Dr.I.B.

GD SURYA PUTRA P, SpF

DEPARTMENT OF FORENSIC MEDICINE, FACULTY OF
MEDICINE, GADJAH MADA UNIVERSITY
CONTENT OF LECTURE
Drowning :
Definition of drowning and immersion
Cause and mechanism of death
Characteristics appearence at autopsy
Laboratory examination
Burn
Definition of heat injury, scald, and dry heat
Ante mortem vs post mortem burn
Appearence at autopsy
Laboratory examination
DEFINITION OF DROWNING
There are :
DROWNING ( water entering to the respiratory tract or
lungs),
IMMERSION ( the corpse are covered from water)
SUBMERSION (The face contact with the water)
So if the dead body found out in the water, it not always
mean caused of dead by drowning.
There are two principle :
Contact with the water
Inhaled water into the respiratory tract
PHYSIOLOGY OF DROWNING :
When people sink, this condition will make :
Breath holding
Involuntary inspiration and gasping for air at the
breaking point
Loss of consciousness
Death
THE CAUSE AND MECHANISM
OF DEAD :
THE CAUSE OF DEATH IS DROWNING
THE MECHANISM :
ASPHYXIA (WET DROWNING)
LARYNGEAL SPASM (DRY DROWNING)
A VAGAL REFLEX (DRY DROWNING)
AUTOPSY FINDING :
In External examination:
A washerwoman appearance in the hands and soles
(Look white and wrinkled)
Goose flesh (cutis anserina)
Mushroom like appearance in the nostrils, mouth,
and airways (white foam or hemorrhagic fluid).
Some times we found signs of asphyxia and Cadeveric
spasm.
Internal examination :
A white or hemorrhagic foam is found in the trachea
and bronchi.
Water may be found in the stomach.
There could be dilatation of the right ventricle.
Pulmonary edema
Brain swelling
Congestion
How to make the diagnosis of drowning :
It based on :
The circumstances of death
A variety of autopsy finding
Chemical test /Laboratory test :
- Histopathology/Toxicology
- Destruction test /Diatoms test
- Test of Lungs Juice
- The Gettler chloride test
Laboratory test :
Destruction test/diatoms test :
To identify diatoms in the tissue of drowning victim.
Diatoms are microscopic unicelular algae (size 5-500 m)
Used closed organ sytem (femoral bone more or encapsulated kidney from a
non-decomposed body).
The sample is digested in consentrated acid, then examined the deposit in
standard microscope.
To see what type of diatoms in the water in which the victim drowned, and
then comparison.
The result negative is not mean, without drowning

)
The Gettler Chloride Test
To determine the victim that dead in fresh or
saltwater.
This is analysis of blood in the right and left sides of
the heart.
In freshwater ,the chloride level was high in the right
than on the left.
In saltwater, the chloride level was high in the left than
on the right.
DIFERENT MECHANISM OF DROWNING IN THE
FRESHWATER AND SALTWATER
IN THE FRESWATER :
Much water entering to the alveoli and absorption to
the circulation
Hypervolume and hemodilusion
Ventrikel fibrilation (Hyperkalemia)
Death
IN THE SALTWATER :
Much water entering to the alveoli contain salt.
Water from circulation exits to alveoli
Hypovolume and hemoconsentration
Edema of Lungs
Death
BURNS TRAUMA
Can be divided into five :
1. Flame/Flash
2. Contact
3. Radiant heat
4. Scalding
5. chemical
The definition :
Flame burns : contact of body and flame (flash)
Contact burns : physical contact between the body
and hot object (70 oC or higher)
Radiant heat burns : caused by heat wave
(electromagnetic wave)
Scalding burns : caused by hot liquids (water)
Chemical burns : caused by chemical substance
Flame burns/flash burn
Flash burns are variant of flame burn.
Caused by sudden ignition or explosion of gases.
Typically is a short duration, burn uniformly.
Result in partial-thickness burns and singed hair.
RADIANT HEAT BURN
There is no contact between body and flame, or hot
object.
Initially, the skin appears erythematous and blistered,
with areas of skin slippage.
With prolonged exposure to low heat, the skin will
become light brown and leathery (a welldone turkey).
Initially the hair is intact, if continues long enough,
there will be charring of the body.
The factor determine radiant
heat burn occur :
Temperature of the heat wave
Time of exposure
Clothing of the skin
OR
SEVERITY OF BURN INJURIES
Depends on :
1. The extend of the burned area
2. The severity of the burn
3. The victims age
4. The present of inhalation injuries
In living individual :
The extent of the burn is indicated as the percentage
of total body surface area
This is determined by the rule of nines
The rule of nines
Death caused by fire
It might be :
1. Immediate
2. Delayed
Immediate death
Caused by direct thermal injury to the body or smoke
inhalation
Delayed death
May be two or three days are caused by shock, fluid
loss, or acute respiratory failure and sepsis
 HOW TO DISTINGUSH
ANTEMORTEM BURNS
There is erythematous
surrounding blisters or burns
There is soot in larynx and
trachea
The livor mortis will have a
cherry-red coloration (mean
carbon monoxide intoxication)
Microscopic examination can
be seen signs of inflammatory
reaction
POSTMORTEM BURNS
There is not erythematous
There is not soot in larynx
and trachea
We can not find the livor
mortis with cherry red
coloration
Microscopic examination can
not be seen signs of
inflammatory reaction
 CONCLUSION
Cause of death by Drowning if we find contact with
the water and inhaled the water into the respiratory
tract
There are signs to distinguish ante mortem from post
mortem burns injuries