Classification of Traumatic Deaths

1. Classification ofTraumatic Deaths Mechanical Thermal Chemical Electrical

2. A sudden death occurs without any forewarning; it is unanticipated. • A traumatic death, in addition to being sudden, can also be violent, mutilating or destructive; it can be random and/or preventable or may involve many deaths. • A sudden, accidental, unexpected or traumatic death shatters the world as we know it. It is often a loss that does not make any sense. • Survivors are the ones to suffer!

3. Mechanical Trauma Divided into two categories: • SHARP FORCE INJURY • Knives, axes, swords • PRODUCE INCISED WOUNDS • INCISIONS • BLUNT FORCE INJURY • Firearm group • Low velocity vs high velocity groups • Non-firearm group- baseball bat • PRODUCE LACERATIONS

4. Mechanical trauma • Divided into two categories: • SHARP FORCE INJURY • Knives, axes, swords • PROCUDE INCISED WOUNDS (Doctors make incisions during surgery) • BLUNT FORCE INJURY • PRODUCE LACERATIONS

5. TRAUMA SURGEONS CLASSIFY TRAUMA INTO PENETRATING OR NONPENETRATING • Penetrating includes gunshot (GSW) and stab wounds. • Non-penetrating include auto collisions and falls (internal bleeding or concussion)

6. Sharp trauma death • Common cause of death by sharp trauma is Exsanguination which means that a major artery or the heart must be damaged to produce death • Exsanguination= bleeding to death

7. Blunt trauma death • Most commonly when the brain has been significantly damaged by force of a hit/fall • Blunt trauma can lacerate the heart or aorta, leading to exsanguination or other complications

8. Firearm Injury • Mostly suicidal or homicidal wounds in the USA • Gunpowder or smokeless powder (nitrocellulose) are common propellants.

9. Rifled weapons vs Smooth bored weapons • Rifles and handguns (most common) • High speed = high powered hunting rifles, military rifles or a .44 magnum • Antique weapons and shotguns are smooth bored weapons

10. Gunshot classifications • Size of bullet • Velocity of bullet • Penetrating gunshot wound has only an entrance wound • Perforating gunshot wound has an entrance and an exit wound (no bullet would be left in the body)

11. Caliber • In firearms, the caliber is the approximate diameter of the bullet used. • When the barrel diameter is given in inches, the abbreviation "cal" is used in place of "inches." • For example, a (small bore) rifle with a diameter of 0.22 inch is a .22 cal; however, the decimal point is generally dropped when spoken, making it "twenty-two caliber."

13. The abrasion ring, and a very clear muzzle imprint, are seen in this contact range gunshot wound. • Contact range= touches the surface

14. Powder tattooing is seen in this intermediate (close) range gunshot wound. • The actual entrance site is somewhat irregular, because the bullet can tumble in flight

15. Darkness around the entrance wound is produced from the gases released as a bullet is fired. • Those gases are Carbon monoxide, nitrogen dioxide, carbon dioxide and few others.

16. Displayed here is an entrance at the left and an exit at the right. • This particular bullet struck at an angle to produce the ovoid entrance. • Exit wounds vary considerably in size and shape because the bullet can be deformed in its transit through the body. • There may be no exit wound at all if the bullet's energy is absorbed by the tissues. • Some bullets (such a "hollowpoint") are designed to deform so that all their energy will be converted to tissue damage and not exit

17. General Pathology Images • Pathology Images • The force may be strong enough to shear off axons, the ends of which retract into globoid shapes that appear with this silver stain of white matter as "retraction balls". • The forces generated by violent shaking or rotational injury (as in a passenger ejected from a moving vehicle) can produce stretching of axons in cerebral white matter. Violent Shaking Rotational injury

18. Natasha Richardson • Starred in “The Parent Trap” • Wife of Liam Neeson (TAKEN) • Traumatic Brain Injury • Not sudden • Mechanical Traumatic Death • Nonpenetrating trauma • The cause of death was "epidural hematoma due to blunt impact to the head."

19. John Travolta's Son Jett • Head trauma associated with seizure • Hit his head in the bathtub and died. • Had Kawasaki Syndrome- collection of symptoms that stem from swollen arteries. • Mechanical Traumatic Death

20. Heath Ledger • The Dark Knight (The Joker) • Brokeback Mountain • ChemicalTraumatic Death • Ruled accidental not suicidal (insurance??) • $10 million policy to Matilda Rose (daughter) • TMZ on the Insurance Policy

21. Other Blunt Force Injury • Most common blunt force injury in our society are from transportation collisions. (planes, train, buses, automobiles) • Gunshot trauma most common for adults and lethal head injury. • Children- lethal battery is most commonly due to head injury…then chest and abdominal trauma

22. Two terms to know: • CONTUSION: an accumulation of blood in the tissues outside the blood vessels • HEMATOMA: A more severe contusion • A contusion with MORE blood • a blood tumor • Hema- Latin for blood • Toma- Latin for tumor Characteristically, blunt impact of the head will produce a hematoma, referred to as a “goose egg” Ms. Keen had a extracranial hematoma. A blood tumor outside the skull. Between the dura mater and the inner table of the skull.

23. Extracranial Hematoma

24. Lobes of the Brain

25. Injury to Parietal Lobe An injury to this part of the brain can lead to reading and object-recognition problems, inability to focus visual attention or to attend to more than one object at a time, dizziness, trouble with math, forgetfulness, loss of awareness of one’s own body parts, concentration difficulty, word recognition and even an inability to tell left from right.

26. Hematoma

27. CONTUSION:

28. Chemical Trauma • Drug overdose • Poison deaths • 50% of all chemical deaths come from ethanol (depressant) DRINKING ALCOHOL • Ethanol is the drug with the longest history of abuse • Depressants cause more deaths than stimulants (cocaine) • Marijuana has never caused an overdose death. (it has caused many driver accidents, domestic disputes and work related issues)

29. Chemical Trauma • CARBON MONOXIDE POISONINGIt is colorless, odorless, tasteless and an explosive gas caused by the incomplete burning of fuels. • Accidental, homicidal, suicidal • CYANIDE POSIONING similar to CO poisoning in that interferences with the oxygenation of the brain • Cyanide has a distinct odor. It smells like almonds (half of population cannot smell it) It is very detectable. • A forensic pathologist can be killed by opening the stomach of a person who has ingested KCN from the release of the gases. • California used KCN tablets to drop into HCl solution in the gas chamber. • Produces a red stomach. (Sherlock Holmes)

30. Thermal Trauma • Exposure to excessive heat or cold may produce death. • HYPOTHERMIA is excessive cold. • Common in intoxicated individuals • Alcohol intoxication reduces the appreciation of the cold while increasing the loss of body heat because of dilatation of the blood vessels on the surface of the body. • HYPERTHERMIA is excessive heat. • Deaths common in elderly people in northern cities and in infants left in parked cars

31. Thermal Trauma • Thermal burns • Hot liquids • Flaming hydrocarbons • Doused with gasoline (Michael Brunner)

32. Electrical Trauma • Ventricular fibrillation- nonpropulsive quivering that leads to no resucitability within minutes • Electrocution • Electrical burns • Struck by lightening • DNR=Do Not Resuscitate (must be written in a will to allow)

33. Asphyxia • Drowning • Dry Drowning- inhalation of water • Manual strangulation- fracture of the hyoid bone • Hangings (instant rigor mortis)

34. Anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. BEES ANTS SHELLFISH PEANUTS