CDI 2 WEEK 4

• Medico-legal cases involve ailments and injuries that require investigations to determine the cause and responsible party
• Medico-legal cases involve medical situations with legal implications for physicians
• Examples of medico-legal cases include:

  • Assault and battery
  • Accidents like road traffic, industrial traffic
  • Trauma with suspicion of foul play
  • Electrical injuries
  • Poisoning and/or alcohol intoxication
  • Undiagnosed coma
  • Chemical injuries
  • Burns and scalds
  • Sexual offenses
  • Abortion
  • Suicide/attempted suicide
  • Asphyxia from hanging, strangulation, drowning, suffocation
  • Custodial deaths
• Medico-legal investigations involve discovery, preservation, documentation, analysis of evidence, and reconstruction of events leading to injury or death
• Steps in a medico-legal investigation:

  1. Investigation of circumstances, witnesses, history, scene, and medical records

  2. Searching the body

  3. Laboratory examinations including ballistics, DNA, toxicology, serology, x-ray, and chemical analysis
• Definition of Death:

  • Human death is traditionally defined as complete irreversible cessation of heart and lung activity
  • Somatic death is the death of a person
  • Cellular death is the death of cells within a person
• Three Modes of Death according to Sharma, 2011:

  1. Coma - death from failure of vital brain centers

  2. Syncope - death from heart failure

  3. Asphyxia - death from respiratory function failure
• Goals and purpose of death investigation:

  1. To help and serve the living

  2. To seek the truth objectively

  3. To document guilt and protect the innocent

  4. To determine the identity of the deceased

  5. To determine the medical cause of death

  6. To determine the manner of death
• Details noted by scene investigators:

  • General conditions of the scene
  • Specific location of the incident
  • Body position
  • Presence or absence of rigor mortis, livor mortis, body cooling
  • Presence or absence of trace evidence, drugs, weapons
  • Presence of important objects or materials
• Death certification involves completing a medical death certificate with personal information of the deceased, cause, and manner of death
• Mechanisms of Death:

  • Cause of death answers why death occurred
  • Underlying proximate cause of death triggers events leading to death
  • Antecedent cause of death is the immediate disease or injury
  • Immediate cause of death is the final complication directly causing death
• Manner of Death:

  • Refers to the means or circumstances of death
  • Can be natural, accident, homicide, therapeutic complication, or undetermined
• Natural deaths are caused by organ failure due to old age or disease

  • Sudden death occurs within 24 hours without a recognizable cause
  • True sudden death occurs instantly, while non-instantaneous sudden death occurs within minutes
• Natural causes of death according to Sharma, 2011:

  1. Disease of Cardiovascular System

  2. Disease of Respiratory System

  3. Disease of Alimentary System

  4. Disease of Central Nervous System

  5. Disease of Genitourinary System

  6. Systemic Disease

  7. Sudden scare or emotional stress

  8. Diagnostic or therapeutic procedures inducing syncope

  9. Reflex inhibition of vagus due to foreign body in the larynx