Dr. Khalid Y.

Mattar

 Ethyl Alcohol

is the most widely used drug

in the world.
 It

is a small, water-soluble molecule which

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

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

 Acute intoxication.  Trauma while intoxication
 Effect of chronic abuse

Concentrations of Some Alcoholic Drinks
Beer, lager, Cider (variable)
Table Wine Champagne Wine Spirits (brandy, gin, whisky, vodka) Liqueurs

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

37-42% 15-55%

In lower concentration This action is confined to the cerebral cortex. . Effect on Central Nervous System: Acting on neural cells in a way similar to hypoxia by reducing their activity. (danger of fatal cardio-respiratory failure) 3. with no effect on the lower brain function. 1. In high concentration Coursing depression of the function of the midbrain and medulla affecting the vital centers. 2.

Effect on the Heart: The effect is central as well as vasomotor.  1. Effect on the Urinary system: Diuretic effect causing electrolyte imbalance. 1. Effect on the vascular system: Vasodilatation causing marked heat loss  1. . Tachycardia in low level and bradycardia in high level. 2.

 Stage of Excitement: Drunker in this stage is:1. pleasure Converses well. felling of well being. 3. 4. May disclose secrets. . Sexual desire may be aroused. Talk in vulgar language and behave in an obscene manner. laughs and smiles readily or become angry easily. 2. 5.

slurred speech and staggering gait) May be untidy in his appearance and suffer from hiccups. Incoordination of thought. 5. (confusion. 3. Euphoric or irritable depending on his emotions Nausea and vomiting are common. . speech and action 2. 4. Most offenses and crimes are committed in this stage. Stage of Incoordination: Drunker in this stage is:1.

temperature subnormal and breathing stertorous. If recovered from this stage. Pulse is rapid. sign of hang-over (depression. Stage of Narcosis: Drunker in this stage is:1. 3. Patient passes into deep sleep and responds only to strong stimuli 2. . headache. gastrointestinal irritation) may continue for 24 hours.

nausea and ataxia Vomiting.Blood Alcohol Concentration 30 -50 (mg/dL) 50-100 (mg/dL) General Effect Impairment of driving and similar skills Reduced inhibition. stupor or coma Progressive danger of death due to respiratory paralysis . laughter. and slight sensory disturbance 100-150 (mg/dL) 150-200 (mg/dL) 200-300 (mg/dL) 300-350 (mg/dL) 350+ (mg/dL) Inco-ordination. stupor and possibly coma Danger of aspirating vomit. unsteadiness. and slurred speech Obvious drunkenness. talkativeness.

Gastric Erosion and Hemorrhage 7. Varices Veins 4. Korsakoff’s Syndrome .Some Diseases Related to Chronic Alcoholism Alcoholic Addiction 1. Coronary Artery Disease 5. Pneumonia 6. Fatty liver and liver Cirrhosis 2. Pancreatitis 3.

3. Slurred speech 5. Confused mental state or impaired memory. . Loss of self control. Dilated pupils and fine lateral nystagmus. 4. 6. Unsteady gait.1. Smell of alcoholic in breath 2.

Blood 2. Urine 3. Breath (breath analyser) .1.

Treatment of Acute Alcoholic Intoxication: .

Patient should be kept worm. 4.1. In very serious cases. 3. 5. Isotonic Saline with 5% Glucose. If patient come with respiratory depression. Stomach Lavage with 5% solution of sodium 2. artificial respiration along with O2 inhalation is must. . bicarbonate. peritoneal dialysis or haemodialysis will be required.

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Dr. Khalid y. Mattar .

Drowning is death through the aspiration of fluid into the air passages. death due to drowning can happened when mouth and nose are covered by water. . Complete submersion of the body is not necessary for drowning to occur.

o o Died of injuries after entering the water.o o o o Died from natural causes before entering the water. Died from submersion. o Died from true drowning. Died of injuries or other unnatural causes before entering the water. Died from natural causes while in the water Died from exposure and hypothermia in the water. . but not drowning.

.

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

thickened.1.  Similar changes are seen in the feet . Maceration of the skin:  Imbibitions of water into the skin. spreading to the palm and back of the hand  The skin become sodden. it is seen first on the fingertips. wrinkled and white in color (washerwoman’s skin).

In about 24 hours: it covers the hollow of hand In 2 weeks: the outer layer of the skin may loosen from the inner layer.    From 2-4 hours it start to appear clearly in the tips of fingers. In about 3-4 weeks: nails will start to be loosen After one month the whole skin may slip off like a glove Depending on the water temperature .

faster the adipocere formation    5 .6 weeks in South Europe Within 2 .6 months in North America 5 . Formation of Adipocere: increase the water temperature.3 weeks in Gulf Area (in summer).2. .

2.) 1.Mechanism of drowning (3. 3. which constituted the last external signs of life. (formation of foam at the nose and mouth). lasting for about 1 min (loss of sensibility and hypoxic convulsions occur). The first stage of respiratory arrest. lasting for about 1 min (struggle to reach the surface). Terminal gasping. lasting for 5 – 10 sec. The second stage of respiratory arrest.5 – 4 min. The stage of deep respiration. . lasting for about 1 min. 4. 5. The stage of surprise.

. but still can be accepted as cause of death.Accidental Drowning:  Usually associated with alcoholic or drugs intoxications  Sudden cooling of the body play an important role in cold water drowning (uncontrollable hyperventilation)  Hypothermia is a later danger.

witnesses or circumstantial evidences.Suicidal Drowning:  Difficult to diagnose if there is no farewell letter.   . Person is usually more or less fully clothed. The deceased can be shone to have been under the influence of alcohol or drugs.

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

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The heat source may be dry which resulting burn injuries. . or it could be wet (hot liquids or steam) which resulting scalding injuries.An exposure of living tissue to high temperatures.

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

Death usually results from. and Irregular disruption in case of splashing depending on the gravity. . Usually accidental especially in children and old people.g. There are certain shape of scald usually sharp demarcated edge corresponding to the limits of contact of the fluid. 2. General Features: 1. fluid and electrolyte disturbance. e. 3. : Horizontal level corresponding the fluid level in immersion case. shock. and infections.

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1. maybe associated with carbonization o o o + Forth degree charring of the body . Second degree burning of the whole thickness of the epidermis and exposure of the dermis. Third degree destruction down to the subdermal tissue. o Classification According to severity First degree erythemia and blistering of the skin.

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

Death caused by fire might be:  immediate due to direct thermal injuries (burn). Late (after the first 3 days) due to sepsis or chronic respiratory insufficiency. acute respiratory failure. or fluid loss. Delayed (within first 3 days) due to shock.   . General Features: 1. or more commonly smoke inhalation.

Burned bodies may present with a position called “pugilistic attitude” or “boxer position”.2. often showing a fine superficial heat fracture on its cortical surface and may crumble on handling. . On gross Examination:  Impossible to distinguish acute ante-mortem from post-mortem burns. Skin might split exposing the underlying muscles and bones.    Burned bone has a gray-white color.

. o Cherry-Red coloration of the hypostases. Autopsy findings:  In case of ante-mortem burns. there will be: o High level of CO in the blood (mostly). o Saver edema of the respiratory system.3. blood and internal organs. and in some cases even in the stomach. o Soot particles in the lower airway passage.

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

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