Far Eastern University – Nicanor Reyes Medical Foundation o Person shall become deformed

LEGAL MEDICINE: PHYSICAL INJURIES o Loss of any other member of his body
Notes from Dr. Lising o Loss the use thereof
o Becomes ill or incapacitated for the performance
PHYSICAL INJURY of work habitually engaged in for more than 90
- Effect of some form of stimulus on the body days
- Becomes apparent only if stimulus applied is SUFFICIENT! ARRESTO MAYOR (MAXIMUM) TO PRISION CORRECIONAL
- May be acute or delayed depending on the type of applied (MINIMUM)
stimulus - Becomes ill or incapacitated for the performance of work
habitually engaged in for more than 30 days
CAUSES OF PHYSICAL INJURIES
- Barometric trauma or Dysbarism ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES (ART
- Radiation from Radioactive substances 264 RPC)
- Heat or Cold (Thermal Injury) - Infliction upon another of any serious physical injury
- Electrical Energy - It was done knowing that the substance is injurious or took
- Chemical Energy advantage of the victims weakness or credulity
- Infection - No intent to kill
- Physical Violence
LESS SERIOUS PHYSICAL INJURIES (ART 265 RPC)
PHYSICAL VIOLENCE - Incapacitate the offended party from labor for more than
- Wound is a natural disruption of the anatomic integrity of a 10 days
tissue of the living body. - Requires medical attendance for more than 10 days
- Is used synonymously with physical injury however, - Qualified by:
physical injury does not always result in a wound. o Manifest intent to insult or offend the injured
person
LEGAL CLASSIFICATION o Circumstance adding Ignominy
o Victim is the offender’s parents, ascendants,
MUTILATION (ART 262 RPC)
guardian, curators or teachers
- Intentionally depriving a person, totally or partially of some
o Victim is a person of rank or authority
of the essential organs of reproduction
- Intentionally depriving a person, totally or partially of any
SLIGHT PHYSICAL INJURIES (ART 266 RPC)
part other than that of the essential organs of reproduction
- Incapacitate the offended party from labor for 1 to 9 days
(arresto menor)
SERIOUS PHYSICAL INJURIES (ART 263 RPC)
- Causes injury which do not prevent the offended party from
- Done by:
working nor require medical attendance (arresto menor,
o Wounding
censure)
o Beating
- Illtreatment by deed
o Assaulting
o Administering Injurious Substances without the
PHYSICAL INJURIES INFLICTED IN A TUMULTUOUS AFFRAY (ART
intent to kill
252 RPC)
- There is a tumultuous affray
SERIOUS PHYSICAL INJURIES (ART 263 RPC)
- Participants suffered from serious physical injuries
- Graduated penalty
- Persons who inflicted could not be identified
- Prision mayor
- All those who appear to have used violence upon the
o Person shall become insane, imbecile, impotent
offended party shall be penalized by arresto from 5 to 15
or blind
days
- Prision correcional (medium to maximum)
o Loss of the use of speech, power to hear/smell,
MEDICOLEGAL CERTIFICATE
loss of an eye, hand, foot, arm and leg
- Needed by the Prosecutor to determine which crime to
o Loss of use of any such member
charge the perpetrator
o Becomes incapacitated for the work in which he
- Contains:
was habitually engaged
o NOI (Nature of Incident)
- Prision correcional (minimum to medium)
o TOI (Time of Incident)

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 o DOI (Date of Incident) § Very little material in a motorcycle to cushion
o POI (Place of Incident) the impact.
o List of Injuries
o Conclusion 5. SPORTS INJURIES
o Boxing
CAUSES OF INJURY (OR NATURE OF INCIDENTS) o Wrestling
1. MAULING o Newer sports with attendant risks:
o Results from a violent altercation between 2 § Mixed Martial Arts
persons or groups of persons § Extreme Games
o Injury may be sustained by: § Sky Diving
§ The feuding parties o Injuries common in combat sports
§ Bystanders § Lacerations to the eyebrow and malar region
2. DOMESTIC INJURY AND INDUSTRIAL ACCIDENT (cheek)
o Usually results from the myriad of combinations of § Hemorrhage secondary to the blood vessel
accidents at home or at work. rupture or fracture of the orbital plate of the
o A physician must note whether there is presence of frontal bone known as Spectacle Hematoma
alcohol on the patient. § Hematoma of pinna with auricular cartilage
3. VEHICULAR ACCIDENT necrosis known as Cauliflower ears
o Factors responsible in VAs § Cerebral concussion
§ Human Factor § Subdural hemorrhage (most common)
§ Human Factor § Pontine hemorrhage (known as boxer’s
§ Mental Attitude hemorrhage)
§ Perception Defects 6. STABBING INJURIES
§ Delayed or Sluggish Reaction Times o Anything with an edge could be used for injuries of
§ Disease this type
§ Chemical Factors o Knives
o Environmental Factor o Bolo / Machete
o Mechanical Factor o Broken bottles
o Social Factor o Scalpels
o Pedestrian o Sharpened instruments such as shanks
7. GUNSHOT INJURIES
FACTORS RESPONSIBLE FOR PASSENGER AND DRIVER INJURY
- Impact within structures CLASSIFICATION OF WOUNDS
- Ejection SEVERITY
- Direct impact with other vehicle occupants. - Mortal
- Acceleration-Deceleration Injury (Whiplash) - Non- mortal

PEDESTRIAN-VEHICLE COLLISION KIND OF INSTRUMENT USED

- Primary Impact - Blunt
o Causes injuries such as bumper fractures as well as - Sharp
patterned wounds of the front grills - Sharp edged Instrument
- Secondary Impact - Sharp pointed Instrument
o Run Over Injuries - Sharp edged and sharp pointed
o Usually results to patterned injuries such as tire - Tearing force
tread contusion as well as patterned abrasions
MANNER OF INFLICTION
4. MOTORCYCLE INJURIES - Hit
o Is a the leading cause of vehicular accidents - Thrust/Stab
o Reason for increase: - Gunpowder explosion
§ Increasing number of motorcycles - Sliding or rubbing
§ Relatively small profile of motorcycles
§ Continued failure to use mandated safety DEPTH OF THE WOUND
equipment - Superficial

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 - Deep CONTUSION
- Penetrating (solid organ) - Effusion of blood into the surrounding tissues
- Perforating (communication between inner and outer - Results from blunt force trauma
portion of the hollow organs. - Does not immediately develop after the trauma
- Medicolegal significance:
RELATION OF THE SITE OF APPLICATION OF FORCE AND THE o May correspond to the shape of the object causing
LOCATION OF THE INJURY it.
- Coup Injury o Extent may suggest the degree of force applied
o Injury same site as the application of force o Distribution may indicate character and manner of
- Contre-Coup Injury injury
o Injury opposite site of the application of force - Age can be estimated by the color
- Coup-Contre Coup Injury o Red to purple-recent
o Both the site as well as the site opposite has injury o Green – 4 to 5 days
- Locus Minoris Resistencia o Yellow – 7 to 10 days
o The site of the injury is at the point of least o Gradual resumption of skin tone – 14 to 15 days
resistance
- Extensive HEMATOMA
- Extravasation or effusion of blood in a newly formed cavity
SPECIAL TYPES OF WOUNDS underneath the skin.
- Defensive wounds - Usually formed if force is applied where the bone is
- Patterned wounds superficially located
- Self Inflicted wounds - Also known as “bukol”

TYPE OF WOUNDS DEEP CLOSED WOUNDS

- Closed Wounds MUSCULOSKELETAL INJURIES
o No breach in the continuity of the skin - Sprain
o May be: o Partial or complete disruption in the continuity of a
o Superficial muscular or ligamentous support of a joint.
§ Petechiae o Caused by a blow, kick or torsion force
§ Contusion - Dislocation
§ Hematoma o Displacement of the articular surface of bones
o Deep entering into a joint
§ Musculoskeletal Injuries - Fracture
§ Internal Hemorrhage o Fragmentation of bone resulting loss of continuity
§ Cerebral Concussion - Strain
- Open Wounds - Subluxation
o Abrasion
o Incised Wound INTERNAL HEMORRHAGE
o Stab Wound - Rupture of blood vessel which may result in hemorrhage
o Punctured Wound
o Lacerated Wound CEREBRAL CONCUSSION
- Concussion is a trauma-induced change in mental status,
SUPERFICIAL CLOSED WOUNDS with confusion and amnesia, and with or without a brief
PETECHIAE loss of consciousness.
- Circumscribed extravasation of blood into the - Most commonly caused by Vehicular Accidents and Sports
subcutaneous tissues or beneath the mucous membrane Injuries
- Usually from the capillary systems
- Causes: OPEN WOUNDS
o Asphyxia ABRASION
o Trauma - An injury characterized by the removal of the superficial
o Coronary occlusion epithelial layer secondary to friction against a hard rough
o Clotting disorders surface.

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 - Usually develops at the precise point of impact o Cylindrical structure with a base which houses the
- May exhibit the pattern of the wounding material different parts of the ammunition
- Also known as “gasgas” o May be:
§ Cartridge with a Rim
INCISED WOUND § Rimless Cartridge
- Wound produced by a sharp edged instrument § Semi-rimless Cartridge
- May be: § Belted Cartridge
o Impact cut – like that of a jungle bolo - Primer
o Slice Cut – like that of a knife o Functions to transform the mechanical energy of
the firing pin to chemical energy by its rapid
STAB WOUND combustion
- Wound produced by the penetration of a sharp pointed and o Located at the base of the cartridge and covered by
sharp edged instrument. a small disc of soft metal known as percussion cap
or primer cap
PUNCTURED WOUND o May be:
- Injury resulting from the use of a sharp pointed instrument § Center fire Cartridge
such as an icepick • Percussion Cap located at the center
• Most common
LACERATED WOUND § Rimfire Cartridge
- Tear of the skin and underlying tissues due to forcible • Primer is placed inside the rim of the
contact with a blunt instrument. shell
• Common in 0.22 caliber firearm
FIREARM § Firearm with a pin
- An instrument used for the propulsion of a projectile using • No longer in use due to inherent
expansive force of gases coming from the burning of instability
gunpowder - Powder or propellant
- Includes: o Gunpowder/Propellant
o Rifles o Primary propulsive force in the cartridge
o Muskets o Types of Propellant
o Shotguns § Black Powder
o Revolvers • (80%KNO3, 15%S, 10%C)
o Pistols § Smokeless Powder
• Single base (either cellulose nitrate or
CLASSIFICATION OF FIREARMS nitroglycerin)
- As to wounding power • Double base (contains both)
o Low velocity Firearm (<1,400 fps) § Semi-smokeless Powder
o High power Firearm (>1,400 fps but usually 2,200- • (80%black and 20% smokeless)
2,500 fps) - Bullet or projectile
- As to the Nature of the Bore o The projectile attached to the free end of the
o Smooth bore cartridge case
o Rifled bore o Classification
- As to manner of firing § Shape of the tip
o Pistol - Single handed weapon • Conical
o Rifle - Shoulder fired weapon • Hemispherical
- As to the Nature of the Magazine • Wad cutter (square nose)
o Cylindrical Revolving Magazine • Hollow point
o Vertical or Horizontal Magazine § Presence or absence of jacket
- Components of a Weapon • Naked Lead Bullet
o The Cartridge • Jacketed Bullet
o The Firearm
• Full Jacketed Bullet
• Semi-jacketed Bullet
CARTRIDGE
§ Special Bullets
- The Cartridge Case or Shell

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 • Armour Piercing Bullets BULLET MOVEMENT
• Phosphorus flare or Tracer Bullet - Forward movement
• Plastic Bullet - Spinning Movement
• Bullet with Plastic Sabot - Tumbling Movement
• Bullet with Secondary Explosion - Wobbling Movement
• Soft Point Bullets - Gravitational Pull
FIREARMS
- Parts of the firearm of medicolegal importance: FACTORS RESPONSIBLE FOR INJURIOUS EFFECT OF THE BULLET
o Trigger with firing pin - Inherent on the bullet
o Barrel o Speed of the bullet
- Trigger o Size and shape of the bullet
o Part of the firearm which causes the firing evolution. o Character of the missile’s momentum in flight
o Classification: - Nature of the target
§ Relation of cocking and trigger pressure - Density of the target
• Single Action Firearm - Length of tissue involvement
• Double Action Firearm - Nature of media Traversed
§ Number of Shots on Pressure on the Trigger - Importance of the Organ Involved
• Single Shot Firearm
EFFECTS OF FIRING EVOLUTION
• Automatic Firearm
- Flame
- Barrel
o Brought about by the ignition of the propellant
o Riflings
o Does not usually go beyond a distance of 6 inches
§ Series of parallel spiral grooves on the whole
and in pistols is often less than 3 inches
length
o Causes burning of the skin in contact or near fire
§ Number – varies from 2-12
- Heated, Compressed and Expanded Gas
§ Twist Rate - expression of 1 complete twist
o Brought about by the limited space in the chamber
§ Direction – clockwise or counterclockwise
of the firearm
o Land
o Responsible for the propulsion of the projectile.
§ Space between 2 grooves
o Responsible for the muzzle blast.
§ Determination of caliber
- Smoke
§ Distance of the barrel between 2 lands
o Product of the complete combustion of the
gunpowder and the propellant.
MECHANISM OF FIREARM ACTION
o Light, almost black and only covers the skin.
- The firing pin hits the primer cap which ignites the primer.
o May be readily wiped off.
- Ignition of the primer initiates ignition of the gunpowder
o May be seen up to a distance of 12 inches
which produces pressure and this pressure pushes out the
- Powder Grains
bullet out of the barrel.
o Product of the incomplete combustion of the
gunpowder and the propellant together with
THING WHICH COME OUT OF THE MUZZLE AFTER FIRING
graphite.
- Bullet
o Relatively heavier than smoke.
- Flame
o May not be readily wiped off and penetrates the
- Heated, compressed and expanded gas
dermal and epidermal layer of the skin.
- Residue coming from:
o Responsible for the production of tattoing.
o Bullet
o May be seen up to a distance of 24 inches
o Fragment
- Contusion Collar
o Lubricant
o Caused by the pressure of the bullet on the elasticity
- Primer
of the skin.
- Powder particles
- Powder grains
CHARACTERISTICS OF POINT OF ENTRY
- Soot
- Depends upon:
- Graphite
o Caliber of the Wounding Weapon
- Rust, Dust
o Characteristics inherent to entrance wound
- Scraping from previous fire
o Direction of fire

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 o Shape and composition of missile some
tissue may
o Range be found in
o Kind of weapon the gun
- Point of Entry – contact fire barrel
Contusio - - Distinct Distinct Distinct Distinct
o Where bone is superficial n collar
§ Wound is large and stellate (star) shaped Tattooin Present Present Present Present if less than Absent
g, 30 cm,
§ Edges may be everted
smudgin is present
§ Burns, tattooing, smudging and singeing of g but of
hair is present lesser
density
§ Muzzle imprint on the skin Burns, Present Present Present If within 3 Absent Absent
o Where bone is deeply located and inches,
§ Wound is usually large, circular and without singeing burns may
of hair be
radiating laceration present
§ Edges may be everted, some tissue may be Muzzle Present Present Present - - -
imprint
found in the gun barrel
on
§ Burns, tattooing, smudging and singeing of the skin
hair is present Others - - Blackening - - -
of the
§ Muzzle imprint on the skin present bullet tract
- Point of Entry – near contact fire
o Wound is usually large and circular depending on POINT OF EXIT (OUTSHOOT)
the angle of fire - No characteristic shape
o Contusion collar distinct - Edges are usually everted
o Burns, tattooing, smudging and singeing of hair is - Point of Exit (Outshoot)
present
o Muzzle imprint on the skin present SPECIAL CONSIDERATION ON BULLETS
o Blackening of the bullet tract - Souvenir bullet
- Point of Entry – short range fire about 1-15 cm distance - Bullet migration
o Edges of the wound inverted - Tandem Bullet
o Contusion collar distinct
o Tattooing and smudging is present SHOTGUN WOUNDS
o If within 3 inches, burns may be present - Classes of Shot in a Shotgun Shell
- Point of Entry – medium range fire about 15-60 cm o Birdshot – small and measuring 200-400 shots in the
distance shell
o Edges of the wound inverted o Buckshot- shot ranges from .24 to .33 inch in
o Contusion collar distinct diameter. Std 12 gauge = 9 shots
o Tattooing and smudging (if less than 30 cm) is o Single Projectile or rifled slug.
present but of lesser density - Types of Shotgun
o Burns and singeing is absent o As to number of barrels
- Point of Entry – greater than 60 cm distance § Single barrel
o Edges of the wound inverted § Double barrel
o Contusion collar distinct o As to the manner of firing and reloading
o Tattooing, smudging, burns and singeing is absent § Bolt Action
SUPERFICIAL DEEPLY NEAR SHORT MEDIUM GREATER
§ Lever action
CONTACT FIRE LOCATED CONTACT RANGE RANGE THAN 60
CONTACT FIRE FIRE FIRE CM § Pump Action
FIRE ABOUT 1-15 ABOUT 15- DISTANCE § Autoloading
CM 60 CM
DISTANCE DISTANCE
Wound large and usually usually large - - -
stellate (star) large, and circular
CHEMICAL ENERGY
shaped circular depending - Causes injury when there is a sudden release of potential
and on the
without angle of fire
energy into kinetic or thermal energy causing a sudden
radiating increase in pressure
laceration - Results in an explosion
Edges may be everted may be - Inverted Inverted Inverted
everted,

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 - Types of Chemical Explosion o Secondary to the effect of blast wave to small
o Diffused Reactant Explosion fragments
§ Caused by a mixture of gas and air and o May be metallic or not
initiated by a flame - Other blast wave effects
§ Examples include: o May cause fall related injuries
• Internal Combustion Engine o Damage to the respiratory organs
• A leaking Gasul o Damage to the ear and the tympanic membrane
• Fuel Air Bomb
o Condensed Reactant Explosion RADIATION RELATED INJURIES
§ Caused by a large quantity of heat and gas TYPE OF EXPLOSIVE
produced as a consequence of a rapid - Fission type
chemical reaction in a liquid or solid o One stage weapons
§ Radiating in an outward direction thus o Early weapons such as the Hiroshima and Nagasaki
maximal damage is sustained nearest the bombs
point of origin - Fusion type
§ Subclassified as: o Two stage weapons
Low order - Relies on burning and confinement to o Modern thermonuclear devices
Explosive produce explosions
(Deflagrating - Gunpowder is the best known low SPECIALIZED TYPE OF EXPLOSIVE
Explosive) order explosive. - Neutron bomb
High Order - Type of explosive which detonates o Primarily a bomb which releases massive amount of
Explosive - Detonation is a chemical process radiation in order kill the populace without
which results in the extremely rapid destroying useful structures
decomposition of nitrogenous - Salted bomb
compound releasing heat and gas as o Nuclear devices to which salts are added which
its by-product insure long term radiation would affect the
- Damage is caused by the shock wave
surrounding area
which results from the sudden release
- Suitcase bomb
of heat and gas
o Man portable nuclear devices
TYPES OF HIGH ORDER EXPLOSIVE
- Dirty Bomb
- Stable
o Not a nuclear bomb per se but a conventional
o Stable until detonated by another explosive such as
explosive which is mated to nuclear material
a blasting cap
o Example: dynamite and plastique such as C4 or
OTHER SOURCES OF RADIATION
Semtex
- Natural Sources
- Unstable
o Sun
o Easily detonates from heat, flame, spark or
o From naturally occurring uranium
percussion
- Man made Sources
o Example: Picric Acid and Nitroglycerin
o X-ray and CT Scan
- Clinical nuclear medicine
INJURY IS DUE TO:
o Radiotherapy
- Primary effects of detonation
o Industrial sources (nuclear power plant)
o Occurs when the body is in contact with the
explosive
BAROMETRIC TRAUMA
o Causes complete disruption or fragmentation of the
victim’s body HYPERBARISM
o Compression-decompression effect brought about - Injuries caused by rapid increase of atmospheric pressure
by sudden rise and fall of atmospheric pressure - Examples:
- Secondary to the blast wave o SCUBA Diving
o Body may be thrown some distance and o Caisson Mining (mining the seabed or deep
dismembered riverbed)
o Hollow organs are most heavily damage
- Peppering of shrapnel

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 HYPOBARISM PROOF OF BURNING ANTEMORTEM OR WHILE THE VICTIM IS
- Injuries caused by rapid increase of atmospheric pressure STILL LIVING
- Example: - Presence of smoke in the air passage
o Alpine climbing (High mountain range) o Grayish-black to black amorphous material in the
o Rapid Ascent from depth in SCUBA Diving mucosa of the larynx, trachea or bronchii
o Rapid depressurization of cabin pressure in aircraft o Inflammation of the lung and airway
travelling at more than 30,00 ft. o Smoke Inhalation
- Heat Stiffening
THERMAL INJURIES o Exposure to temp >75°C
- Caused by appreciable deviation from normal temperature o Assumes the pugilistic attitude – lower and upper
- either a decrease or an increase extremities are flexed and hands are clenched
o Cold – frostbite
o Heat – burns or scalds CHEMICAL BURNS
- Results from the action of strong acids and alkalis and other
DEATH OR INJURY FROM COLD irritant chemicals
- Unusual in tropical countries - May cause extensive tissue destruction.
- Frost Bite
- Cause of death ELECTRICAL ENERGY
o Decreased ability of the Red Blood Cell to deliver - Lightning Strikes
oxygen - Electrical Current
o Diminished ability of the tissue to utilize oxygen.
o Vascular effects of cold causes hemostasis and later LIGHTNING
cell death, necrosis and infection - Electrical charge in the atmosphere
- May reach 1 Gigavolts and 10,000 to 200,000 amperes
DEATH OR INJURY FROM HEAT - The distribution is variable and unpredictable
- Either: - Lichtenberg Figures – characteristic of lightning strikes
o Scalds
o Burns ELECTRICAL CURRENT
- Main cause of death is shock
LOCAL EFFECTS - Principal factor is the intensity of the current or the
- Burn amperage
o Dry heat (flame, heated solid, radiant heat)
o Occurs at or above the site of contact FACTORS AFFECTING ELECTRICAL SHOCK
o Singeing of the hair is present - Personal idiosyncracy
o Unclear boundaries - Disease
o Severe o Heart Disease, presence of pacemakers
o Clothing involved - Sleep
- Scalds o Increases resistance to electrical current
o Moist heat or steam
- Amperage
o Occurs at or below the site of contact
o 70-80 in AC
o Absent
o 250 in DC
o Distinct boundaries
- Resistance of the body
o Limited
o Lesser resistance = greater injury
o Clothing usually uninvolved
- Nature of the current
PURPOSES OF INTENTIONAL FIRE OR ARSON o AC vs DC
- To conceal identity and true cause of death - Grounding
- To commit homicide - Duration of contact
- To commit insurance fraud - Kind of conductor
- To commit suicide - Point of entry
- To perpetuate a cause.
MECHANISM OF DEATH
- Ventricular fibrillation

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 o The heart is unable to contract properly leading to o Small pox
loss of cardiac output and circulation o Ebola
o Occurs in Low voltage injury o Lassa
- Respiratory Failure o Anthrax
o Paralysis of the nervous system in charge of
breathing ASPHYXIA
o Occurs in High voltage injury - Asphyxia – absence/loss of O2
- Mechanical asphyxia - In Greek means “absence pulse or hartbeat”
o Prolonged convulsions often result from electrical - “suffocation”; death due to anoxia/hypoxia
injury - Body deprived of O2 while in excess of CO2 (i.e. hypoxia and
hypercapnea)
ELECTRICAL BURNS
- Other names include: 7 MAJOR TYPES OF ASPHYXIA:
o Electrical necrosis - Environmental
o Electric marks - Suffocation
o Current markings - Traumatic or crush asphyxia
- These may be seen at the point of entry and point of exit - Choking
- Metallization - Strangulation
o A specific feature of electrical injury - Hanging
o Metal of the conductor is volatilized or vaporized - Inhalation
and the particles are driven into the epidermis
o Color depends of the conductor CAUSES:
§ Iron = yellow brown - Physical obstruction or passage of air to or from lungs
§ Copper = bluish - Crushing or constriction of chest or abdomen
- Choking
INFECTION - Drowning
- Caused by a pathogen - Strangulation or external constriction of the neck or throat
- May be: - Reduction of the airways due to anaphylaxis or asthma
o Viral - Inhalation of vomit
o Bacterial - Positional asphyxia
o Parasitic o Erotic asphyxia – “breath control play”
o Prions o Breathing in low oxygen environment

- Of medicolegal importance: - Seizure which stops breathing activity

o Weaponized strains pathogens. - Sleep apnea
- Drug overdose
HISTORICAL IMPLICATIONS - Problems during childbirth can lead to newborn
- Used since time of antiquity experiencing asphyxia
- Assyrians – Used fungus to poison enemy wells
- Hannibal – Used snakes on enemy ships MECHANISMS OF DEATH
- Mongols - animal carcasses to poison enemy wells - Compression of jugular veins with or without that of carotid
- Advent of germ theory arteries à reduced O2 reaching the brain, loss of
- Weaponization of botulism and brucellosis consciousness, and even death
- Compression à loss of consciousness
o 10 seconds: if both carotid arteries compressed
WEAPONIZATION
o 1 minute: if only jugulars compressed
- Increasing resistance to environmental factors - Loss of consciousness à few minutes
- Means:
o Adding cancer genes to increase the robustness of STAGES OF ASPHYXIA
the pathogen - Struggle – force breathing
- Combining bacteria with viruses - Quiescence – unconscious, lifeless
- Combining gene enhancers, promoters or suppressors to
- Convulsions – disturbs scene, incontinence
viruses
- Apnea – lifeless, weak pulse
- Using bacterial combinations
- Usually studied pathogens

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 GENERAL SIGNS OF ASPHYXIA
- Cyanosis – plum color
- Congestion – face
- Petechial hemorrhages – distribution of diagnostic
importance
- Edema
CLASSIC SIGNS OF ASPHYXIA
- Congestion of face – due to venous congestion
- Facial edema – increased venous pressure causes tissue
fluid transudation
- Cyanosis – excess de-oxygenated hemoglobin in the venous
blood
- Petechial hemorrhages in the skin and eyes – due to raised
venous pressure
DEATH FOLLOWING ATYPICAL COMPRESSION OF NECK
- Three elderly women living in nursing home
- Asphyxia caused by atypical compression of the neck by
metal bed bars placed on the side of bed to prevent patient
from falling
- minor nature of skin lesions and absence of blood
infiltrations in the anatomic structures of the neck made it
difficult to diagnose the cause of death
PETECHIAL HEMORRHAGES
- does not only occur during vascular compression
OBSTRUCTION OF AIRWAY
- Smothering: covering of the mouth or nose (or external
occlusion) by a plastic bag or in overlay deaths may see
abrasion in a homicidal smothering especially if victim put
up a struggle
- Gagging: tongue is pushed backwards and upwards, and
the gag becomes saturated with saliva and mucus causing
further obstruction by the foreign body and tongue
EXHAUSTION OR DISPLACEMENT OF ENVIRONMENTAL OXYGEN
(SUFFOCATION)
- Occur in tight or confined spaces where toxic fumes are
released from bedding or in drowning
- “pure” asphyxia à rapid, painless loss of consciousness à
death, if nor discovered
- No diagnostic autopsy findings
FAN DEATH
- Originated from South Korea
- Legend says that an electric fan, if left running overnight in
a closed room, can result in the death (suffocation,
poisoning, or hypothermia) of those inside
- Includes air conditioner or fan in a car
LEGAL MEDICINE: PHYSICAL INJURIES
PERINATAL ASPHYXIA
- Condition in neonate where there is the following
combination:
- An event or condition during the perinatal period that is likely
to severely reduce O2 delivery and lead to acidosis; and
- A failure of function of at least two organs consistent with the
effects of acute asphyxia.
- Causes: incidence of antenatal and intrapartum asphyxia is
higher in complicated pregnancies and those associated with
diminished placental reserves:
o Hypertensive disease of pregnancy or preeclampsia
o Intrauterine growth restriction
o Placental abruption
o Fetal anemia
o Post-maturity
o Unphysiological labor (e.g. induction)
o Malpresentation including vasa previa
AUTOEROTIC ASPHYXIA (AEA)
- Using strangulation to enhance the pleasure of
masturbating
THRILL SEEKING
- Most common motivation for adolescent AEA appears to be
thrill seeking and/or sexual experimentation in
combination with a pseudo- masochistic fantasy of
bondage and pain.
- 12 typical autoerotic death scene characteristics have been
reported: location, body position, high risk element, self-
rescue mechanism, bondage, masochistic behavior,
clothing, protective measures, sexual paraphernalia and
props, masturbatory activity, evidence of prior autoerotic
activity, and no apparent suicidal attempt.
- Not all would be present within death scene, the following,
at the very least, must be present:
o Reasonable expectation of privacy
o Evidence of solo sexual activity
o Evidence of prior high-risk autoerotic practice
o No apparent suicidal intent
SPACE MONKEY
- Common game among junior and senior high school
students
- One person hyperventilating then holding the breath while
another person hugs them from behind
- Valsalva maneuver (VM) – hug and breath holding
enhances this effect
o Weightlifters: holding breath and squeezing
abdominal muscles as they lift
o Increase in intrathoracic pressure which creates high
pressure on the great veins (superior and inferior vena
cava) à reduces blood return to heart à reduces
blood output from the heart à reduced blood output
and O2 to brain (cerebral hypoxia) à person faints or
passes out
Notes from Lecture Handouts of Dr. Lising, Caramelmachiatto, No Name Trans
VISION 20|20 10 OF
AD ASTRA PER ASPERA 10