Forensic Medicine

by

Dr. bashar al-momani

Forensic Med.
 Forensic Medicine.

 Forensic medical expert.

 D.D of Unconsciousness

 Tanatology “ science of Death ”

 Forensic Medicine Definition

 Forensic medicine is a branch of

medicine that
applies the principles and knowledge of
the medical sciences to problems in the
field of law.
 Forensic Medicine Definition
 Forensic medicine is a medical science that
studies the
 somatic and psychiatric injuries,
 tanatology,
 medical ethics,
 and professionalism.
 Forensic medical expert

 Forensic medical expert have to know

medical sciences very well

 He must distinguish between diseases and

traumatic injuries
 Characteristics of forensic
medical expert

1. Caution.
2. Intelligent.
3. Good medical knowledge of all medical
branches.
4. Honesty and accuracy.
5. Well knowledge of criminal sciences and
criminal law.
 Duties of forensic medicine are:

1. Autopsy.

2. Examination the live people who have

injuries.

3. Determination the age

 :Duties of forensic medicine are
4. Determination the
 a- Recovery and healing period
 b- Inability degree.
 c- Disability degree.
 d- Incapacity.

5. Determination the mental and

psychiatric situation of accused.
 :Duties of forensic medicine are

6. Studying the medical documents and

files to evaluate the medical practice.

7. Studying the medical documents and

files of accuser for the trial forensic
medical
 :Duties of forensic medicine are
8. Forensic medical laboratory services

1. Toxicology .
2. Histopathology.
3. Serology,
4. Biochemistry,
5. Molecular Biology,
6. DNA laboratory
7. Medical Imagination and Radiology,
8. Microbiology,
9. Physical Technology
 Branches of forensic medical
centre

1. Clinics

2. Morgue

3. Laboratories
 Laboratories -3
a. Forensic Pathology.

b. Forensic Medical Imagination and Radiology.

c. Forensic Toxicological.

d. Forensic Immunological.

e. Forensic Physical Technology

 TANATOLOGY

 It is the science which studies the death

 ;Definition of death

 Death is an argumentative subject until

now, and there is no obvious definition
about it.
 :forms of death
1. Cerebral (Brain) Death.

2. Apparent Death.

3. Clinical Death.

4. Biological Death.
Differential Diagnosis of Death

a. Syncope

b. Coma.

c. Death.
 COMA
 there are different stages of
unconsciousness;

1. Lethargy,

2. Stupor,

3. Coma.
 LETHARGY
 1- Dullness,
 2- Mental disturbance,
 3- Thinking disturbance,
 4- Sever Sleep feeling,
 5- Response to Physical, and Sound
stimulants.
 STUPOR
 - Non response to stimulants,
 - but there is Irritation after stimulation.
 COMA
 - Non response and
 - Non irritation to any stimulant.
 Reasons of coma
 1- Crainiocerebral trauma;
 2- Metabolic encephalopathy
 3- Infections; Meningitis, Encephalitis…..
 4-Tumors.

 Reasons of coma
 5- Massive lesions intra skull.
 6-Other lesions; like…
 Psychiatric,
 Syncope,
 Epilepsy….
;Symptoms and Signs of coma
 1- Disease history
 2-Temperature…
 3- Pulse…..
 4- BP.
 5-Respiratory system
 ;Symptoms and Signs of coma

 6-Skin
 7-Body orifices
 8- Odor of breathing;
 9-Nervous system;
 SYNCOPE
 It is temporary unconsciousness,

 because of disturbance
 in
 the cerebral function.
 ; Reasons of SYNCOPE

 -Vasovagal;
 -Cardiac;
 -Orthostatic hypotension;
-Cerebral artery Obstruction;
 -Carotid sinus;
 ;Reasons SYNCOPE
 -Pain of 9th cranial nerve;
 -Micturition syndrome;
 -Cough syndrome;
 -Hysterical syndrome;

-Hypoglycemia syndrome;
 -Hyper ventilation syndrome.
 ;Diagnosis of SYNCOPE
 -History,
 -Symptoms
 -Signs;
 ;D.D of SYNCOPE
 -Coma,
 -Dizziness,
-Vertigo,
 -Epilepsy.
 Syncope Epilepsy
Immediately, Immediately 1- Onset
except the vagus
type.
None Aura 2- Prognosis
Short Long 3- Unconsciousness
period
Changing from Non relation 4- Posture
posture to
another (Standing to
lying or lying to
standing)
Rare Generalized 5- Convulsions
Rare Generalized 6- Tongue Bite
non Head ache, 7- Sequels
Drowsiness
 DEATH
 Definition:

Death is an argument subject,

because there are many types of death,
so every type has a concrete definition.
 Types of death .
1. Cerebral Death,

2. Apparent Death,

3. Clinical Death,

4. Biological Death.
 Manners of death
1. Violent deaths;
a. Accidents,
b. Suicide,
c. Homicide.

2. Suspicious deaths,
 Manners of death
3. Sudden deaths,

4. Unexpected deaths,

5. Deaths without a physician in

attendance,

6. Deaths in an institution.
 ;Cerebral Death (Brain Death)
 It's the irreversible cessation of cerebral
functions;

 the cardiac and respiratory functions

artificially work by resuscitation apparatus.
 Signs indicating irreversible
:cessation of brain function
 1) unconsciousness (coma),

 2) absence of spontaneous breathing,

 3) moderately or more frequently maximally

dilated pupils, Pupils which do not react to light,

 4) absence of oculocephalic reflex,

 Signs indicating irreversible
:cessation of brain function
 5) absence of corneal reflex,

 6) absence of reaction to painful stimulus in the

area of innervations by the trigeminal nerve,

 7) absence of laryngeal and bronchial reflexes,

 Brain death

 Brain death is very important because it is

the status which physicians can perform the
transplantation of human organs.
 Brain death can be declared with
,certainly if

1. the capacity for reception of stimulation and

reaction to stimulation are completely absent.

2. spontaneous breathing is completely absent,

3. reflexes are absent,

 Brain death can be declared with
,certainly if

 This is reflected by the

4. flat EEG (silence); for 30 minutes,

5. circulation in the brain stops; for 30 minutes

 Criteria for establishing brain
:death consist of

1. EEG silence,
2. caloric vestibular test; no eye movement,
3. electronystagmography; flat curve,
4. echo-encephalography; no echo pulsation;
5. temperature of brain lower than that of the
body,
 Criteria for establishing brain
:death consist of
6. intracranial pressure very high

7. carotid and vertebral angiography; no

contrast filling of the brain vessels, blood
flow; no circulation,
 Criteria for establishing brain
:death consist of

8. determination of brain oxygen consumption,

9. radioisotope scintigraphy, or gamma chamber

examination; verifies cessation of
cerebrospinal fluid circulation.
 :Apparent Death
 It `s low functions of the respiratory,
cardiac, and nervous systems.
 :Apparent Death
 It occurs with some cases like;
 -Electrical injuries,
 -Drowning,
 -Hypothermia,
 -Coma,
 -Narcotics,
 -Hypnotics,
 -Yoga…..
 :Apparent Death
(Vocal letters; A, E, U, O, I);

 A= alcoholism,
 E= epilepsy,
 U= uremia,
 O= opium,
 I= injury.
 :Clinical Death
 Individual is declared dead when there is
irreversible cessation of vital functions,
 the respiratory,
 cardiac,
 and nervous (cerebral);
for continuous period more than 5 minutes.
 :Biological Death

 It is stopping of the
metabolic functions in the cells,
and
in-between them.
 :Biological Death
 it is stopping the function of Golgi
Apparatus.

 it is the stopping of the functions of the

cellular membrane.
 Biological Death:
 It started at the moment of brain death
onset.

 It finished at the death of the last cell in the

organism.

 The occurrence sequence in the cells is the

same of embryological formation of them.
 :Biological Death

 It lasts 20 -24 hours.

 This is the appropriate duration to perform

the transplantation.
 Biological Death:
 The time of Biological Death of the human organs
after the occurrence of clinical death varies from one
organ to the other;
for example;
–Kidney is died within 45 minutes,
–Liver is died within 15 minutes,
–Skin is died within 10 hours,
–Cornea is died within 20 hours.
 Forensic medical Viewpoint of
:DEATH

 it is appearance of postmortem signs:

1. eye postmortem signs,

2. decreasing of the body temperature (cooling),
3. lividity,
4. rigidity.
5. Decomposition.
 Biological death

 Biological death followed the Clinical death.

 Biological death of the Central Nervous

System occurs after 5 minutes of the

cessation of cerebral blood circulation,

 Biological death
 while the muscle tissue survives for a
significant longer time.

 This property is used in the postmortal

electrical excitability tests.
 :Death Stages

 1-Agony
 a) Pre Agony
 b) False Death
 c) Final Agony

 2- Clinical Death:

 3-Biological Death:
 Agony:
a - Pre Agony

 There are disturbances of vital functions

-high or low BP,
- rapid or slow Respiratory rate,
- rapid or slow Pulse

 Period of it is: long in diseases,

but Short in trauma.
 Agony
b- False Death

 The Vital functions stop.

 Period is short (3 seconds - 3 minutes).

 Agony
c- Final Agony
- Expiration; deep
– BP; very high (200-230) ml,
– Pulse; rapid (200-300/ minute),
– Face; brownish,
– Mouth is closed.
– Eyes are half opened.
– Mandibulary muscles are convulsive
(Hypocratic face).
 Agony
c- Final Agony
 If mouth was opened, and eyes were opened
also; it means the dead was surprising.

 If the mouth was opened, and the eyes were

closed; it means that dead was fear.
 Agony
c- Final Agony

 It is the last trial to protect the organism; so

it increases the vital activities,

so the Central arteries of brain are dilated.

 The organism fails to continue life.

 POSTMORTEM SIGNS

 -EARLY Signs,
 - LATE Signs.
Thanks for attending