Resuscitatve Artifacts

injuries observed on the patient’s body during the initial scene investigation.

includes any and all resuscitative efforts by trained and untrained personnel, which may have caused injury to the body.

“IATROGENIC COMPLICATIONS”

What are Resuscitative Artifacts?

◦Laryngeal abrasions from traumatic intubation

◦Skin & soft tissue lesions, rib & sternum fractures from chest decompression

What can we usually find?

Surgical stab wounds for insertion of tubes & drains Laparotomy, tracheostomy, & thoracotomy incisions Incisions for peritoneal lavage Cutdowns of wrists, antecubital fossa, & ankles

Also…

May be misinterpreted! Therapeutic tubing (i.e. IV lining, respiratory

tubes, catheters, tracheostomies) should never be removed prior to sending a body to the coroner

Chart should be reviewed prior to autopsy Treating physicians should be consulted

Resuscitative Artifacts

Physicians, Fire Personnel, and Law Enforcement ◦ resuscitative treatments often cause external or

internal injuries to patients – documentation necessary

◦ resuscitative artifacts and any associated equipment visible on the body should be documented in the investigative report and photographed.

agency and contact name and number of the individual who attempted resuscitation should also be documented in the report for follow-up as necessary.

Pre-terminal Resuscitative Treatment

Relatives, Neighbors, Good Samaritans• the investigator needs to document

resuscitative efforts by photographing any artifacts or injury visible on the patient.

• include the name and contact information of the individual who attempted resuscitation and their relationship to the patient.

Trauma• Any visible trauma to the patient should be

documented by the investigator and photographed for the pre-autopsy report to the pathologist.

Poisoning or Intoxication• Any suspected blockage of the patient’s respiratory

tract from poisoning or intoxication should be investigated, collected, documented, and reported to the pathologist before autopsy. Any suspected poison or toxicant, including medication bottles with pills, cleaning agent bottles should be collected.

Death Due to Trauma, Poisoningor Intoxication

Decompostion and Autolysis

AUTOLYSIS◦ the breakdown of cells and organs through an

aseptic chemical process caused by intracellular changes

PUTREFACTION◦ post- mortem destruction of soft tissues of body

due to action of bacteria & endogenous enzymes

Definition

AutolysisPutrefactionBlack putrefactionButyric fermentationSkeletonization/Dry decay

STAGES OF DECOMPOSITION

first few days after death no physical signs of decomposition yet, but

homeostasis has stopped cellular and soft tissue changes

body enters algor mortis reduction in body temperature following death

FRESH/ AUTOLYSIS

When the body’s cells reach the final stage of autolysis, an anaerobic environment is created allowing the body’s normal bacteria to break down the remaining carbohydrates, proteins, and lipids. The products from the breakdown create acids, gases, and other products which cause volatile organic compounds and putrefactive effects.

Odor, color changes, and bloating of the body. BACTERIA’S ROLE

◦ Activity in the cecum turn the lower part of the abdomen green

◦ break down hemoglobin into sulfhemoglobin which causes the green color change.

◦ enter the venous system causing blood to hemolyze (formation of red streaks in the vein)

formation of gases ◦ enters the abdomen which forces liquids and feces out of

the body◦ enter the neck and face, causing swelling of the mouth,

lips, and tongue.

PUTREFACTION

skin also fragile, leading to skin slippage, making it difficult to move a body. Body hair comes off easily.

discoloration from green to brown transition of the early stage of putrefaction to the advanced decompositional stages.

the body cavity ruptures, the abdominal gases escape and the body darkens from its greenish color. ◦ These activities allow for a greater invasion of

scavengers, and insect activity increases greatly. ends as the bones become apparent, which

can take anywhere from 10 to 20 days after death depending on region and temperature.

dependent on the degree to which the body is exposed.

BLACK PUTREFACTION

body begins to dry out human carcass is first mummified, and then

goes through adipocere formation◦ Adipocere (grave wax) formation loss of body

odor and the formation of a cheesy appearance on the cadaver.

◦ Mummification post-active stage because there is less definite distinction between changes and they are indicated by reduced skin, cartilage, and bone. It is also indicated when all of the internal organs are lost due to insect activity.

BUTYRIC FERMENTATION

Occurs when the last of the soft-tissue has been removed from the body

more highly dependent on soil type and pH, along with presence of groundwater.

DRY DECAY/ SKELETONIZATION

Greenish discoloration of the lower quadrants of the abdomen

Greenish discoloration of the head, neck, & shoulders

Swelling of the face due to bacterial gas formation; “marbling”

Bloating Purge fluid

Sequence of Decompostion

Hemolysed blood leaks out into the tissues Tissues and organs soften and degenerate

into a mass of unrecognizable tissue Adipocere

◦ firm greyish-white to brown wax-like material composed of oleic, palmitic and stearic acids