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
 Characteristic’’s 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
 The breaking point for breath
holding
 Loss of consciousness
 Death
THE CAUSE AND MECHANISM
OF DEAD when the person sink:
:
 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.
Mushroom like appearance
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 :
 Diatoms are microscopic unicelular algae (size 5-500
µm)/fitoplankton.
 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 with wha type we found in the organs
 The result negative is not mean, without drowning
EXAMPLE TYPE OF DIATOM
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
Degree of burns wounds

First
degree/Superficial

Seconds/Partial-
thickness
Third/full-tickness
OR
SEVERITY OF BURN INJURIES
 Depends on :
1. The extend of the burned area
2. The severity of the burn
3. The victim’s 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