding Crux: Accidental Deaths Can Also Have Congested Viscera. Ante mortem Agonal Reaction Post mortem Agonal Artefact Stomach contents aspirated and goes to lower respiratory tract mixed with fluid and mucus choking effect death Never reaches to lower respiratory tract.
  11. 11. • Embalming : chemical treatment of dead body to protect from decay. • Trochar insertion for arterial access from • Existing wound – may change size shape direction , can create false tracks • Freshly created wound – may simulate stab or gunshot wound 2. Embalming Artefact:
  12. 12. TROCHAR INSERTION FROM NECK AND ABDOMEN
  13. 13. • Embalming fluid may extravasate blood from veins & arteries, may mistaken as bruise; Or small bruise large bruise • Embalming fluid interferes in toxicological analysis.
  14. 14. 3. Internment & Exhumation Artefacts Fungus on injuries & natural orifices Area underlying simulate bruise Digging may produce fracture of bones
  15. 15. Exhumed body
  16. 16. 4. Artefacts due to handling of cadavers • From transportation • Abrasion, laceration, blood spots on clothes and body which was absent in original. • From careless handling • Bruise in occipital area due to head bumping on hard surface, differentiated by wiping off the bruise. • Fracture ribs and vertebras. • Weak, osteoporotic bones may get fractured due to counteract the Rigor Mortis. • Brush abrasions on back by dragging.
  17. 17.  Abrasion  Laceration Antemortem Postmortem Looks brownish or reddish Brown or parchment like Scab is noticed if gets older Scab is never noticed Bleeding surface present if fresh No bleeding surface is evident Healing is evident No such thing can ever happen Can be found on any part of body Usually on bony prominences Surface is moist Surface is dry Antemortem Postmortem Vital reactions will be seen No vital reaction will be seen Margin is bruised No bruising is seen on margin
  18. 18. Post mortem abrasion
  19. 19.  Bruise – it is essentially a vital phenomena Antemortem Postmortem Swelling Cannot be similar as antemortem Evidence of extravasation of blood Can be produced like antemortem to some extent with in 2 minutes to maximum of 2-3hrs, that to on the tissue which can be forcibly compressed against the bone. Extravasated blood will impart colouring to the affected area But disproportionate to effect of force, bruise will always be less Colour changes denote resolution of bruise Occipital postmortem bruise simulate antemortem bruise , difference is absence of vital reaction apart from microscopy. Detection of enzyme ascertain antemortem origin eg. – esterase, aminopeptidases, acid phosphatase, alkaline phosphatase
  20. 20. False simulated artificial bruise • Irritant substances can do so • Done to substantiate a false charge of assault • By plumbago zeylanica, rolsea, semicarpus anacardium • Margins contain tiny vesicles containing acrid serous fluid • Surrounding skin shows inflammatory reaction • Diagnosis is made by incision, clot cannot be wiped off
  21. 21.  Clotted blood  Postmortem blood clot is of 2 types:  Red current jelly: forms rapidly, soft, lump, slippery, uniformly dark red.  Chicken fat: forms when clotting occurs slowly, consist of 2 layers:  Reddish moist lower layer: consist of red cells, soft, lumpy.  Bright yellow upper layer: of fibrin and serum, jelly like. Antemortem Postmortem It cannot be wiped off as it fibrin. It can be wiped off easily because it does not have fibrin.
  22. 22. 5. Artefacts due to Rigor Mortis • To move the body, breaking is done, resulting in asymmetrical Rigor Mortis • May cause misinterpretation of Time Since Death. • Heat/Cold stiffening may pose as an artefact against Rigor Mortis. • How to differentiate heat/cold stiffening to Rigor Mortis:
  23. 23.  Gas stiffening may simulate Rigor Mortis, but with the following features one can easily differentiate it from Rigor Mortis:  Putrefactive changes will be seen, as it is due to inflation of tissue spaces by gases of putrefaction, which is not seen in heat or cold stiffening.  No particular order of appearance or disappearance as in Rigor Mortis  Joints are not tight, so can be moved easily.  No muscle shortening as in heat stiffening.  Stiffening will pass if gas is allowed to escape by incisions over the areas.
  24. 24. Rigor Mortis
  25. 25. Heat Stiffening
  26. 26. Gas Stiffening
  27. 27. 6. Artefacts due to hypostasis • Localised hypostasis may be mistaken as bruise • Hypostasis in dependent part of – • Heart - Resemble Myocardial Infarction. • Lung - Pneumonic or broncho-pneumonic consolidation. • Intestine – suggest corrosion or strangulation. • Stomach – looks like poisoning. • Hypostasis in nails sometime confuses with cyanosis. • Hypostasis artefact colors in – • Refrigeration – pink. • Carbon Monoxide poisoning– cherry red. • Hydrogen Cyanide poisoning – bright red. • Potassium Chromate / Bichromate – chocolate brown. • Phosphorus poisoning – dark brown.
  28. 28. Hypostasis like bruise
  29. 29. Hypostasis of lung
  30. 30. hypostasis in refrigerated body: pink colour
  31. 31. Decomposition artefacts: • It brings lots of significant changes which can be mistaken as artefact on naked eye examination. Some of the following are:
  32. 32. Sl. No. Artefact Misinterpretation Remark 1 Swollen oedematous corpulent in early stage Antemortem obesity 2 Blood stained froth from mouth and nostrils Pulmonary oedema, head injury etc History can tell about head injury or drowning 3 Postmortem blisters Antemortem blisters due to burn or scald Difference shown in other slide. 4 Post mortem bleeding from severed blood vessels Antemortem bleeding Antemortem bleeding cannot be wiped off 5 False groove over neck due to tight collar, neck tie Strangulation Close observation, history, ecchymosis if evident. 6 Separation of head sutures or burst of abdomen due to gas Trauma Close observation and history 7 Gas in heart and blood vessels Embolism Alkaline Pyrogallol gas treatment - gas will turn brown due to O2 in antemortem embolism
  33. 33. Sl. No. Artefact Misinterpretation Remark 8 Rupture of oesophagus & stomach due to gastric juices corrosive acid poisoning Absence of vital signs 9 Hypostatic discolouration of intestine strangulated or infarcted bowel History of hospitalization, histopathology. 10 Stains on face due to regurgitation chemical burns chemical analysis 11 Vaginal introitus will be loose, lax and flaccid with blood stained discharge with bluish discolouration of mucosa sexual assault History, vaginal swab, uterus examination and histopathology will bring the truth. 12 Decomposing pancreas acute pancreatitis Signs of inflamation and fat necrosis willn be seen in antemortem cases 13 Fissure or split in skin lacerated or incised wound
  34. 34. Heat cracks resemble lacerations
  35. 35. Postmortem and antemortem blisters
  36. 36. 8. Artefacts due to post mortem corrosion Gasoline exposure to skin in accidents causes soiling After drying – abrasion or thermal burn
  37. 37. 9. Artefacts associated with accidental deaths – Railway electrician on electric poles • Get electrocuted die fall on track run over by train • Accidental run over antemortem post mortem run over Identification is difficult difficult to tell about ante / post mortem
  38. 38. 10.Artefacts due to animals or insect bites – Rats & rodents – nibbled pale white – Dogs & jackals – deeper teeth impression Superficial Stab Injury – Cat bite – small & rounded – In drowned bodies – lips cheek eyelids, genitalia, tips of genitalia, finger toes, muscles of limbs Homicidal inflictions by fish, crab etc
  39. 39. Animal bite resembling stab wounds
  40. 40. Gnawing Effect
  41. 41. Postmortem vulture eating, appearing gun shot
  42. 42. – Ants, cockroaches bites in moist area (eyes, lips, axila, etc), brown parchmentised area antemortem abrasion – Maggots – in antemortem injuries changes stab or gun-shot wounds
  43. 43. Ant Bite
  44. 44. Gun shot appearing wound, made by maggots
  45. 45. 11. Toxicological artefacts : Erroneous results of tests. • Faulty collection & faulty preservation of samples • Blood sampling for alcohol estimation – from peripheral veins • Preservative used is NaF (Sodium Fluoride). • Introduction of contaminants in body fluid may lead to erroneous results of tests. • Decomposed and embalmed bodies can have ethanol & methanol respectively.
  46. 46. • Blood came out from torn or cut vessels • Post mortem clot can be wiped off • Ante mortem clot cannot be wiped off 12. Artefacts due to post mortem bleeding
  47. 47. Due to lesions of organs before death 1. Artefacts in respect to gun-shot wounds • Surgical/Medical tending – cleaning debridement etc, removes gun powder, and changes the all over character, as in J F Kennedy murder case • Decomposition causes peeling of epidermis, disintegration of tissue • Trochar insertion in embalming – track distortion, false track, detection of direction of fire may become difficult
  48. 48. 2. X-ray Artefact • In a dead body x-ray for gun-shot bullet, false missile shadow can be found due to, bullet in shirt pocket, bullet not fired, bullet between shirt fold etc. 3. Artefacts induced by criminals • Dismemberment of body part, mutilation • Post mortem injuries
  49. 49. Artefacts during Post Mortem Examination 1. Injury to visceral organs – ante mortem injuries 2. Fracture of skull bones, may continue with antemortem fracture, misinterpretation of whole fracture 3. Hyoid and thyroid fracture during forceful extraction the heart and lungs 4. Bleeding in neck; anti/post mortem ? Can be told only after enzyme study. So, take out heart, lung, brain before neck.4
  50. 50. Medico Legal Importance Wrong conclusion as to • Cause of death • Mode of death • Nature of death • Antemortem or Postmortem Unjustified suspicion of foul play Misguided direction to investigating officer Miscarriage of justice
  51. 51. Take home message ARTEFACT MAY LEAD IMPRISONMENT OF INNOCENT AND FREEDOM OF THE GUILTY.
  52. 52. THANK YOU

Editor's Notes

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