Legal Med Midterms

Notes on Legal Medicine
Legal medicine (AKA forensic medicine) branch of medicine that deals with application of knowledge to legal problems and proceedings Medical jurisprudence - branch of law that deals with application of law to medicine or conversely medical science to legal problems Forensics application of scientific knowledge to legal problems and proceedings - Used in the p rs it of ! stice in co rt proceedings and in the protection of the p blic from environmental ha"ards Pathology branch of medicine that deals with diagnosis of disease and ca ses of death by means of laboratory e#ams of body fl ids$ cell samples and tiss es from the body% if alive & biopsy if dead & a topsy' systematic e#ternal and internal e#amination of the dead a s bspecialty is forensic pathology( a forensic pathologist e#amines persons who died s ddenly$ ne#pectedly$ violently or a medically nattended death$ an e#pert in determining the ca se and manner of death$ involved in crime investigation$ case coordinator for the medical$ forensic and scientific assessment of a given death )may be the lead investigator)$ e#pert in interpreting the scene of death$ assessing the consistency of witnesses and interpretation of pattern in! ries Medico-Legal officer physician who is involved in medico-legal d ties *+,% -. ,ode of *anitation( Any medical officer )M/0$ 1/0$ 2istrict /ealth 0fficer)$ medical offices from law enforcement agencies$ ,/1 and members of the medical staff of accredited hospitals% Medico-legal cases( deaths or in! ries involving persons who have no means of being identified$ those who are prono nced dead on arrival on +1s$ deaths nder the following circ mstances 3death occ rred within 45 ho rs of admission$ clinical ca se of death is nknown$ ne#pected s dden death especially when the person was of apparent good health$ d6t nat ral disease b t associated with physical evidence of fo l play$ death as a res lt of violence$ s icide or poisoning$ death d6t negligence of a 7 rd person$ incl ding cases of child ab se$ physical and se# al ab se$ rape$ dr g addiction and iatrogenic ca ses of in! ry$ disease or death )one ca sed by the medical professional s ch as the doctor6n rse)$ etc8
Child protection specialist - new kind of specialist in the field of pediatrics' deals with medico-legal cases of children who were allegedly ab sed N0 formal training on how one becomes a Medico-legal officer% Doctor as a witness: ,an either be a professional witness or an ordinary6 fact witness or both 9ive fact al medical evidence$ cannot give comments or opinions :U; an e#pert witness can give an opinion abo t medical facts +#pert witness has special knowledge as well as c rrent knowledge or skill gained by ed cation$ training$ or e#perience in the field of e#pertise +#plain scientific matters that may or may not be nderstood by ! dges Medical e#pert testimony co ld either be for the prosec tion or for the defense Medical testimony m st be ob!ective and acc rate Law does not make a < alification of an e#pert physician based on a medical specialist )so look into their < alifications$ their formal training etc)
,hild =rotection has set < alifications of a doctor who can provide care for the se# ally ab sed child and these are doctors who can also give e#pert testimony in co rt% >% 4% 7% 5% .% pediatrician$ gynecologist$ pediatric gynecologist$ family medicine )important that there?s e#pos re to children) formal training pdated with research st dies e#perience reg lar conference$ cons lt one another here and abroad etc =age 1 of !

=re-trial preparation of the e#pert witness refreshes the level of e#pertise$ enhances < ality of opinion e#pressed and saves time% Lawyers m st also be prepared in their < estioning% =ermit the witness to e#plain and L@*;+N% Know the val e of the medical literat re presented% Ahen it comes to research the best level of evidence is a blind test that is random% =rotect yo r witness% 2o not allow yo r witness to be harassed by the other side% @f it?s a child witness know the r les in e#amination of a child witness% "hat you should not do: >% 4% 7% 5% .% B% D#$%& A person is alive beca se of the 7 main parts of the body( >% ;he brain' 4% ;he respiratory center' and 7% ;he circ latory center Co heart p mps blood thro gho t the body to circ late o#ygenated blood% ;hese are the two most important systems( yo r cardiac and circ latory system and respiratory system that will keep yo alive$ and the main center for control is the brain% Definition of death: ;he cessation of life in a previo sly living organism% @t is a process$ not a single event% ask a < estion yo do not already know the answer do not < arrel with the witness ask clear < estions Allow witness to e#plain his answer% An e#pert witness has a right to e#plain% do not ask long and comple# < estions especially with children do not ask absol te < estions )always$ never etc) nor se nnecessary ad!ectives
Medical and legal stat s of death( o Medical 2octor proclaims or prono nces a person dead% o Legal +#tinction of the person?s identity$ etc% ;he ascertainment of death is a chemical problem% @t?s the doctor who will determine when a person has died% 'tages of Death: >% ,linical or somatic death 4% :rain death 7% :iological death 5% ,ell lar death Clinical or somatic death: ;he respiratory and circ latory f nctions have ceased% : t beca se of an advancement in medicine$ the circ latory and respiratory f nctions may be restored thro gh res scitating meas res% Co may end p as a person who?s wide awake$ contin o sly breathing$ heart still beating% 0r yo may end p as a person who?s awake$ heart beating$ b t yo ?re not breathing on yo r own% 0r yo may end p as a person who?s ! st o t% Co are nconscio s and cannot comm nicate with yo r environment% Co ?re breathing$ either on yo r own with yo r heart beating on yo r own$ or yo r respiration is being assisted$ with yo r heart beating on its own% @f there?s irreversible nconscio sness$ with spontaneo s respiration and heart beat$ it cannot be accepted as tr e death% ;he person is still breathing on his own% /e?s nconscio s b t he?s breathing on his own$ his heart beating% (rain death: =age of !

@f the brain does not receive o#ygenated blood within 7-D min tes$ yo r heart stops beating% Ne rons die if there?s no o#ygen bro ght to the brain within D min tes% :rain death follows a stage( >% ;he cerebral corte# or that part of the brain with higher f nctions die first% 4% ;he cerebell m )the part of the brain that?s for keeping yo r balance and coordination) follows% 7% ;he last to go is the brain stem% @t is in the brain stem where the cardiac and respiratory centers lie% @t?s the stem brain that?s what will keep yo alive% *o we have what we call a persistent vegetative state% Co ?re completely nconscio s b t yo ?re breathing on yo r own$ with yo r heart beating% 0r yo may have assisted ventilation% And it is ass med in s ch a state that the brain itself is f nctioning% /igher brain centers are dead e#cept for the brain stem% :eca se the brain stem is not dead yet$ the cardiac and respiratory centers are working% *o even if yo ?re totally nconscio s$ yo may be breathing on yo r own and yo r heart is beating on its own% 0r yo r heart is beating b t yo r are breathing thro gh a ventilator% And the only thing that?s needed is to keep feeding the patient% *o these are the people we call vegetables% (iological death: /ere finally$ even the brain stem dies% All components of the brain die$ closely followed by cell lar death% Cellular death( ;hink of cells as mini tiny factories% *o in cell lar death$ these factories sh t down one by one% And event ally$ they wo ld ! st break p and decay% ,ell lar death itself also does not happen all at once% ,ells die slowly% :eca se evidence now is showing that$ let?s say$ yo r skin and bones may remain what yo call metabolically active )still alive for many ho rs)% ;hat?s why after death$ if yo need to transplant or se bones or skin$ they may be harvested and c lt red p to >4 ho rs after the heart has ceased beating% Ne rons of co rse die after 7-D min tes% ;he heart and kidney can still be sed if they?re harvested within E ho rs of cessation$ after the person is prono nced death% *o it?s very important$ especially when we?re talking abo t transplantation% ;he person m st be prono nced dead by the attending physician% *o death act ally takes a long time% @t doesn?t mean that ! st beca se the person stops breathing and his heart is not beating$ he?s dead% @t?s a transfer from one state of viability to another and may be slow or rapid depending on certain factors$ like yo r age% ;he very yo ng and the very old$ they die faster% Fery yo ng$ beca se they?re very immat re$ the very old beca se of the wear and tear% ;hey don?t have defenses anymore so they can die really fast% @f yo ?re very thin$ if yo ?re malno rished$ if yo have all these diabetes and heart problems$ yo r death will be faster% 0r environmental factors )good thing it doesn?t snow here)% @f yo ?re sickly and its cold o tside$ yo ?re not wearing anything$ or yo ?re malno rished$ yo ?re going to die fast% *o it?s the physician who prono nces death when what yo call the Gpoint of irreversibility? has been breached% And when is thatH Ahen does a doctor say that the point of irreversibility has been breachedH ;raditionally$ when the doctor doesn?t feel a p lse or doesn?t hear the heart beating and the person is no longer breathing$ we say the person may have died% >% 0ther ways of finding o t whether that person is really dead is by p tting a mirror on the face$ at the mo th and nose$ of the person% @f there?s no condensation on that mirror$ it means the person is not breathing% 4% Ahat we can do is also look into the eyes$ thro gh the p pils% Ae can see what we call the Gf nd s? where yo can see the blood vessels% @f the blood vessels are not p lsating$ that means the heart is no longer beating% Ae can se ++9 )electroencephalogram) test% : t in the province$ yo don?t have ++9% ;he doctor s ally ses what yo call the ophthalmoscope to look into the eye and check if there?s still p lsation% *ometimes$ they don?t have a mirror$ so doctors bring compacts$ like the ladies% *o it?s ! st a p lse or listening to the heartbeat% 7% Co can also try to monitor response by giving painf l stim lation to the patient% 0ne is press re on the glabella )N.B. the space between the eyebrows$ nless yo have a nibrowI)$ press re on the stern m$ or pinch the finger% *o if the person is alive$ he?s going to drive yo away beca se these are very painf l areas% +specially if the person is lying down and yo ?re standing p$ and yo p t so m ch press re$ that can be very painf l% =age ) of !

5% ;he other ones and very importantly$ will be the absence of brain stem refle#es% Meaning the response to pain stim li in these areas come from the brain stem% @f these are absent$ that means the brain stem is dead% Corneal refle* what we do is get a wisp of cotton and to ch the cornea% Co know how painf l that is% *o a person will blink% @f yo ?re dead$ yo won?t feel anything anyway% *o a live person will be in pain% 'hine light into the pupils if yo ?re dead$ yo r p pils are e#pected to be dilated% @f yo shine a light$ the p pils sho ld normally constrict% A dead person will not have that refle# anymore% +culo,esti-ular response we in!ect ice cold water into the ear% And we normally e#pect the eyes to move the opposite side% *o if the eyes will not move$ then there?s no refle#% .ag refle* when yo p t a t be$ catheter$ or tong e depressor and try to stim late the back of the throat% Co ?re going to gag if yo ?re alive% $pnea test )Gapnea? means no respiration at all) this is done mostly on people on ventilators% Ahat is done is$ we get what we call arterial blood gases% +ssentially$ we want to know what the level of o#ygen and carbon dio#ide is in the blood% *o while on the ventilator$ o#ygen is flowing into the l ngs% Ae get the arterial blood gases then the ventilator is t rned off for abo t .->J min tes% After that period of time$ arterial blood gases again are taken% @f the o#ygen level of the blood is very$ very lowKthere?s a certain n mberKif the carbon dio#ide level is very$ very high$ that is a sign that the patient is not breathing at all% @f all of these are not present$ then the person is dead% =l s$ yo can also have a silent ++9 where no more brain activity is going on% ;here are criteria for death% As @ said earlier$ beca se of new developments in medicine$ a person may not be declared dead immediately% 0f co rse$ the first thing that came p was yo r cardiac p lmonary res scitation ),=1)% : t we have other advancements% Ae have fibrillators% Lirst$ when a person s ffers from a heart attack$ it has been proven that the heart fibrillates% ;he person faints beca se the heart fibrillates% /ow does a heart look like when it?s fibrillatingH @magine a bag of live worms% Co look at the o tside% @t?s ! st going like that% @nstead of p mping blood o t$ yo r heart is ! st going like that when yo s ffer from heart attack% @f yo p t yo r stethoscope on the chest$ yo ?re not going to hear it so yo ?re going to say he?s dead% : t applying defibrillators can still revive the heart% ;hat?s why its very importantKif any of yo witness a person who may be ndergoing a heart attackKto ! st have to call the emergency medical services% /ere we have +1UL% ;hey have defibrillators ! st to get yo r heart to start p mping immediately% ;here?s what yo call for a person who needs a heart transplant% ;hey have what yo call assisted devices )not a pacemaker)% @t?s practically there p mping beca se the heart m scle itself is not p mping$ or inade< ately p mping% Co have yo ventilators% ;hese are machines that help yo breathe% : t we have a problem whereinKbeca se of modern res scitation technology$ even if all brain f nctions will have ceased e#cept for the cardiac and respiratory centersKyo r heart can still be beating$ b t yo may still be connected to a ventilator% *o are yo going to say that the person is practically deadH ;he heart is still beating% ;he brain stem is still alive% ,an yo say that person is deadH @f yo discontin e ventilation$ is it homicideH :eca se it?s very hard to keep this person alive for a long time% @t can be physically$ emotionally$ financially draining% ;he care there is every ho r$ every min te% Co t rn that person to sides and he?s not even responding to yo % *o how does one determine deathH /niform Determination of Death $ct defines death as either( irreversible cessation of the circ latory and respiratory f nctions' or irreversible cessation of f nctions of the entire brain$ incl ding the brain stem% And the determination of death m st be made in accordance with accepted medical standards% &ar,ard Criteria essentially the same definition% a% Unreceptivity and nresponsiveness meaning there?s a total nawareness of e#ternally-applied stim li$ pain stim li$ etc% ;here m st be complete nresponsiveness despite application of painf l stim li% b% No spontaneo s movement or breathing absence of spontaneo s m sc lar movement or breathing$ as well as absence of response to stim li$ s ch as pain$ to ch$ sight$ etc% c% No refle#es =age 0 of !

d% ,onfirmation by two ++9?s there m st be two ++9?s taken 45 ho rs apart% @ don?t know if yo remember this person% ;his one person was essentially declared dead% *he?s breathing on her own$ her heart is beating$ she was ! st being fed% : t the h sband$ probably tired of taking care of her$ went to co rt and asked the co rt to declare her dead$ so they ! st stopped her feeding$ and she died of starvation% ;o me$ she does not fall nder the /arvard criteria or the Uniform 2etermination of 2eath% *o let?s go to organ and tiss e transplantation% @n organ transplantation$ there are instances when the person m st be dead first% @f yo will look at the 0rgan 2onation Act of >-->$ death is defined as( MThe irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem. A person shall be medically and legally dead if either: (1) n the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of natural respiratory and cardiac function and, attempts resuscitation !ould not be successful in restoring those functions. n this case, death shall be deemed to have occurred at the time these function ceased " or (#) n the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions" and considering the absence of such functions, furthers attempts at resuscitation or continued supportive maintenance !ould not be successful in restoring such natural functions. n this case, death shall be deemed to have occurred at the time !hen these conditions first appeared. The death of the person shall be determined in accordance !ith the acceptable standards of medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of !hom must be appropriately $ualified and suitably e%perienced in the care of such patients. The death shall be recorded in the patient&s medical record.N *o the attending physician may call another cons ltant' he and the attending physician can be the ones to declare a person dead% Now going to problems regarding transplantation$ the problems are consent and a thori"ationKwho will consent or a thori"e to donate organs$ who will determine death in case of proc rement from a cadaver% And there is a problem of rationing organs$ there?s not eno gh organs for transplantation% More so in the U* and + rope where they do a lot of organ transplantation% *o here for s$ a person who may e#ec te or a thori"e to have a part of his body donated is anyone above >E% @n the U*$ there in their driver?s license$ it?s indicated if yo want to donate yo r body or a part of yo r body$ and a tomatically$ yo ?ll be sent to the hospital and the hospital will harvest yo r organs% 0f it co ld be anybodyKsomebody of legal age can sign for yo % Co r parents$ siblings$ or g ardian% And the organs have to be harvested within E ho rs% *o yo have to consider the time to remove$ travel time$ time to operate the recipient$ etc%$ so yo have to make the decision fast% Manner of e*ecuting a donation: ;he death of a person from whose body an organ will be removed after its death for the p rpose of transportation to a living person$ shall be diagnosed separately and certified by 4 < alified physicians$ neither of who sho ld be a member of the recipient team% ;he s rgeon who will be the one to remove the organ cannot be the people who will declare that person dead$ etc% @t?s conflict of interest% @t sho ld only be the attending physician% 'ources of organs: o Let s contains cells which we call Gstem cells?% ;hey contain cells that have the potential to become any kind of tiss e$ provided that tiss e is placed in the right environment% *o if yo p t a tiss e in the area of the heart$ that tiss e will develop into heart cells% Anencephaly infants are babies born with only the brain stem intact% ;hey don?t have a sk ll cap$ they don?t have the higher brains$ b t ! st the tiny brain stem% ;hat?s why they?re alive$ they have all those refle#es$ they?re breathing e#cept for that abnormal head% : t when they die$ their hearts can be sed for transplanting to babies with congenital heart diseases% o Artificial animal transplants ;he problem here is$ it?s not matching% @ don?t know how compatible yo can be with a pig or a cow% And the problem there also is$ that animal may have some kind of disease which the h man never gets% Ahat?s going to happen is$ it?s passed on to the h man being who received the disease from the pig?s heart% *o how are yo going to c re that illnessH =age 1 of !

Ae do have problems with sing animal tiss e$ altho gh the =hilippine /eart ,enter sed to transplant pigs? heart valves$ etc% into heart valves of patients b t they?ve stopped% /omologo s transplantation when tiss e is removed from one part of the body and p t back into yo r own body% *o yo scrape skin from yo r thigh$ probably to cover a b rned area in yo r back% 0r yo chip part of yo r pelvis and transplant it to an area where there?s a bad fract re$ for that fract re to heal faster% 0r in cases of Oehovah?s Aitnesses$ who cannot accept blood from any other person% @ had an e#perience where a patient had to ndergo an open heart s rgery% )Lor those who ndergo open heart s rgery$ yo heart has to stop beating%) *o the blood m st go thro gh a cardio-p lmonary bypass machine and then ret rned back to yo r heart$ bypassing the heart and l ngs% *o in this case$ it?s the patient?s own blood that?s circ lating$ dil ted with @F fl ids% Co r tiss e is taken from a living donor and these tiss es will be matched first with a recipient% @f yo ?re compatible$ yo r blood can be e#tracted and transf sed to another person% ;here?s what yo call bone marrow transf sion$ for patients with le kemia with white blood cell problems% ;here are also people who will donate their own kidneys for a fee% : t bear in mind the Anti-;rafficking in =ersons Act 4JJ7$ *ec% 5%$ wherein yo ?re not allowed to sell yo r organs% Now$ cadaver donation is act ally the ma!or so rce of all tiss es for transplantation% *o yo r driver?s license may indicate that yo want to donate an organ or everything% Most of organs for transplantation come from dead people b t they m st be harvested soon after the patient is declared dead% o ,loning if yo have problems$ they?ll ! st give yo yo r clone%
o o
Ahen everybody dies changes can happen% /ow do we estimate the time of deathH #$2L3 C&$4.#' %&$% &$PP#4 $F%#2 D#$%&: >% 1igor Mortis 4% ,adaveric1igidity 7% =ost Mortem /ypostasis 5% ,ooling of the body after death or Algor Mortis Ahen the heart stops and the breathing stops event ally there?s a falling blood press re$ there?s no more o#ygen and the cell method will stop working and beca se of that yo r nerve cells will die and there?s going to be no more ne rological activity% Ahen blood press re falls down and there?s no more circ lation$ yo wo ld become pale% ;here wo ld be pallor personae$ there will be eye changes$ refle# is gone$ the p pils will not dilate and will not constrict if it?s shown light$ the blood vessels in the f nd s that yo see that are act ally retina% Co won?t see any p lsation and if yo to ch the eye$ it?s very soft% M scles will become flaccid% As soon as there is a loss of the m scle tone it becomes flaccid and this is termed the primary flaccidity and this may retain any activity and may respond to other forms of stim li that?s why yo might see some twitching of the toes or some m scle twitching that?s reacting to the stim li% @t?s not act ally dictated by higher senses% ;here will also be loss of m scle tone so yo r anal sphincter will ! st come o t% Co r rinary sphincter$ yo r rine will ! st come o t% 0r some semen might ! st be emitted b t that doesn?t mean that he had ! st had se# before he died% ;here will be revegitate of the gastric contents beca se there is a sphincter in the esophag s and in the stomach% ;hat will also be rela#ed so when the person falls on his back or even head down stomach opening rela#es$ gastric sphincter will flow backwards this can be conf sed as if the person died beca se of asphy#iation )gastric contents going into the airway)% ;he only way we can say that a person died beca se of asphy#iation from aspirating food is from eyewitnesses? acco nt% @f food debris can be fo nd down to the smallest part of the l ng and then we can say he asphyrated and that is the ca se of his death% 2igor mortis5 ;he temperat re dependent physico-chemical changes or chemical reactions occ r within motor cells as a res lt of lack of o#ygen% 2ifference between a normal metabolic pathway and the ano#ic )no o#ygen pathway)% A normal metabolic pathway happens within yo r body$ within yo r system% An important reprod ction of energy in yo r body$ yo r A;= sing o#ygen% *o if there is no more o#ygen it?s ! st gl cose that is being sed to prod ce A;= b t then witho t o#ygen it will not go thro gh this process of o#idity PPPP lactic acid pathway and will prod ce a lot of lactic acid in the body% Aith the lack of o#ygen$ very little A;= or energy$ more of lactic acid what happens isPPPCo r m scles are made p of fibers of cells-acti enmycin fibers% ;hey bind together and they form a gel and that makes the m scles stiff% @t?s that lactic acid =age 6 of !

that will ca se yo r m scles to gel p th s become stiff% And this can develop fast especially if there?s no blood in the PPPP levels% +specially d ring e#ercise or when the acidic levels are high or when somebody is stressed or d ring electroc tion when the m scle will be repetitively stim lated$ the m scles will keep fle#ing and fle#ing$ the o#ygen levels can be low$ glycogen or gl cose levels can be low$ it will become acidic so rigor mortis can be very fast% @t may not be detected in people who have low m scle b lk% ;here?s not m ch m scle% *o what?s there to hardenH @t is s ally detectable first aro nd the eyes and aro nd the !aws and fingers and it will develop from the head down$ from the smaller m scle down to the larger m scle gro ps% @n determining the presence or absence of rigor mortis$ it is only estimating the time of death% 1igor mortis is a variable process beca se it can be affected by a lot of environmental factors% @t is nreliable to find o t the time when the person died% @f the person is e#posed to a cold temperat re he will develop rigor mortis longer as compared to a person who is in a warmer temperat re which will be of shorter d ration% @n temperate conditions it?s first detected in the face between > to 5 ho rs after death$ in the limbs between 5 to B ho rs after death$ the strength of rigor will increase in the legs B to >4 ho rs% After that$ when cell lar metabolism or decomposition of the cells begin$ the m scles now will lose its cohesiveness$ its gel-like property now will get lost% @n this stage of rigor mortis$ the body ends enters the stage of secondary flaccidity which occ rs between 45 to .J ho rs after death% ;wo types of rigor mortis( primary flaccidity within 45 ho rs$ it becomes stiff' after that the stiffness is gone and that?s called secondary flaccidity% 0ne can test for rigors% @f a !oint is fle#ed at death$ apply some press re% @f it !erks back$ that means there?s rigidity% @f the body feels warm and is flaccid$ it may have been dead for less than 7 ho rs% @f it is warm b t stiff$ it may have been dead for 7 to E ho rs% Ahen the body is cold and stiff$ it may have been dead for 7B ho rs% @f it is cold and flaccid p to secondary flaccidity$ therefore$ more than 7B ho rs% Cada,eric rigidity5 Another term for this is instantaneo s rigor or captalictic rigidity% ;his is based on certain findings wherein some people die holding grass in their hands or holding a g n when he died% Most likely the mechanism behind has something to do with a ne rogenic kind of activity when that person is highly stressed at the time of death% Lorensically$ if a person dies and is fo nd in the water and holding on to something like a grass fo nd o tside of that body of water then that person was alive before he was fo nd in the water% 0r that person may be holding something that belongs to the alleged perpetrator or whoever was with that person last may be holding on to something% Post mortem hypostasis5 At death$ circ lation stops$ all m scles rela#$ incl ding the m scles in the blood vessels% Aith the rela#ation of the m scle tone in yo r blood vessels$ the blood will settle down in areas where the blood vessels are dependent% ;he blood has cells and fl id% ;he passive settling of the blood cells nder the infl ence of gravitiy to the blood vessels in the lowest area of the body% ;his is forensically important% @t is not always seen in the body% @t may be absent in the yo ng or in the old$ those who are anemic% @t may PPPP by that skin colors$ !a ndice or yellowish coloring of the skin% @t mostly forms on the back$ b ttocks sides$ and back of the neck beca se s ally when a person dies he?s lying flat on his back b t there are some areas of that persons back that co ld be so pressed on a certain part$ like on the bed% A person died on his back so the b ttocks probably pressed on the bed will have PPPP called blanching% Meaning$ the blood vessels have been s< ee"ed$ so blood vessels co ld settle in this area% ;he part of the b tt not in contact with the bed may be fo nd to have a post mortem hypostasis% Co can tell the person?s position when he died% Ahen he?s hanging$ hypostasis will be on the lower e#tremities not in the torso% 9ravity% @f the body fall head first$ the hypostasis will be in the pper part of the body as compared to the lower part of the body% ;here may be some changes in the color after death% @f the color changes in a cherry pink color$ most likely that person died of carbon mono#ide poisoning' dark red$ by poisoning' bron"e$ infection ca sed by an organism called PPPP% @f the body was moved and hypostasis is already happening$ there co ld be layering of that hypostasis% $lgor Mortis5 ;he body will take on the temperat re of the environment% @t is sef l indicator of the time of death d ring the first 45 ho rs post mortem% ;he se of body temperat re as estimation applies only to cool and temperate climates not m ch in tropical areas beca se the cooling of o r body will not be as m ch beca se o r environment is warm% @t?s best meas red sing core temperat re like rectal temperat re taken at e#amination or on discovery% Using oral temperat re is not advisable% +#amining gastric contents at the time of death will only tell yo what he ate the last time% @t is diffic lt to se this estimation of the time of death% :efore$ it was believed that o r stomach empty into the intestines within one ho r% ;hat?s no longer correct% @t also depends on the kind of food that yo eat% Latty foods remain longer in the stomach compared to non-fatty food% Another method is looking at the presence of insects in the body% ;here are some insects that like to feed on the h man body% 2epending on what stage of the insect% Co have to get a forensic entomologist% @n other co ntries$ depending on the season$ they look at the animal bites% @n the winter season$ it?s ! st the bears that are there in the forest% @f it?s s mmer$ it?s ! st the s< irrels that are there% =age 7 of !

@t is very important that an e#aminer gives an estimation of the time of death% ;here is a bracket probability giving an earliest or latest time which the doctor feels that death m st have occ rred% @t?s within a range% Decomposition or putrefaction5 Most common root of decomposition of the body after death and early changes may be conf sed to be signs of violence or tra ma% ;here is li< efaction of soft tiss es over a period of time% ;he earlier the process starts the faster it progresses% @n a week or so the body cavities will b rst and the tiss es will li< efy and drain away onto the gro nd% Mummification5 ;he body cavities dry p and it s ally happens in hot or warm environment and also in cold dry areas% Adiposer m% ;here?s a chemical change in the body fat' the feat res are retained apparently no decomposition happens% 8mmersion5 @t slows down the process of decomposition% A body will decompose in air faster than in water% ;he most common position of the body in the early stage is$ if the chest contains air then the chest is floating and the limbs are hanging in the water so yo r hypostasis is e#pected to be in the hands and in the feet% @f there are animals in the water$ e#pect also that there will be bites in yo r hands and feet% @f the water is shallow$ e#pect the hands and the feet to be dragging on the river bed% Loss of epidermis first and then there will be gaseo s decomposition so that the body will start to float% ;here co ld be adiposere formation if the body is nder water% Ahen the body is b ried it will decay more slowly b t if the s rro nding is wet$ very acidic$ the body will decompose faster% +vent ally yo r skin will fall off% Aithin two years$ no more skin tiss es$ it will then be all skeletal and what will remain will be yo r tendons$ yo r ligaments$ hair and nails% Aithin five years$ nothing is left on the bones and all the !oints now will be disartic lated% Co can se the bone marrow to get the mytocondreal 2NA% @t?s one way of identifying a person% : t the mytocondreal 2NA is only that of the mother% Post mortem injuries5 @t can be determined by looking at the edge of the wo nd% @f yo are in! red before yo died$ there will be inflammatory response after yo r in! ry% @f yo ?re in! red after yo r death$ there will be no more inflammatory process that will go on% #m-alming5 @t is a physically invasive process in which special device are implanted and chemicals and techni< es are sed to give an appearance of restf l repose% Lirst the bag is placed on the stainless steel$ place the person in table washed with insecticide and germicide and olfactant$ the insides of the nose and mo th are swabbed with sol tion$ the m scles are massaged to soften it$ creams is placed on the face and then massage so it will look soft% ;he facial feat res are set by p tting cotton in the nose so it?s not gonna collapse$ p tting eye caps below the eyelids so it will not look s nken% $rterial em-alming5 ;hey in!ect an embalming fl id into an artery% ;hey in!ect one gallon or so of a mi#t re of formaldehyde and other chemicals with water% ,hemicals are also in!ected thr syringe into the other parts of the body% Ca,ity em-alming5 ;he tr car is inserted intto the navel and an instr ment is inserted to p nct re organs that contain air% 9ases and fl ids are withdrawn% Ll id is p t inside the cavity% ;he an s and vagina are t cked with ga "e to prevent seepage of fl id% @ncisions and holes are made in the body$ tinatahi$ and then the body is washed again% ;his is the whole embalming process% #*humation5 ;his is the province of a skilled and e#perienced forensic pathologist% @f the ca se of death is poisoning$ the pathologist m st also get soil samples beca se there might be fl id in the body that may have seep into the soil or in the coffin and fl id from these areas is best taken to determine if there?s any poison present there to determine if the person really died of poisoning% Ahen yo e#h me a body yo have to ask the co rt$ there has to be a co rt order first% ;here m st be legal reason for e#h ming a body%
2+A;/ @NF+*;@9A;@0N%% @t involves police investigation and the application of forensic science% Kinds of death that re< ire investigation in the =hilippines$ nderstand the principles of death investigation incl ding the a topsy% Learn and nderstand the contents of a medico legal a topsy report and how the medico legal findings become sef l to the legal system% =age ! of !

;he p rpose of death investigation is to identify and develop an nderstanding of the death of that person% ;wo types of death investigation( >% ,linical death investigation happens within the hospital% ;he doctor or the medical officer or the pathologist wants to know what that person died of$ what was the illness$ did he die of a certain disease or in! ries$ or of poisoning% @t?s ! st within the hospital setting% 4% Medico legal investigation - maybe there?s some fo l play in the ca se of death% @t may be that there is a police investigation going on regarding the death of that person% Ahen that nat ral death occ rs$ the doctor will sign the death certificate$ once the death certificate is signed then the body can be disposed of the$ the death certificate will incl de the ca se and manner of death% @f the death is nat ral and no doctor can complete the certificate then that death m st be investigated and the death be classified% 2eath that cannot be e#amined by the doctor is e#amined by a variety of legal officers-the medico legal officers or the medical e#aminers% /erein the co ntry based on the ,ode of *anitation$ cases where a topsies were performed are those that are re< ired by special laws pon the orders of a competent co rt$ a mayor or provincial or city fiscal pon the written re< est of police a thorities whether the solicitor general or the city or provincial fiscals are a thori"ed by e#isting laws shall be when necessary to disPPP and to take possession of the remains for e#amination to determine the ca se of death$ whenever the nearest of kins shall re< est in writing the a thorities concerned to a certain ca se of death% @n order to be a topsied yo have to get the consent of the relatives and more often than not they will not consent% @f there is fo l play yo have to r n thro gh this people like the city fiscal or the police ! st to ask for a re< est for a topsy% And the police a thorities won?t even ask for the a topsy for the medico legal investigation of the death of the person% ;hese are the problems in o r co ntry it?s very hard to go beyond% @t might be that a member of the family killed that person% @f somebody is in the hospital and somebody in the room killed that patient$ the doctor will wonder how he can die s ddenly% * dden infant deaths% ;hese are the cases that need medico legal investigation% 20As$ people who died and had not been identified$ ne#pected s dden death especially when the deceased was in an apparent good health$ death with nat ral disease b t associated with physical evidence s spicio s of fo l play$ death as a res lt of violence$ accident$ s icide$ poisoning$ death d e to the negligent or improper act of another person$ deaths of persons whose bodies are too b rned% ;hese are deaths that also need medico legal investigation based on the ,enter for 2isease ,ontrol in >--E% @t incl des death which had occ rred in c stody$ these are the types of death that ate not listed in o r law that are classified as medico legal cases% A year ago$ there were >- deaths in the ::1, and there?s no a topsy that was done% 2eaths of persons whose bodies need to be cremated or b ried at sea beca se once yo cremate the body yo have no more body to e#h me% ;hat?s related to disease relating to the employment to or accident on the !ob$ deaths that are related to the disease that might constit te as threat to p blic health% ;hese are the deaths that are not incl ded in o r list% @n the U*$ they have a death investigation team% An a thor says that death investigation is composed of a coroner$ a medical e#aminer and a forensic a topsy technician )there?s no s ch thing daw$ it?s the embalmer)% ;hey have to involve themselves with the people who investigate the scene they also do their own investigation on the backgro nds$ cond ct e#amination in the laboratory$ they also deal with evidence that cons lt with concerned parties like the all types of forensic people as well as the police investigators and they m st testify in co rt% @n o r co ntry$ we have a medical e#aminer$ b t most often than not it is really the embalmer who does the a topsy% 0 r medico legal officer will ! st look at what the embalmer is doing% 2octor Lort n was doing an a topsy on a child and she fo nd something n s al when she feels the rib of the child$ there?s may be a fract re% *he tells the medico legal officer who had a topsied that girl and said feel this o t% ;his is abnormal% ;he medico legal officer said$ he called the embalmer and say$ will yo please feel that rib if it?s abnormal or not% ;he laboratory e#aminations will have to be done in Manila$ the =N= ,rime Lab and the N:@ ,rime Lab% )M@ don?t know and @ don?t think they obtain evidence$ @ don?t think they even cons lt with concerned parties b t they will testify in co rt% And @ don?t know what kind of information they get if they?re only looking at the body% And @?m speaking from e#perience%N) Aims of a death investigation( the medico legal officer m st find o t who died$ when that person died$ why that person died$ and where that person died$ and how that person died% ;he doctor will have to go to the scene together with the police officers% 0r a trained pathologist is the best person to investigate this death' he has to get physical and testimonial evidence$ photographs and videos and trace evidence$ social history$ interview the family and the relatives% 9et the medical history of that person$ medical records from the hospital or medical records from the physician% Medico legal report is important in the process of death investigation% A topsy is a post mortem e#amination where the e#aminer wants to see with his own eyes% @t?s a scientific =age 9 of !

investigation of a dead body performed primarily to determine the ca se of death and identify the disease that are present% @n academic instit tion these are only for teaching and research p rposes% : t for forensic a topsies it is to determine whether a given death was an accident$ homicide or s icide or a nat ral event% An a topsy can be performed by any doctor b t m st be performed ideally by a properly trained pathologist% 0 r medico legal officer had not had any formal training in doing a topsies% =ersons a thori"ed to perform a topsies in o r co ntry( ;he aim is identify the body$ estimate the time of death$ identify and doc ment the nat re and n mber of in! ries% *pecific ob!ectives( interpret significance and the effects of the in! ries$ identify the presence of any nat ral disease$ interpret and identify the significance of the nat ral disease present$ identify the presence of poisons$ interpret the effect of any medical or s rgical treatment% @t is not ! st looking% @t is also analy"ing what is seen and has also to see what?s not there% A topsy will consist of an e#ternal e#amination% +#amine the whole body on the o tside% ,ollect and trace evidence especially nder the nails$ on the mo th$ etc% After cond cting an e#ternal e#amination taking all the necessary pict res and doc mentation of the in! ries incl ding si"es and location of all those in! ries an internal e#amination is done where the body is c t p$ each internal organ is removed$ weighed and dissected$ in! ries are looked for$ signs of a nat ral disease are looked for% Anything that?s abnormal there are looked for% =art of the a topsy is a laboratory e#amination wherein tiss es$ fl ids$ any weapon fragment b llets or whatever are collected and e#amined% A topsy incl des gross observations and microscopic e#amination of all the tiss es% ;hat medico legal a topsy m st determine the ca se of death% ,a se of death( @t is the disease process or in! ry responsible for initiating the train of events whether their brief or prolonged sing the fatal end res lts% @t?s that which starts the event% Mechanism of death( ;he physiologic or biochemical derangement prod ced by the above ca se which is incompatible with life that is how the disease or the in! ry leads to death% Manner of death( ;he fashion or mode in which the ca se of death came into being% @t may be nat ral$ accident$ s icide$ homicide$ it can be nclassified whether if it is d e to alcohol or dr g% @t co ld be ndetermined% @n the homicide classification of death$ this is sed to classify the kind of death% @t is not sed to imply criminal intents% ,riminal intent is left to the police investigators$ into the legal process not in the doctors% @t is only sed here that the person died beca se of a volitional act of somebody% Undetermined ca se or manner of death it co ld be like there are so many manners of death that co ld have happened and it?s very hard to determine which one weighed more in killing that person% +#ample( if yo ?re a person who loves to drink a lot of alcohol$ eat a lot especially pork$ smoke so yo ?re prone to have high blood cholesterol level so yo will develop a coronary artery disease% ,oronary artery disease can ca se two problems in yo r heart( electrical dist rbance and heart fail re% :eca se of the block in yo r coronary artery there?s not eno gh blood s pplying the heart$ so it co ld be that the nerves of yo r heart or the lethical wires of the heart are not well s pplied by blood% *o it?s not going to p mp reg larly and rhythmically% Librillation or a fibrillating heart$ like a bag of worms$ so that heart is not p mping blood at all% @t?s not p mping blood o t% +very time yo r heart p mps o t of its chamber it will also s pply blood to the heart m scles% A heart fail re is ca sed by poor o#ygenation beca se of poor blood flow to the heart m scles% @f a part of yo r heart m scle is weak$ it?s not gonna p mp blood% Co r heart?s gonna have an ineffective p mp so yo ?re gonna have a heart attack% Ahen yo die$ the manner of death is classified as nat ral% Ahen yo are stabbed$ yo ?ll lose a lot of blood$ that?s the mechanism% /anging$ s icide$ strang lation$ the mechanism there is asphy#ia$ a lack of o#ygen in the system% ;he medico legal report m st show these three information% Unfort nately$ o r system of death$ according to 2octor Lort n$ is not scientific based and is haggled by the policy of no aggressive complainant$ no case and the practice of relying mostly on witnesses% @f there?s no complaint$ there?s no case% /ere is a case of a girl who died in a Monday morning% *he was apparently well 5 days prior to her death% ;he following day she did not feel well$ she complained of vag e abdominal pain% *he stayed in bed and ate what was fed to her% ;wo days before she died$ she ref sed to eat and contin ed to complain of abdominal pain% /er mother noted that her abdomen was becoming distended% *he still ref sed to eat the ne#t day% And beca se of that the mother?s live in boyfriend beat her with an electric wire% ;he child still didn?t eat and died the following day% ;he mother?s live in boyfriend was arrested and was charged with for violating 1A DB>J$ the Anti-,hild Ab se Law% ;he a topsy report =age 1: of !

concl ded that the child died of pne monia% As to the manner of death$ there was no report% :ased on the re< est of the mother this child was e#h med% ;his is the case where 2octor Lort n felt an abnormality in the child?s rib% ;he child had br ises% ;he police were saying that she died of beating% 2octor Lort n fo nd o t that her intestines had telescope nto itself )the smaller part will enter into the bigger part) there will be intestinal obstr ction% ;he ca se of death is int ss sception% ;he mechanism of death is the biological and physiological changes in the body' yo ?re not eating$ yo ?re starving$ yo ?ll have lactic acidosis and yo r heart is going to stop beating if it?s in an acidic medi m% ;he manner of death is homicide beca se the mother?s live in boyfriend ref sed to bring the child to the hospital even when the mother pleaded to bring the child to the hospital% : t maybe it?s nintentional beca se he probably ! st did not know% 8D#4%8F8C$%8+4 +F %&# L8;84. $4D %&# D#$D Medical reasons for establishing the identity of a living person and a dead body( a person is comatose infant person who has mental defect there is lang age barrier the person may tell false information regarding his identity even if details is known b t personal details are needed to be confirmed for p rposes of immigration or inheritance for paternity and filiations for proper s pport$ inheritance and parental a thority for investigation of the death especially if it involves mass disaster for p rposes of inheritance$ ins rance$ retirement$ immigration$ etc
Co need the help of e#perts or forensic people like forensic pathologist$ orthodontologist$ anthropologist when the dead bodies are severely in! red or severely m tilated$ decomposed or skeleti"ed% ;he identity of a person is established by comparing or matching the parameters that can be meas red with the parameters of another person which is s spected to belong to the body being meas red% ;he best feat re on how to identify a person is his specific feat res that are matched to one that is known to a certain person% M+;/02* 0L @2+N;@L@,A;@0N( Morphological characteristics5 ;his is a method of identifying criminals thr height$ weight$ general physi< e$ hair color and length$ presence of beard and m stache$ skin pigmentation and other facial appearances$ eye color$ shape of the lips$ and chin% ;hese can differentiate one person from another )e%g% race)% Picture: get the frontal and the side view shot )more often than not$ yo r left profile is different from the right profile) ;o determine the age( white thing around the eye$ teeth only p to age 4. and a range is given$ *-ray )o#ification centers$ bone growth) Clothing and jewelry5 %attoos5 =age 11 of !

+ther mar<s: *triae$ pimples$ cleft lip$ tribal marks$ body piercing% &ealth records )scar$ disease) ;ertillian system of identification5 9et >> meas rements from the person Arite down and describe all the person?s individ al markings and personal characteristics @t is flawed$ it does not take into acco nt changes with age Aas replaced with the se of fingerprints%
Fingerprints %hree main patterns: loops$ whirls and arches or a combination of any of these three% Used to ascertain a positive @2 of a person No two persons have the same fingerprint even twins ,annot be altered by time or in! ry ,an be e#tracted in any s rface they come into contact with% %hree %ypes Patent prints -left when a foreign s bstance on the skin of a finger comes in contact with the smooth s rface of another ob!ect Plastic prints -left when a finger to ches a soft malleable s rface Latent prints - impressions secreted in a s rface or an ob!ect that is invisible to the eye$ the res lt from perspiration from the sweat pores fo nd on the ridges of sweat pores -invisible to the eye -visible prints -no need for enhancements -visible prints - no need for enhancements - needs d sting) enhancement )e%g%
No less than >B points of similarity before declaring prints to be identical ;he investigating agency m st already have a file of fingerprints for comparison For decomposed or damaged -odies: se e#pert' can be obtained from despomated shedding the strat m corne m )the fisrt s bmersion' sing the s rface below the strat speciali"ed techni< e from a fingerprint skin of the nderlying epidermis after layer) when it comes to prolonged m corneum =age 1 of !

Palm prints and sole prints it is believed that people do not have the same Lip crease pattern #ar-shape ;ein pattern in the dorsal part of the hands (ite mar< (ones( se#$ age only p to age 4.$ height$ race$ personal identiy( dependent on ante-mortem data Facial reconstruction( soft tiss e thickness of the sk ll Photo superimposition( photo of possible individ al is overlaid with a photographic transparency of the sk ll which has been scaled down to the eyes %issue and cell samples: blood type$ protein comple#es$ blood en"yme systems$ etc D4$ profiling: sed in e#cl sion and identification thr body fl ids$ hair strands' 2NA analysis can yield a positive identity
Principles o o no two persons have the same 2NA pattern e#cept for identical twins or clones each part of yo r body contains the same 2NA
@f the 2NA pattern left at the scene of the crime does not match the s spect?s 2NA pattern$ the s spect was never in that scene% @f it matches the s spect?s 2NA pattern$ it p ts the s spect in the vicinity of the scene of the crime b t does not necessarily mean that he is g ilty of the crime% ;he 2NA molec le consists of two strands of s gar and phosphate molec les that link to one another to form a do ble heli#% ;en percent of the molec le is sed for genetic coding and the rest are silent% ;hese silent "ones repeat themselves$ meaning$ there is only >J percent of the billions of molec les in the body and only a few percent is specific to yo alone b t the distrib tion is ni< e for each one of s$ the se< encing is different% ;he 2NA is fo nd in the n cle s and it is a do ble heli#% @t is very stable b t the specimen that contains the 2NA that is to be analy"ed can easily be contaminated by the collector% 2NA typing is a well-established means of identifying h man remains and is a powerf l tool resorted to when traditional methods of identification are not helpf l% 2NA fingerprinting is the last resort in identifying people% @t?s sed for healthcare$ pharmace tical research$ evol tion and forensic% ;here are 7 ways of determining 2NA se< ences% ;ypes of samples needed for 2NA analysis( it m st have n cle s )white blood cells$ hair root$ spermato"oa)% =age 1) of !

9et a b ckle smear from the side of yo r mo th$ vaginal swabs and anal swabs to determine presence of semen or C chromosome within D4 ho rs placed in a ref right away$ blood% *emen on clothing can stay for a year% /alf of o r chromosomes come from o r father and the other half from o r mother%
(lood groups can only be sed for e#cl sion in paternity or maternity testing' not acc rate like that of 2NA analysis% @f the child?s blood type is 0 and the mother?s blood type is 0$ the father?s co ld be A or :% *amples for 2NA testing( mother$ child and probable father% @n paternity e#cl sion$ if there?s none matching profiles in at least two 2NA locations it can constit te concl sive proof that the alleged father is not the biological father% @n child se# al ab se cases$ it does not necessarily e#onerate the s spect from the ab se charges' it ! st means that the ab se did not impregnate the child% @n paternity incl sion$ complete matches in the 2NA profiles of the child and the alleged father will not necessarily establish paternity% ;he strength of the matches is determined statistically%
@2+N;@L@,A;@0N 0L L@F@N9 AN2 2+A2 Use of 2NA evidence in co rts( @mportant to se 2NA- allowable for @2 and testing of parentage *, said 2NA can be sed as corroborative evidence together with other evidences Lind o t how sample collected$ handled$ possibility of contaminating samples$ standard proced re followed in analysis$ proper standards followed in cond cting tests and < alifications of the analysts who cond cted the 2NA tests )< estions that sho ld be answered when yo present evidence in co rt) :y itself 2NA cannot establish the g ilt of an individ al )powerf l corroborative evidence) only 2NA e#perts can say that the 2NA samples belong to the s spect 2NA e#perts are the most appropriate persons to answer < estions regarding 2NA forensic process% Lind o t his professional < alifications$ how reliable is their 2NA testing process and the laboratory itself% +#pert witness will interpret the 2NA res lts and will e#plain the match or e#cl de a s spect as a possible so rce of the 2NA%
2NA report contains( what were the samples tested the controls sed 2NA profile of sample consistent with that of the s spect?s *tatistics of the probability that the evidence sample came from the s spect ,oncl sion based on the res lts of their test
/ow are these interpretedH @ndependent 2NA profiles of the victim )se# ally assa lted kid) and the reference samples are compared% ;he res lts are either inconcl sive or there?s an e#cl sion or an incl sion%
>% 8nconclusi,e - 2NA testing did not prod ce info that wo ld incl de or e#cl de the s spect% May res lt from =age 10 of !

improper collection$ handling or storage and can occ r when < antity of intact 2NA is ins fficient or sample contains comple# mi#t re from several individ als )do not contaminateI) 4% #*clusion - if the 2NA profile from the sample does not match the profile of the s spect?s 2NA reference sample% * spect e#cl ded as a so rce of the 2NA b t does not e< ate to innocence and does not a tomatically absolve s spect of the crime beca se he may have committed the crime b t did not leave any 2NA samples% May indicate involvement of another person% 7% 8nclusion 2NA sample from the s spect?s 2NA reference sample matches the 2NA profile of the sample taken from the victim or scene of the crime% * spect is incl ded as a potential so rce of the 2NA b t does not a tomatically determine the s spect?s g ilt% Co have to present other evidences to prove if he?s g ilty or not% *tatistical analysis will estimate significance of the match( >% random match pro-a-ility - probability that an innocent individ al who is nrelated to the s spect and chosen randomly from the pop lation will match the 2NA profile taken from the crime scene 4% Li<elihood ratio ratio of the probability that the 2NA profile in the evidence sample came from the s spect and the probability that the 2NA sample came from a random nrelated person% 1atio of the probability of the match given that the defendant is g ilty to the probability of a match that the defendant is innocent% P >$ JJJ & very strong evidence to prove that this 2NA belongs to defendant @NOU1@+* - from bl nt and sharp forces "ounds= injuries tiss e damage from mechanical force or from non mechanical forces' breach in the skin' ca sed by o tside ob!ects or force either physical or chemical - 1es lts from accident$ act of self-harm )self-inflicted) or from action of a third party /ow ca sedH >% >inetic ca sed by application of mechanical or physical force Mechanical force ca ses two types of tra ma( bl nt and sharp :l nt force tra ma ca ses abrasions$ cont sions and lacerations *harp force tra ma leads to incised wo nd or stab wo nd 4% 4on-<inetic in! ries come from non-motion tra ma like thermal$ chemical$ electrical$ radiation or e#pos re to atmospheric press re @mportant when describing the wo nd how it looks like$ what kindH 2emand from doctor$ yo have to know whether bl nt or sharp force$ what are the dimensions$ positions$ etc% $-rasion s perficial type' involves epidermis' no bleeding involved' e%g% scratch' deep abrasions can have bleeding beca se of blood vessels ;angential glancing impact )something falls on yo r body) cr shing' si"e and shape will depend on the kind of ob!ect which comes into contact with the skin Linear abrasion$ broad$ cr shed%
Contusions$ br ises )ecchymosis$ hematoma) breakage or r pt re of blood vessels ca se escape of blood from blood vessels to the dermis res lting to discoloration +#ternal br ising and internal br ising )br ises on internal organs) ;he greater the force the greater the br ising the site of br ising does not necessarily reveal the site of tra ma beca se blood is not static$ can move by gravity initially reddish 6 p rplish to yellowish or brown )d6t breakdown of hemoglobin) =age 11 of !

;he s al g ide in determining the age of the br ises has been discarded% @t was discovered that some br ises will only appear later on when there was already br ising in the m scles for a long time% depends on the site and how bad was the bleeding they do not acc rately reflect the ob!ect ca sing them b t there are some patterns that indicate the type of weapon sed often associated with abrasions and lacerations less associated with incised6stab wo nds beca se in stab wo nds the blood is allowed to escape6 seep nder the skin more prominent if force applied on bony areas so if yo see br ise on abdomen greater force was applied for a br ise to res lt ,an occ r after death since blood vessels are easily broken when dead% Lo nd on areas on the dependent part of the body )by gravity)
Lacerations res lt of bl nt force overstretching the skin and there will be a split of the f ll thickness of the skin deep and will bleed important to look for bridging fibers )remain intact in lacerations and will not be c t) skin can be compressed within the applied force and the nderlying bone rare in soft fleshy areas of the body margins are always ragged if ca sed by thin sharp ob!ect$ the wo nd is sharply defined and may be mistaken for incision b t nder the microscope there co ld be abrasions and cont sions on the edges and bridging fibers in the laceration
'harp force injuries: >% @ncised wo nds also ca sed by ob!ects with sharp and c tting edge and disting ished from a stabbed wo nd by being longer than deep - +dges will give indication of the sharpness of the ob!ect sed% Fery sharp ob!ects will not leave br ising on the edges$ no bridging fibers% - rarely life threatening nless it c ts deep into a tiss e like yo r ! g lar artery 4% *tab wo nds wo nds that are deeper than they are longer 2epth of the in! ry will make it fatal beca se of the bleeding Any ob!ect with a point or a tip can ca se it$ edge need not be sharp% =ressed into the skin with eno gh force to overcome the nat ral elasticity of the skin Appearance does not necessarily mimic the cross-sectional shape of the ob!ect sed% ,ontraction of the elastic fibers of the skin will distort a slit like wo nd after removing the weapon *hape of the wo nd can tell yo if it was a single edged weapon or do ble edged knife = shing the edges of the wo nd together is not an effective way of meas ring the si"e of the wo nd and determining the si"e of the weapon *i"e of the wo nd will depend on the shape of the blade and how it was inserted% Movement of the knife in the wo nd will change the shape and can enlarge the wo nd opening @f knife f lly inserted br ising might res lt d6t the hilt of the weapon or by the hand of the assailant -
Mechanism of 8njury ) ways of infliction of a wound
>% accident 4% self-infliction 7% action of a third party
=age 16 of !

:y looking at the in! ries alone it is very diffic lt to determine which of these three ca sed a wo nd% Co have to look at circ mstances% 9et a history on how it was inc rred% :ite marks in a child is pathognomonic and the child was definitely ab sed% ;o identify the teeth marks yo need a dentist and yo need to get an impression of the s spect?s teeth and compare% @t can also be a so rce for 2NA collection% D#F#4'# "+/4D' Lo nd in victims who are trying to defend themselves from an attack so it will depend on the kind of weapon sed Areas ( Underside or posterior sides of the arms and hands 'elf-inflicted injuries - no definite characteristics that define these% : t a person who wants to h rt himself prefer stab or incised or g nshot wo nds% @n areas that can be reached$ n s al areas incl de the eyes$ lips$ nipple and genitalia% :l nt force in! ries are rarely self-inflicted% 'ur,i,al: @f there?s a lot of bleeding the body has a mechanism to prevent shock called Compensated shoc<5 : t if he will not get any medical attention and body can?t maintain it$ body will go to ncompensated shock and will lead to death% Fiolence against women% 1A -4B4% Ahen do violence against women and their children occ rH Fiolence according to the A/0( the intentional se of physical force or power$ threatened or act al against one?s self or another person )here we?re talking abo t another person) that res lts in or has a highlight res lting in in! ry$ death$ psychological harm$ mal-development or deprivation% ;he intentionality is always associated with the committing of the act itself irrespective of the o tcome of the violence% @f somebody h rts another person or threatens to h rt another person that in itself$ the intentionality is there already% ;here m st be a relationship wherein one person perceives himself or herself as more powerf l than the other person% *o this wo ld incl de threats$ intimidation$ neglect acts of omission or all types of physical$ se# al and psychological ab se% * ch an ab se co ld also happen within a marriage% @t does not necessarily lead to in! ry$ disability or death b t it will pose s bstantial b rden on individ als$ families$ comm nities$ healthcare systems worldwide and this conse< ences can either be immediate$ latent or can lasts for years after the initial ab se% ;he conse< ences s ch as psychological harm do not e#pect it to happen immediately all the time% 1A -4B4 is gender based% According to the UN 2eclaration on the elimination of violence against women$ it?s a gender based violence performed by a h sband or an intimate partner% @n the U*$ most of the recorded incidents of in! ries in women are from violence of their intimate partners% @t occ rs everywhere% @t refers to any behavior within in an intimate relationship that ca ses physical$ psychological$ se# al harm$ to those in the relationship% And the term battery iss es the ab se occ rs repeatedly in the same kind of relationship% 2ifferent forms( physical aggression$ psychological ab se$ economic ab se% Lactors( the man grew p in an ab sive atmosphere$ witnessing domestic violence by children$ co ple married very yo ng$ the man is alcoholic ab se6s bstance ab se$ economic stress$ no s pport fort the family in the comm nity$ if c lt re accepts that men have the right to hit women% ;wo types of violence( the severe and escalating form of violence and the moderate form of violence% ;raditionally$ man?s beating is a conse< ence the man?s right to inflict physical p nishment on his wife% ;here are many c lt res that believe that a wife is a man?s property% Ahat are the events that trigger partner violenceH Aoman ref ses to have se#% Not preparing the food% Aoman asks where the money goes% A lot of men have no work% @t is essentially abo t power and control% : t women still stay in the relationship% ,ycle of violence% Lirst$ tension b ilding% *econd$ honeymoon stage% :ack again to the tension b ilding% +#c ses of the batterers( M@ only p shed herN' M@ did not hit herN' M@t?s her fa ltN' M*he?s hystericalN' Mshe br ises easilyN Aomen in a violent relationship try to protect their children% ;hey try to adopt in s ch a way that the children will be protected from harm% Aitnessing domestic ab se by children is an ab se in itself% =age 17 of !

,onse< ences( they keep complaining of pain everywhere in their body even if there is nothing wrong with them$ they may end p smoking$ overeating$ or they will stay idle$ they become depressed Myths abo t domestic violence( it is not a common occ rrence' women are ! st as violent as men' men are bro ght p to be the aggressive person' women are bro ght p to be the s bmissive gro p' alcohol ab se ca ses domestic violence )alcohol inhibits yo r actions so yo are braver to hit the other person)' domestic violence is s ally a onetime domestic occ rrence' men who batter are often good fathers% 5J to DJ percent of men who hit their wives ab se their own children either physically$ se# ally or psychologically% Ahen there is violence in the family all members are participating in the dynamics$ therefore$ all m st change to stop the violence% :attered women are mach chisyic and provoke the ab se they m st like it or they wo ld leave% /@;;@N9 @* N0; 2@*,@=L@N@N9% :attered woman syndrome% @t refers to a scientifically defined pattern of psychological and behavioral symptoms fo nd in women living in battery relationships as a res lt of c m litative ab se% @t is the psychological$ emotional$ behavioral reactions and deficits of victims and their inability to respond effectively to repeated physical and psychological violence% @t is a state of a woman in a highly ab sive relationship resorts to m rder or aggravated res lt of her spo se as a res lt of her belief that it is the only way to save her from death% Ahen a person is nder chronic stress$ there will be abnormal secretion of cortisol and beca se of that the brain becomes hyper-alert for danger and the woman now will be foc sed more on s rviving to the point that she will forget abo t trying to maintain her healthy cognitive and social skills% ;hinking properly becomes disr pted% *ocially$ she will not know to relate with her children and she may be even become ab sive to her children$ she will not know how to relate to her neighbors beca se all that she?s trying to do is s rvive% :eca se of so m ch fear other parts of the brain will wear o t% *he may either create permanent memories of what has been happening to her and she may foresee that everything will ! st keep happening% ;here co ld also be e#treme an#iety% 2epression% 2iffic lty forming attachment to other people% @n a way$ she isolates herself% *he can have sleep problems% *he can be a very imp lsive person% ;hey will appear helpless% +#pos re to a remand of earlier tra ma to perceive threats or to generali"e reminders will make either respond an#io sly$ she?s gonna start to become panic$ aggressive may even provoke threatening behaviors from others% ;here co ld be a post tra matic stress disorder% Any intr sive recollections of the tra matic events will create hyperaro sal or hyper-vigilance% ;here?s avoidance behavior$ emotional longing$ disr pted interpersonal relationship$ body image distortion and se# al intimacy iss es% Ahen the cycle of violence becomes worse it may come to a point where she co ld kill the man when he is asleep or is dr nk beca se that is the time that she is stronger$ or she herself will end p dying% ;he medical evidences sho ld incl de the interview of the woman as to what had happened% A social worker?s interview and investigation is also needed% Ahat the doctor can add to that interview will the physical e#amination and doc mentation of the in! ries$ the laboratory e#amination$ and psychological or psychiatric eval ation will also be good if the woman intends to file a case and other evidence that sho ld incl de crime scene investigation$ acco nts from witnesses$ and a social worker?s investigation also% =hysical ab se% A/0( ,hild ab se or maltreatment that consists of all forms of physical$ and6or emotional maltreatment$ se# al ab se$ neglect or negligent treatment of commercial or other e#ploitation res lting in the act al or potential harm to the child?s health$ s rvival$ development or dignity in the conte#t of the relationship of responsibility$ tr st and power% Lor medical eval ation we have to incl de the comprehensive medical history or child-sensitive forensic interview$ physical and laboratory e#amination% Ae treat that patient and we do crisis interventions and referrals% ;he p rpose of o r eval ation is to eval ate the medical problems$ gather evidences$ and give the child a therapy by making s re that the child is safe and protected% @n the U*$ it is the interviewer who tells the co rt what the child told her% ;he child-sensitive interview is done sing the appropriate lang age depending on the child?s age$ nonleading < estions are asked initially and when the child starts to disclose everything down to the specifics that?s when we ask specific < estions b t make s re not to ask yes or no < estions and make s re that the story comes from the child?s mo th% ;ake into consideration the lang age development of the child% ,hildren do not keep time% ,hildren ! mp from one event to another% =hysical ab ses are acts of commission by a caregiver% ;here has to be a relation of tr st$ power and a thority% @n 1A DB>J$ altho gh child ab se refers to infliction of physical in! ry$ physical in! ry in 1A DB>J incl des b t is not limited to lacerations$ fract red bones$ b rns$ internal in! ries$ severe in! ries s ffered by a child% @t does not say who inflicts this in! ry$ it doesn?t say whether it?s intentionally inflicted kind of in! ry which A/0 adds the word Mintentional%N =age 1! of !

0ne% ;he in! ry is not only inflicted b t it?s non-accidental% );he three mechanisms of in! ry( accidental$ self-inflicted and action of a third party%) ;he pattern of in! ries fit a biomechanical model of tra ma that is considered% A lot of in! ries have been scientifically st died and there have been concl sions are made wherein they said that it can only be ca sed by an ab sive act of another person% ;he pattern of in! ries may correspond to infliction with an instr ment in a manner that wo ld not occ r thro gh play or nat ral environmental interactions% *haken baby syndrome% Ahen the baby is shaken he will have s bd ral hematoma$ that?s bleeding within the brain$ retinal hemorrhages$ witho t any evidence of e#ternal in! ries% ;he baby?s head is bigger than that of the body% ;he neck m scles are weak% ;he baby can present s dden sei" res$ stop breathing$ vomiting$ and poor feeding% Another in! ry that can happen is rib fract res% ,hest compression in ,=1 does not ca se this kind of fract res% Another problem that can happen is cervical cord in! ry wherein the baby stops to breathe% Ahen yo shake the baby?s head$ it will c t the nerve connections in the brainstem )it is where yo r respiratory and circ latory centers are$ it is what yo call the cervical cord)$ it is known as diff sed a#ional in! ry$ no time for bleeding to happen% 1etinal hemorrhage is a bleeding at the back of the eye% Lrom a lot of short falls )short falls-falls less than 5 feet)$ ma!ority of children do not have serio s head in! ries beca se the e#tremities hit the gro nd first% Medical evidences will be the medical history$ family and social history$ investigation of the child?s environment$ physical and laboratory e#amination% Q estions that yo have to ask( Ahen did it happenH Ahere did the in! ry occ rH Aho witnessed at the time of possible in! ryH Ahat did the caregiver do after the in! ryH @n form lating o r impression we have to ask these < estions% 2oes the history reasonably e#plain the in! ryH Aas there any e#planation given as to how the child inc rred the in! riesH @s the statement given consistent with the development capabilities of the childH @s there any delay in seeking medical careH @s the history vag eH Medico legal principles( we can only offer an opinion of the presence of an ab se beca se we want to p t the child in a safe place after% Ae cannot give yo an opinion abo t the g ilt of an alleged perpetrator nor can we give yo an opinion of his intents% @NOU1@+* L10M L@1+A1M* Firearm - weapon that fires single or m ltiple pro!ectiles propelled at high velocity by gases prod ced thro gh rapid confined b rning of a propellant% Projectile any ob!ect that is sent thro gh space by the application of force% Lor firearms$ the pro!ectile is called a b llet or a pellet or a shot which is made of metal ) s ally lead)% *ome pro!ectiles will fragment inside the target while others do not% %wo -asic types of firearms: >% Artillery ) s ally the big ones) 4% Lirearms - very portable and has a range of acc racy of less than one mile% a% riffled weapon which is a pistol and a riffle b% shot g n &andgun or pistol the smallest of all firearms$ fired from the hand$ it has a riffled barrel% Co can have a revolver wherein after the b llet is fired a brass case which contains the e#plosive remains in the cylinder nlike an a tomatic when it is fired the empty cartridge case falls on the gro nd% 2iffle - it?s a long barrel$ with a high m ""le velocity$ a riffled barrel$ and b ilt for acc racy and long range )>%B km) and yo have to aim to hit yo r target 'hotgun firearm with a smooth bored barrel designed to fire m ltiple pellets that will come o t from the barrel and to be fired from the sho lder% @t is designed to < ickly hit a moving target% Co don?t need to aim$ ! st point and shoot ;he other types are machine g ns and s bmachine g ns% $mmunition or projectile it?s called a ro nd or a cartridge% ;he cartridge packages the b llet$ the g n powder into a single metallic case precisely made to fit the firing chamber of a firearm% ;he cartridge case e#pands and seals the chamber against rearward escape of gases% ;he primer e#plodes on compression igniting the propellant% ;here are two types of primer( the center fire and the ring fire% ;he propellant is within the cartridge% ;his propellant b rns to =age 19 of !

prod ce large vol mes of gases nder press re% ;he tip is the b llet )either lead or metal !acketed)$ which is the part of the cartridge that leaves the m ""le% Projectile from a shotgun - shotg n shell% ,ylindrical cartridge of a plastic or cardboard t be with a brass base% ,ontains tiny lead shots% :ottom of the cylinder is the e#plosive powder and the center is yo r detonator% Leaves the barrel as a composite missile becoming appro#imately 7JJ individ al shots as the missile moves f rther down the barrel% ;rigger is s< ee"ed$ the firing pin will strike primer and ignite the powder within the cartridge and the b rning powder will create the press re which will p sh the b llet o t of the m ""le% @mportant to know these things to identify whether the b llet wo nd is from close contact or distant contact% @f close contact yo will not only see the b llet wo nd b t also some of the gasses$ g npowder resid e on the victim?s body as compared to distant contact$ b llet entry is the only thing evident% "ound -allistics st dy of pro!ectile penetration% Ao nding effect of a pro!ectile is act ally prod ced by the transfer of kinetic energy from the pro!ectile to the tiss es% ;he greater the kinetic energy or the velocity the greater the wo nding potential% @f pro!ectile does not e#it the body then the energy in that pro!ectile will be pro!ected within the body ca sing f rther damage% @f it e#its the body then only some of the kinetic energy is transferred to the tiss es% Mechanisms -y which projectile disrupts tissue ( direct laceration of the tiss e drilling effect$ it ! st goes thro gh the tiss es% Main mechanism in a low velocity weapon% =ermanent cavity is prod ced% 0n the other hand a temporary cavity is prod ced by the shockwave or the other press res that come along with the firing of the g n% ,an be prod ced s rro nding the permanent cavity where the b llet passes by% : t if it e#ceeds the nat ral elasticity of the tiss e$ that tiss e can r pt re and it becomes a permanent cavity% @n a description of a 9*A )g nshot wo nd) it is important that the doctor will describe the wo nd and its location to determine circ mstances of the shooting% =ermanent cavity - where the pro!ectile passed thro gh the skin Abraded margin aro nd the wo nd- like an abrasion or cont sion ring or br ise' ca se is the forward motion of the b llet pon entering the skin abrading the margin of the entry wo nd Microtears- tiny lacerations on the edge of the wo nd from high velocity center fire rifle b llet 9raying l bricant or debris of the b llet wiped off the wo nd edge$ sm dging or blackening deposition of soot from partially b rned gasses% ;attooing )*tippling) b rning grains imbedding the skin' if it is seen it means immediate or close range distance :randing or b rning from the hot gasses of the m ""le at close range M ""le cont sion ca sed by the skin impact against m ""le )close range) )e%g% m ""le imprint) Contact range wounds m ""le to target distance( in contact with the body or only a few centimeters away from the body% +dges of 9*A seared by the gasses$ blackened by soot and propellant$ and there is concentric blackened "one% Metal fragments may be fo nd within the wo nd% 9 n placed over bony areas$ 9*A can come o t in a stellate )#shape) or lacerated appearance% M ""le to target distance is greater than >J feet all yo will see is the 9*A entry% #*it wounds )in rifle wo nds) will have inverted flaps beca se the b llet will go o t% :igger than an entrance wo nd% Co may not see any stippling or soot% '&+%./4 "+/4D' - large contact entrance hole with significant damage to the margins R g n resid e deposits ,lose range )less than . ft from m ""le to target) can prod ce single large defect which will appro#imate the weapon bore% @ntermediate range ). to >J ft) central defect prod ced by the shot and the wadding with s rro nding wo nds =age : of !

beca se of the tiny pellets% 0nce amm nition leaves m ""le$ pellets will start to separate% Not only central defect can be seen b t also tiny defects coming from individ al pellets% Long range whole thing breaks o t% Co still see tiny concentric defects from individ al pellets% #*it wounds rarely seen if fired in the chest and abdomen% ,an be seen if fired in the head$ mo th of h ge r gged appearance% &ow are they supposed to -e in,estigated? :ody m st be handled as little as possible to avoid loss of evidence /ands m st be paperbagged )not plastic) beca se in plastic moist re can develop% :ody transported in a body bag to preserve trace evidence and avoid contamination 2 ring a topsy$ M2 m st take an #-ray and look for metal fragments in the body% Medical +#aminer pl s e#pert m st recover resid es with >JS nitric acid and swab the area$ not a paraffin test% =araffin test is obsolete% ;hey m st describe the wo nds in detail Lf% < estions m st be answered( >% is there pro!ectile presentH AhereH 4% pro!ectile fragments presentH AhereH 7% type of weapon or amm nitionH 5% path of pro!ectileH Lirearms investigation is a comparative investigation% 2one macroscopically and microscopically% : llets are compared and matched to specific firearms% As well as$ acc rately determine the distance of the shooting% : llets will have rifling of the LA that was sed% 1ifled LA will leave a mark on b llets% +ach LA has a ni< e rifling pattern% @f no marks on the b llet then g n sed has smooth barrel witho t any rifling% $CC8D#4%@ '/8C8D# +2 M/2D#2? 'uicide no notes are left in ma!ority of cases% Ao nd site within the range of the deceased% Us ally contact wo nds% *ites of the wo nd s ally incl de the head$ chest and abdomen% Un s al location$ think homicide% Aeapon sho ld be present at the scene of the crime% May not be near the victim since he may have moved if he did not die instantly% @f s icide r led o t it co ld either be accident or homicide so look at the circ mstances% M ltiple LA wo nds s ggest homicide% 84A/28#' F2+M #BPL+'8;#' #*plosi,e5 A mi#t re of an o#idi"ing agent and f el% %wo parts: >% Low e#plosives e#ert a throwing effect in a factory or people nearby of any ob!ect 4% /igh e#plosives they can e#plode between > tho sand to E$ .JJ meters per second ca sing more shattering and devastating effects in a farther distance #*plosion5 A res lt of endothermic chemical reaction wherein there is a generation of h ge amo nt of gas with the release of vast amo nt of heat that occ rs very < ickly% Different types of -om-s: >% 9eneral p rpose 4% Lragmentation 7% =enetration bombs 5% ,l ster bombs Mechanisms: (last ca sed by tremendo s dynamic over press res generated by recoillation of a high e#plosives% /alf of the total energy generated will ca se the bomb casing to swell >%. times its normal si"e before it will er pt into small fragments and that energy will send the fragments flying o t in all directions% ;he remaining energy is =age 1 of !

e#pended in the compression of air s rro nding the bomb prod cing the blast effect% 2estroys the skin or m scle even to the point of amp tation% 2amaging effects( fragmentation$ crater-ring effect$ fire$ p re blast )ca sed by gas) *econdary effects( b rns$ missile in! ries$ pepper$ all types of in! ries from collapse of a b ilding and destr ction of a vehicle +#change principle( MAhen any two ob!ects come into contact there is always transference of material from each ob!ect onto the other%N Paraffin test5 A test that determines the presence of nitrates and nitrites that may have come from a g n powder or primer inside the b llet casing that ignites when a g n is fired% @t has to be warm to open the pores of the skin )beca se the g n powder is embedded into the skin) so that the nitrate compo nds will go o t and will be left in the paraffin wa#% =resence of nitrite or nitrate in the wa# glove )with the se of an acid) prod ces specks of violet-bl e colors%
$'P&3B8$5 Absence of p lse% @t describes a range of conditions for which the lack of o#ygen is considered the ca se% Mechanism: obstr ctive or non-obstr ctive ;he obstr ctive type is medico-legally significant% Classical Features: @t is not diagnostic% Not definite signs of asphy#ia like( facial congestion$ facial edema$ facial cyanosis$ petechial hemorrhages in the skin and in the eye$ star dose spots Conditions=causes >% * ffocation Lack of o#ygen in the inspired air +#ample( = tting plastic bags on the head of prisoners ;here is < ick death and minimal signs of asphy#ia e#cept for pallor in the face Not str ggling to breath' there is low e#ternal press re 4% *mothering ;he victim str ggles May e#perience cyanosis and congestion :r ises and abrasions on the face$ on the lips$ or inside the mo th Non-str ggling victims( may not see any of the signs' diffic lt to diagnose 7% ,hoking or gagging @nternal obstr ction of the pper airway passages by an ob!ect or s bstance impacted in the pharyn# or laryn# M c s membranes swell or congest if yo breathe thr yo r nose ;here will be respiratory distress$ can become cyanosis and congested face and neck p 5% *trang lation or hanging ;hree forms of prime forensic importance Man al strang lation Ligat re strang lation se of band aro nd the circ mference of the neck /anging press re of the ligat re on the neck prod ced by the weight of the body ,an res lt into two effects( classical asphy#ia signs the person died a slow death' no asphy#ia signs there was s dden cardiac arrest ;he effects and events depends on the method sed$ si"e of the press re$ and the force with which the press re is applied =age of !
O g lar veins drain veno s blood ) n-o#ygenated blood) from the head% @f there is obstr ction$ the blood will remain in the head% ;he person will swell$ congest or become cyanotic% ;he arterial veins will r pt re ca sing petechial hemorrhages nderneath the skin% 0bstr ction in the carotid artery )carries o#ygenated blood) ca ses cerebral skemia and the person will collapse beca se of lack of o#ygen in the brain% *tim lation of the barrow nerve endings in the neck will bring abo t the slowing of the heart% +#ternal signs( abrasions and br ises in the neck area$ laryngeal damage$ .% ;ra matic asphy#ia )restricting the movement of the chest) +#ternal press re is p t on the chest thereby restricting respiration ,lassic signs( very congested from face and neck p$ person becomes very bl e or red$ e#tensive petechia :lood from above the chest cannot ret rn to the heart$ it?s ! st like obstr cting the ! g lar veins B% =ostrial asphy#ia 2isabled or nconscio s person lies with the pper half of the body lower than the rest of the body ;here is press re in the abdomen that does not allow the diaphragm to move' it?s like tra matic asphy#ia where there is restriction of chest movement ,ommonly seen on persons arrested$ they are p shed to the gro nd /emoglobin carries o#ygen b t it prefers carbon mono#ide% Lail re of o#ygen tili"ation will paraly"e the chest m scle% &3P+B8$5 =artial lack of o#ygen% $4+B8$5 ,omplete lack of o#ygen% %2$4'P+2% 84A/28#'@ D2+"484.@ $LC+&+L ) .2+/P' +F ;8C%8M' =edestrian$ passengers$ cyclists or motorcyclists %2$4'P+2% 84A/28#':
Primary injuries from the direct contact of the vehicle =rimary in! ries are recogni"able and may take the pattern of the b mper for e%g%% Aherever the in! ry is that?s the point where the pedestrian was hit% ,l es as to the speed on the car( T 4J km6hr thrown off the hood either forward or sideways 4J-BJ km6hr victim may fall on the hood and head may strike windshield BJ->JJ km6hr victim may fly p in the air and he can fall on the car or beyond the car% 'econdary injuries from the contact of other ob!ects or the gro nd after contact with the vehicle 0ften more serio s and potentially lethal than primary in! ries )e%g% head and spinal in! ries)
Car occupant ;he in! ries s ffered will depend on the kind of impact =age ) of !

Fehicle hit from behind called acceleration impact *ide impact and rollovers least common Lrom the front - there will be acceleration then deceleration% 2eceleration impacts witho t restraint )no seatbelts) and yo ?re accelerating with the car and the car hits another car yo r body is still accelerating' yo r head can hit the windshield or yo r chest the dashboard and other in! ries on the pper part of the body% ;here co ld also be in! ries on the lower part of the body$ in the ankles$ hips or knees% 0rgans in yo r body also accelerate and in the act of deceleration p lmonary veins$ aortic veins attached to the body can be torn off so there?s internal bleeding% Co may also s stain in! ries within yo r brain since the brain moves in yo r sk ll% yo may have conc ssions and cont sions%
Motorcyle injuries d e to falls from the machine yo can have abrasions$ in! ries in the head bicycles more milder forms since lower speeds b t the problem is when they are hit by other vehicles wear appropriate safety gears
8MM#2'8+4 $4D D2+"484. 2ifferent things :odies recovered from water co ld have died from nat ral ca ses before entering the water% 2etermine A0N victim died of nat ral ca ses before entering the water or while in the water having entered it either vol ntarily or accidentally% 2id he die of nnat ral ca ses before entering the waterH 2id he die from e#pos re or hypothermia while in the waterH 2ied of in! ries after entering waterH 2id he die of s bmersion or drowningH 'u-mersion ! st act ally being in the water% A person who drowns can have signs of being s bmerged b t a person who was s bmerged in water does not necessarily mean he drowned% @f yo died before yo were placed in the water yo are s bmerged% '='* of 'u-mersion: >% 4% 7% 5% washerwoman?s fingers6hand macerations and skin will peel off after weeks of immersion decomposition +vent ally yo r body will float% ;he only time body won?t float is when yo ?re s bmerged in very cold water%
/ow do we know if these in! ries are post-mortem or ante-mortemH @n! ries m st be seen nder the microscope and if there?s inflammatory reaction seen then yo know in! ries are before death since there are no inflammatory reactions if yo got in! red after yo died% D2+"484. yo die of s ffocation beca se of water within yo r l ngs and yo have to be immersed in water +ffect depends whether yo drowned in fresh or sea water% Lresh water is absorbed into o r circ latory system res lting to vol me overload and hemodil tion$ event ally leading to cardiac arrest% *ea water more concentrated than blood$ so fl id in o r blood will go o t into o r l ngs and there?s p lmonary edema or congestion res lting to hypo#ia$ respiratory arrest$ cardiac fail re and cardiac arrest =ost mortem findings variable and ca se of death hard to prove . stages a% Co str ggle$ yo may find br ises in yo r chest and sho lders b% Co get tired and yo sink c% Co don?t want to breathe in water so yo stop breathing% :eca se we hold o r breath carbon dio#ide goes p so respiratory centers in o r body say breathe so we breathe in water d% ,o gh vomit$ loss of conscio sness% ,onv lsions% @nvol ntary respiratory movements and we keep inhaling water% e% 1espiratory arrest and cardiac arrest% =age 0 of ! -

Co co ld drown within >J min tes @n >J-4JS of the victims laryngospasm can happen and since laryn# remains closed water cannot enter l ngs & dry drowning - ;he rest there?s rela#ation of the airway and water enters the l ngs - ;here can be blood tinged froth in the mo th and nostrils which is more common in seawater drowning% - *and$ silt$ seaweed may be fo nd in the l ngs sign of life before immersion - :U; Linding of foreign material in stomach weighs heavier than finding them in the l ngs beca se there?s a sphincter of some sort in the stomach which does not rela# when yo ?re dead nlike airways which can rela# so water may flow freely% Mechanism of death as a 1es lt of * bmersion is not always classical drowning beca se most of them die < ickly and the res lt is s ally cardiac arrest% No niversally accepted laboratory test to confirm drowning% @f they find diatoms in the blood or l ngs it?s ! st corroborative evidence of drowning% Lorensic pathology - if there?s water in the l ngs victim was alive when he entered the water and if there?s no water in the l ngs it can be dry drowning or death prior to s bmersion% =athologist m st determine if there?s laryngospasm% Q estions to answer in an investigation( >% 4% 7% 5% was the person dead or alive when he entered the water is the ca se of death drowningH @f not what is the ca se of deathH why did the victim enter the waterH why was the victim nable to s rvive in the waterH 2id this victim have other health problems or he was already in! redH .% what were the circ mstances preceding deathH very important to identify the body% B% what were the circ mstances when the body was recoveredH D% a topsy findings U?s > and 4 are very important beca se these will have to be correlated with a topsy findings and if there?s conc rrence between the two then pathologist can make the findings% -
$LC+&+L Alcohol ab se s ally enco ntered in child ab se and rape cases% @t?s a dr g and addictive% Makes one prone to accidents and an homicide% '='* of alcohol into*ication: >% +#citement - lack of inhibition or self-control$ feelings of well-being 4% @ncoordination and ,onf sion loss of nervo s control of yo r body$ bl nting of perceptions$ no m sc lar corrdination$ na sea$ vomiting$ cardiac and respiratory symptoms 7% Narcossis or ,oma deep sleep$ slow breathing$ paralysis of cardiac and respiratory centers which can lead to death Males cannot say that they co ld not have raped a girl beca se they were dr nk beca se erection can happen in the e#citement stage% 0n the other hand$ they take advantage of girls when the girls get into the incoordination and conf sion stage )2r g facilitated se# al ab se) /ow do we diagnose dr nkennessH >% 4% 7% 5% .% B% D% E% alcoholic smell of breath or vomit s dry tong e e#cessive salivation irreg lar behavior bloodshot eyes thickness of speech tremors$ error of coordination and orientation :est tests( blood alcohol content ):A,)$ rine test for alcohol and breath analy"er test =age 1 of ! nderlying ca se of misdemeanor$ assa lt and

;ests for error of coordination( >% 1omberg test 4% eye movements - place a pen in front of his eyes and there?s nystagm s and place the ob!ect on the side of the eyes and there?s !erky movements 7% walk and t rn test walk in a straight line heel to toe - steps then do a < ick t rn 5% 0ne leg stand .% finger to nose test B% let him pick a small ob!ect from the floor witho t falling off D% may also be asked to do some tasks like recite the alphabet in a rapid fashion :A, Normal below J%.S )H Maybe Ma?am meant J%J.)$ %>-%>. S - impaired fac lties$ not fit to drive vehicles$ if & J%>.S and non-habit al drinkers into#icated to the point of staggering$ J%4S habit al drinkers at the second stage and J%.S stage of ,oma% Lactors that affect absorption of alcohol( >% weight- the heavier yo are$ the more water content and since alcohol is sol ble in water$ alcohol is easily absorbed in the water content of o r body so a person with more water content does not easily get dr nk as a person with less water content or weight 4% Latty foods delay alcohol absorption% Alcohol is absorbed in the small intestine b t yo can delay absorption if alcohol stays in stomach%
/nderstanding the Child Child de,elopment: - ,ontin o s process that starts from birth to mat rity$ and goes to define stages and phases% :efore yo can go to the ne#t phase$ the child m st master first the previo s stage% - Now the skills and the comple#ities as he grows older centers all in the physical$ mental$ social$ and emotional f nction of that person% @t affects cognitive development$ emotional development$ and social development% 85 First ) to 0 years of -a-y: - Ne rons start to connect with one another% And the only way these ne rons get connected with one another is if the baby is stim lated at the time when he is born% - +#perience leads to ne ral changes in the brain% - Fis al stim lation sho ld happen in the first B months for the necessary ne ral pathway to develop% - Co are now developing comm nication with the baby% @f yo meet the needs of the child$ that child will learn to tr st yo and will develop an attachment to yo as a caregiver% - @f yo need the baby to master a certain task$ he m st be stim lated at the right time$ given the right e#perience% +#ample$ a B-month-old baby$ yo can?t teach that baby to walk$ since he has not developed the m scles to s pport his own body to walk or stand on his own or balance himself% - ;hey learn to recogni"e their father and mother% Ahen looking at ob!ects and yo hide it right away$ they will think the ob!ect is no longer e#isting% ;hey don?t know the ob!ect is there and event ally as they grow older$ peek-a-boo is an important game for babies$ beca se they will learn yo are still there act ally% - ;o ching is very important for children% Lor children who are not to ched at all$ when they grow p they don?t want to be to ched$ since it?s strange for them to be to ched% - ;hese babies are learning to be a tonomo s$ they are learning how to toilet train and how to be independent and if yo don?t allow them to toilet train themselves$ learn new skills$ they will not develop self-esteem% - ;hey now have the ability to symboli"e% @n the beginning$ they know the mental image of what an apple is% :y the time they are > or 7 years old$ now they can say this is an apple% - *o they are ready to play with other people% ;hey will only do things for the approval of a parent$ they will do things not to be p nished% ;hat?s all what they care abo t for the first 7 years of life% - ;he se# al behavior at this stage is more on to ching and looking% ;hese are ! st learning% *e# al behavior at this age is merely knowing abo t the difference between the vagina and penis% - As early as two years of age$ they already learn the concept of right and wrong% @t has nothing to do abo t pleasing the parents or they are being p nished% Moral control is internali"ed by age B thro gh consistent parental =age 6 of !

monitoring$ praising of good behavior$ identification of parental val es$ etc% 8mpact of a-use at this stage: - Lor babies$ as they grow$ anything the parents do is correct$ so if the babies sees the father and mother < arreling$ they wo ld see that as a normal thing to happen% - Ahen they are ab sed at this age$ especially when it comes to corporal p nishment$ they will only nderstand the pain' they don?t nderstand the reason for the p nishment% - ;hese children are egocentric in thinking% +verything is @$ me mine% ;hey cannot relate themselves to the o tside world% @t?s p to the parents to teach the child to relate with the o tside world by allowing the child to play$ to converse and talk with him$ to interact with his environment$ to do things on his own% - ,hildren have immat re reasoning% ;hey think everything that happens is their fa lt% @f they get physically ab sed$ the child thinks$ G@t?s my fa lt%? - @n co rt$ lawyers sho ld arg e ob!ections o t of the child?s hearing% ;he child will think it?s his fa lt( MMy lawyer is sho ting at me beca se @ probably did something wrong%N 885 Preschool: - May signal the start of mental and behavioral problems% ;he child grows older$ learns new skills$ learns to be ind strial$ etc% @f the child doesn?t learn new things$ she will learn not to take any initiative at all and not develop self-esteem% - Morally$ they will do things to please the other people other than the parents% Now they have a conscience and are aware of social norms% - A 5-year-old victim will say$ M/indi ako magsasabi kahit kanino kasi Gyan ang sabi nila%N 0r M/indi naman ito bad kasi ginawa ni tatay% /indi naman masakit$ nakakakiliti nga%N - A --year-old victim will say$ M:astos Gtong ginagawa ko% K ng mags mbong ako$ kawawa naman si tatay$ baka mak long din siya%N A 5-year-old is more inward-looking as compared with a --year-old% 8mpact of a-use at this stage: - 1esearch shows that those with m ltiple personalities disorders and other forms of disassociation s ffered ab se prior to E or - years old% 8885 $dolescence - ;he offset of adolescence for girls is at >J->5$ boys >7->5% ;hey?re now learning how to think abstractly$ b t their thinking is still egocentric% ;hey cannot handle hypothetical sit ations yet% - ;hey now follow r les and the val es of society$ b t they may not nderstand the concept of val es and r les% : t here$ they?re finally learning who they are% - @nitially$ it was tho ght that the brain develops only in the first 5 years of life$ when all the ne ral connections are being made% @t was fo nd that d ring the adolescent stage$ a lot of the ne ron pathways that were hardly sed got pr ned away and new pathways are being created% Another thing that they learned was that the development of the brain is from the least comple# to the most comple#$ which is p in front% - ;he frontal lobe$ where yo have what is called the neo-corte#$ develops$ the area that reg lates o r emotions$ abstract thinking$ and helps s do o r e#ec tive f nctioning% @n teenagers$ this is the area that?s most developed% ;he frontal corte# reaches f ll mat rity aro nd 4J years old% @t?s the area for planning$ reasoning$ imp lse control$ reg lation of emotions$ learning from e#periences$ and weighing risks and rewards% ;his is the last part of the brain that develops% *ome st dies have shown that this is completed at the age of 4. for males$ earlier in females% - ;he child has preference for physical activity% - ;he person has diffic lty holding back or controlling emotions% ;here?s still no ade< ate control from the prefrontal corte# to the amygdala% )Mood swingsI ;ry to remember yo r teenage years%) - *t dies show that$ altho gh the intellect al activity develops at >B to >D$ psycho-socially$ he?s still not mat re ntil he?s 4.% - ;he adolescent brain is a reward-seeking brain$ this is where they?re s sceptible to pear-press re% At the age of >5$ they tend to commit crimes% - *o the adolescent is act ally still egocentric% ;hey believe that they alone have diffic lties$ no one else can nderstand or sympathi"e% ;hey believe that nothing can harm them% Morality: - Ability to differentiate between right and wrong and nderstand how to make choices% ;his is discernment% Again$ the child?s physical$ intellect al$ emotional$ and mental skills$ as well as his environment will infl ence the =age 7 of !

development of his morality% *o yo have to look into his backgro nd% 8;5 16 C : years old (3oung adulthoodD - ;hey contin e to develop$ emotionally$ physically$ and morally% Now they get into relationships% Ahen it comes to se#$ it?s more on e#perimentation in the early stages% : t as they go into >D->-Kthat?s what yo call late adolescenceKit?s already more for being in a relationship% ;his is part of normal development% @t?s p to yo to g ide yo r children% - 2isting ish between occasional e#perimentation and end ring patterns of tro blesome behaviors% ;hese are s ally harmless e#perimentation% *eemingly behavioral problems are not end ring problems% Ae have to disting ish those problems that arise d ring adolescence and those that have roots in earlier periods% Most teens who have rec rrent problems with the law have problems at home and at school from an early age% )/ello$ Ooavan Lernande"I ;he newspapers keep saying$ Gthe adopted son4#?% ;hey?re ! st r bbing it in% /e might not have developed attachment as a child%) Ahen does attachment developH :efore age >% - Many of the problems adolescence e#perience are transitory in nat re and are resolved at the beginning of ad lthood% - ;he effects of being ab sed are( @t can affect their identity$ their intimate relationships% - @n yo ng ad lthood$ yo learn whom yo care to be with% @n ad lthood$ yo learn what yo care to do and who yo care to be$ what and whom yo take care of%
=age ! of !

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Legal Med Midterms

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Notes on Legal Medicine

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Notes on Legal Medicine

Notes on Legal Medicine

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Notes on Legal Medicine

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Mechanism of 8njury ) ways of infliction of a wound

>% accident 4% self-infliction 7% action of a third party

Notes on Legal Medicine

Notes on Legal Medicine

Notes on Legal Medicine

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