Dr. Khalid Y.

Mattar

 Ethyl Alcohol

is the most widely used drug

in the world.
It

is a small, water-soluble molecule which

can distributed easily throughout the body water and cross easily the blood brain barrier causing a depression effect on the brain function.

 Death related to alcohol generally fall into one of three categories:

Acute intoxication. Trauma while intoxication

Effect of chronic abuse

Concentrations of Some Alcoholic Drinks

Beer, lager, Cider (variable)
Table Wine Champagne Wine Spirits (brandy, gin, whisky, vodka) Liqueurs

3-5% 5-7%
9-12% 18-20%

37-42% 15-55%


1.

Effect on Central Nervous System:

Acting on neural cells in a way similar to hypoxia by reducing their activity.

In lower concentration This action is confined to the cerebral cortex, with no effect on the lower brain function.
2.

In high concentration Coursing depression of the function of the midbrain and medulla affecting the vital centers. (danger of fatal cardio-respiratory failure)
3.


1.

Effect on the Heart:

The effect is central as well as vasomotor. 2. Tachycardia in low level and bradycardia in high level.

1.

Effect on the vascular system:

Vasodilatation causing marked heat loss

1.

Effect on the Urinary system:

Diuretic effect causing electrolyte imbalance.

Stage of Excitement: Drunker in this stage is:1. 2. 3. 4. 5.

felling of well being, pleasure Converses well, laughs and smiles readily or become angry easily. May disclose secrets. Talk in vulgar language and behave in an obscene manner. Sexual desire may be aroused.

Stage of Incoordination: Drunker in this stage is:1. Incoordination of thought, speech and action

2. 3.
4. 5.

(confusion, slurred speech and staggering gait) May be untidy in his appearance and suffer from hiccups. Euphoric or irritable depending on his emotions Nausea and vomiting are common. Most offenses and crimes are committed in this stage.

Stage of Narcosis: Drunker in this stage is:1. Patient passes into deep sleep and responds

only to strong stimuli 2. Pulse is rapid, temperature subnormal and breathing stertorous. 3. If recovered from this stage, sign of hang-over

(depression, headache, gastrointestinal irritation)

may continue for 24 hours.

Blood Alcohol Concentration

30 -50 (mg/dL) 50-100 (mg/dL)

General Effect
Impairment of driving and similar skills Reduced inhibition, talkativeness, laughter, and
slight sensory disturbance

100-150 (mg/dL)
150-200 (mg/dL) 200-300 (mg/dL) 300-350 (mg/dL) 350+ (mg/dL)

Inco-ordination, unsteadiness, and slurred speech

Obvious drunkenness, nausea and ataxia Vomiting, stupor and possibly coma Danger of aspirating vomit, stupor or coma Progressive danger of death due to respiratory

paralysis

Some Diseases Related to Chronic Alcoholism Alcoholic Addiction

1. Fatty liver and liver Cirrhosis
2. Pancreatitis 3. Varices Veins

4. Coronary Artery Disease 5. Pneumonia

6. Gastric Erosion and Hemorrhage
7.

Korsakoffs Syndrome

1. Smell of alcoholic in breath

2. Loss of self control.

3. Dilated pupils and fine lateral nystagmus. 4. Slurred speech 5. Unsteady gait.

6. Confused mental state or impaired memory.

1. Blood
2. Urine

3. Breath (breath analyser)

Treatment of Acute Alcoholic Intoxication:

1. Stomach Lavage with 5% solution of sodium 2. 3.

4.

5.

bicarbonate. Isotonic Saline with 5% Glucose. Patient should be kept worm. If patient come with respiratory depression, artificial respiration along with O2 inhalation is must. In very serious cases, peritoneal dialysis or haemodialysis will be required.

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Dr. Khalid y. Mattar

Drowning is death through the aspiration of fluid into the air passages.

Complete submersion of the body is not necessary for drowning to occur, death due to drowning can happened when mouth and nose are covered by water.

o o o o

Died from natural causes before entering the water. Died from natural causes while in the water Died from exposure and hypothermia in the water. Died of injuries or other unnatural causes before entering the water.

o o

Died of injuries after entering the water. Died from submersion, but not drowning.

Died from true drowning.

The general identification procedures. Police investigations. Medico-legal identification

1. Maceration of the skin:

Imbibitions of water into the skin, it is seen first on the fingertips, spreading to the palm and back of the hand

The skin become sodden, thickened, wrinkled

and white in color (washerwomans skin).

Similar changes are seen in the feet

From 2-4 hours it start to appear clearly in the tips of fingers. In about 24 hours: it covers the hollow of hand In 2 weeks: the outer layer of the skin may loosen from the inner layer. In about 3-4 weeks: nails will start to be loosen

After one month the whole skin may slip off like a glove Depending on the water temperature

2. Formation of Adipocere:

increase the water temperature, faster the adipocere formation

5 - 6 months in North America 5 - 6 weeks in South Europe Within 2 - 3 weeks in Gulf Area (in summer).

Mechanism of drowning (3.5 4 min.)

1.

The stage of surprise, lasting for 5 10 sec.

2.

The first stage of respiratory arrest, lasting for about 1 min (struggle to reach the surface).
The stage of deep respiration, lasting for about 1 min. (formation of foam at the nose and mouth).

3.

4.

The second stage of respiratory arrest, lasting for about 1 min (loss of sensibility and hypoxic convulsions occur).
Terminal gasping, which constituted the last external signs of life.

5.

Accidental Drowning: Usually associated with alcoholic or drugs intoxications

Sudden cooling of the body play an important role in cold water drowning (uncontrollable hyperventilation)

Hypothermia is a later danger, but still can be accepted as cause of death.

Suicidal Drowning:

Difficult to diagnose if there is no farewell letter, witnesses or circumstantial evidences.

Person is usually more or less fully clothed. The deceased can be shone to have been under the influence of alcohol or drugs.

Homicidal Drowning:

Extremely rare.
If there is evidence of tying or weight attached to the body or some injuries, homicide may be strong in such circumstances.

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An exposure of living tissue to high temperatures.

The heat source may be dry which resulting burn injuries, or it could be wet (hot liquids or steam) which resulting scalding injuries.

Classifications:
1. According to the cause: o Fire flames. o Exposure to sun. o Hot liquids. o Radiation. o Artificial lights.

General Features:
1.

Usually accidental especially in children and old people.

There are certain shape of scald usually sharp demarcated edge corresponding to the limits of contact of the fluid. e.g. : Horizontal level corresponding the fluid level in immersion case, and Irregular disruption in case of splashing depending on the gravity.
2. 3.

Death usually results from, fluid and electrolyte disturbance, shock, and infections.

1.
o

Classification According to severity

First degree erythemia and blistering of the skin. Second degree burning of the whole thickness of the epidermis and exposure of the dermis. Third degree destruction down to the subdermal tissue, maybe associated with carbonization

+ Forth degree charring of the body

2.

Classification According to the percentage of coverage (Rule of 9) :

General Features:
1. Death caused by fire might be:

immediate due to direct thermal injuries (burn), or more commonly smoke inhalation. Delayed (within first 3 days) due to shock, acute respiratory failure, or fluid loss.
Late (after the first 3 days) due to sepsis or chronic respiratory insufficiency.

2. On gross Examination:

Impossible to distinguish acute ante-mortem from post-mortem burns.

Burned bodies may present with a position called pugilistic attitude or boxer position. Skin might split exposing the underlying muscles and bones.

Burned bone has a gray-white color, often showing a fine superficial heat fracture on its cortical surface and may crumble on handling.

3. Autopsy findings:

In case of ante-mortem burns, there will be: o High level of CO in the blood (mostly). o Soot particles in the lower airway passage, and in some cases even in the stomach.

o Cherry-Red coloration of the hypostases, blood and internal organs.

o Saver edema of the respiratory system.

Determination the cause of death as some fire cases are used to conceal homicides ???????????????????????