Forensic Pathology for Police - Brainshare Public Online Library

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272 11 Drug-Related and Toxin-Related Deaths Cocaethylene has pharmacologic properties similar to, but more powerful than cocaine. Ethylene Glycol Ethylene glycol is the major ingredient within many antifreeze preparations (Disc Image 11.20). It should be considered poisonous and is occasionally encountered in forensic casework. The typical situation is a chronic alcoholic who obtains some antifreeze, likes the sweet taste, and drinks it because of the unavailability of EtOH. Another situation is an accidental ingestion, typically by a child, who also enjoys the sweet taste. Occasional suicidal ingestions are encountered, as are homicidal poisonings. A relatively small amount (100 mL) is considered a lethal dose, and the lethal blood concentration is around 2.4 g/L. Once absorbed, ethylene glycol is metabolized to many compounds, including oxalate. The toxicity is related to CNS depression, seizures, acidosis, and renal failure. Calcium oxalate crystals can be easily identified within the kidney on microscopic examination; polarization helps to identify the crystals (Fig. 11.17). Urine samples can also contain the crystals, and sometimes the urine will fluoresce when exposed to ultraviolet light (a Wood’s lamp) (Disc Image 11.21). Of importance is the fact that many routine toxicology screening methods do not identify ethylene glycol. As such, if it is suspected, a specific test for ethylene glycol should be requested. Alternatively, microscopic sections of kidney can be screened for the presence of calcium oxalate crystals. Fig. 11.17 Calcium oxalate crystals within the kidney in a case of ethylene glycol poisoning Methanol Methanol (methyl alcohol) is also referred to as “wood alcohol.” It is used as a solvent, a fuel, and in certain antifreezes. A small amount is produced in humans. Routes of exposure include ingestion, inhalation, and absorption through the skin.
Amphetamines and Similar Substances 273 It is metabolized to formaldehyde and formic acid. These substances are all toxic, resulting in CNS depression, acidosis, and blindness if the person survives. The minimal lethal dose is relatively small, similar to that of ethylene glycol. Isopropanol Isopropanol is commonly known as “rubbing alcohol.” It is used for first aid and as a method of cleaning the skin prior to needle puncture. It is considered a CNS depressant, but in reality, isopropanol is not toxic in itself, but is metabolized to acetone, which has toxic effects. Small amounts of isopropanol in postmortem blood samples are probably due to one of several possibilities, including conversion from acetone in the setting of diabetic ketoacidosis or starvation, or contamination from “alcohol wipes” used during medical or autopsy procedures. A dose of 250 mL can be lethal. Amphetamines and Similar Substances Amphetamines are stimulant drugs. There are numerous drugs classified as amphetamines, many with specific street names (see below). Several amphetamines have legitimate medicinal uses but most are used solely for recreational abuse. Some of these are referred to as “designer drugs” − they may be ingested, injected, smoked or snorted. The primary effects are on the CNS and cardiovascular systems, including possible hallucinations, psychosis, and elevation of blood pressure. Deaths related to the toxic effects of amphetamines may be related to CNS seizure activity or cardiac arrhythmias. Tolerance may occur with amphetamines. Unlike certain other drugs, where a specific level must be present in order to consider the death as an “overdose,” the mere presence of amphetamines within the decedent, in the absence of another explanation for death, is considered enough evidence to rule the cause of death as being due to the toxic effects of amphetamines. Examples of amphetamines include: amphetamine, methamphetamine, dextroamphetamine (Adderal), methylphenidate (Ritalin), methathinone (CAT), methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”), methyl-2,5-dimethyoxyamphetamine (DOM), and paramethoxyamphetamine (PMA). Some of these (MDMA and PMA) are commonly used at “rave” parties. Street names are numerous and include “uppers,” “speed,” “ice,” “crank,” the “love drug,” “crystal,” “glass,” “tina,” and “pep pills.” Persons known to ingest huge quantities are sometimes referred to as “speed freaks,” and the process in which a person uses large quantities is referred to as a “speed run” or “speed binge.” Chronic methamphetamine users frequently develop “meth mouth,” a condition of poor oral hygiene, resulting in loss of teeth, probably related to a combination of drug-induced teeth-grinding (bruxism), dry mouth (xerostomia), and general lack of concern (Fig. 11.18). Methamphetamine can be produced relatively easily, although “meth labs” can be quite dangerous. Various
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Forensic Pathology for Police, Deat
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Joseph Prahlow Indiana University S
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vi Dedication accepted the free gif
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viii Foreword quality photographs i
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x Acknowledgements Counties, as wel
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Contents Part I Introductory Topics
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Contents xv Hepatobiliary System .
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Contents xvii RespiratorySystem....
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Contents xix Mercury ..............
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Contents xxi Strangulation . ......
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Contents xxiii Negligence/Neglect .
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About the Author Joseph A. Prahlow,
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Chapter 1 Introduction to Pathology
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Introduction to Pathology 5 Table 1
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Introduction to Pathology 7 Fig. 1.
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Introduction to Pathology 9 Fig. 1.
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Introduction to Pathology 11 Fig. 1
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Introduction to Pathology 13 Fig. 1
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Selected References 15 Disc Image L
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18 2 Introduction to Forensic Scien
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Chapter 3 Introduction to Forensic
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Duties of the Forensic Pathologist
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Training and Qualifications of Fore
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Training and Qualifications of Fore
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Selected References 47 Selected Ref
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50 4 Death Investigation Death Inve
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52 4 Death Investigation met in ord
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54 4 Death Investigation leading to
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56 4 Death Investigation Fig. 4.2 A
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58 4 Death Investigation Fig. 4.5 P
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60 4 Death Investigation Fig. 4.9 I
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62 4 Death Investigation apartment
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64 5 Death Certification Fig. 5.1 A
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66 5 Death Certification Fig. 5.4 A
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68 5 Death Certification latter, th
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70 5 Death Certification infrequent
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72 5 Death Certification changes in
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74 5 Death Certification suicides.
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76 5 Death Certification death is i
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78 5 Death Certification use involv
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Chapter 6 Overview of Anatomy and P
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Introduction 83 Table 6.1 (continue
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Introduction 89 Term Definition Tab
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Introduction 91 “mucous membranes
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Specific Organ Systems 93 functions
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Specific Organ Systems 95 Fig. 6.2
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Specific Organ Systems 97 Microscop
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Specific Organ Systems 107 respirat
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Specific Organ Systems 111 water co
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Specific Organ Systems 115 Platelet
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Disc Image Legends 125 Disc Image 6
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Part II General Topics in Forensic
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130 7 The Postmortem Forensic Exami
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Chapter 8 Postmortem Changes and Ti
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Early Postmortem Changes 165 Fig. 8
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Early Postmortem Changes 167 can be
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Decomposition 169 exposed to sunlig
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Decomposition 171 Fig. 8.8 As decom
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Decomposition 173 Fig. 8.12 As deco
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Decomposition 175 Fig. 8.16 If flie
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Postmortem Injuries 177 Fig. 8.20 I
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Time of Death Estimation 179 Time o
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Time of Death Estimation 181 Fig. 8
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Chapter 9 Identification of Human R
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Introduction 187 Fig. 9.2 Badly dec
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Common, Non-scientific Methods of I
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Scientific Methods of Identificatio
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Scientific Methods of Identificatio
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Identification Based on Other Uniqu
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Identification Based on Other Uniqu
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Unidentified Remains 199 Fig. 9.16
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Selected References 201 Disc Image
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Chapter 10 Natural Deaths One man d
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Infectious Disease 207 to as “hyp
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Cardiovascular System 209 refers to
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Cardiovascular System 211 related t
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Cardiovascular System 213 heart int
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Cardiovascular System 215 Aortic An
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Cardiovascular System 217 Vasculiti
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Cardiovascular System 219 Valve Dis
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Page 249 and 250: Central Nervous System 223 Neoplast
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Page 267 and 268: Reticuloendothelial and Immune Syst
Page 269 and 270: Endocrine System 243 infection, dis
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Page 279 and 280: Disc Image Legends 253 Disc Image 1
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Page 327 and 328: Chapter 12 Blunt Force Injury Death
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Special Topics Related to Blunt For
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Selected References 335 Toro K, Szl
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338 13 Gunshot Wound Deaths shotgun
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340 13 Gunshot Wound Deaths Fig. 13
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346 13 Gunshot Wound Deaths targets
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348 13 Gunshot Wound Deaths (a) (b)
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350 13 Gunshot Wound Deaths Image 1
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354 13 Gunshot Wound Deaths Miscell
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362 13 Gunshot Wound Deaths may be
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368 13 Gunshot Wound Deaths X-Rays
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370 13 Gunshot Wound Deaths left-ha
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372 13 Gunshot Wound Deaths NYCLAD
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374 13 Gunshot Wound Deaths Disc Im
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376 13 Gunshot Wound Deaths Disc Im
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Chapter 14 Sharp Force Injury Death
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Stab Wounds 381 to describe the sha
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Stab Wounds 383 describing “clust
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Incised Wounds 385 Fig. 14.9 A supe
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Incised Wounds 387 Although knives
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Special Issues 389 Fig. 14.16 A sta
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Special Issues 391 Defensive Wounds
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Special Issues 393 disorders; howev
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Special Issues 395 area of “radio
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Special Issues 397 Artifacts A fina
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Selected References 399 Disc Image
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Chapter 15 Asphyxial Deaths So Juda
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Suffocation 403 Fig. 15.1 Petechiae
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Suffocation 405 Certification of th
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Suffocation 407 usual occluding sub
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Suffocation 409 being able to expan
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Neck Compression (Strangulation) 41
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Chemical Asphyxia 419 the object ha
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Chemical Asphyxia 421 Fig. 15.21 A
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Other Issues 423 to function proper
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Other Issues 425 (a) (b) Fig. 15.24
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Other Issues 427 the arms/hands bou
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Selected References 431 Prahlow JA,
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434 16 Drowning Physiology and Mech
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436 16 Drowning Fig. 16.2 Thedriver
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438 16 Drowning Fig. 16.4 “Cadave
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440 16 Drowning Finding water withi
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442 16 Drowning Fig. 16.10 Marked d
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444 16 Drowning Fig. 16.14 True ant
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446 16 Drowning Manner of Death A l
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448 16 Drowning Pachar JV, Cameron
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450 17 Electrical Deaths Fig. 17.1
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452 17 Electrical Deaths required f
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454 17 Electrical Deaths death (Fig
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466 17 Electrical Deaths Disc Image
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Chapter 18 Temperature-Related Deat
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Hypothermia 471 constrict, thus con
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Hypothermia 473 Fig. 18.3 Prominent
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Hyperthermia 475 Toxicology testing
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Hyperthermia 477 Fig. 18.8 A 24-yea
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Selected References 479 disease. In
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Chapter 19 Burns and Fire-Related D
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Introduction 483 Fig. 19.3 Example
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Burn Types 485 Fig. 19.5 A postmort
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Burn Types 487 Chemical Burns As me
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Fire Deaths 489 Fire burns represen
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Fire Deaths 491 Fig. 19.11 Dense so
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Fire Deaths 493 Fig. 19.13 Multiple
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Fire Deaths 495 a CO test or an ins
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Fire Deaths 497 Fig. 19.20 Atrue an
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Disc Image Legends 499 Disc Image L
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Chapter 20 Deaths in Infancy and Ch
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Discarded Fetuses/Infants and Fetal
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Discarded Fetuses/Infants and Fetal
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Birth-Related Infant Deaths 507 abr
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Infant Deaths 509 Fig. 20.3 A diaph
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Infant Deaths 511 Fig. 20.6 The pre
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Natural Death in Childhood 513 path
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Accidental Childhood Deaths 515 pon
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Homicidal Childhood Deaths 517 occu
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Homicidal Childhood Deaths 519 Fig.
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Homicidal Childhood Deaths 521 in a
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Classification of Childhood Homicid
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Pediatric Autopsy Considerations 53
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Disc Image Legends 535 Disc Image L
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Selected References 537 Selected Re
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540 21 Miscellaneous Topics Aircraf
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542 21 Miscellaneous Topics CAMI to
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544 21 Miscellaneous Topics To summ
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546 21 Miscellaneous Topics typical
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548 21 Miscellaneous Topics quite o
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550 21 Miscellaneous Topics Fig. 21
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552 21 Miscellaneous Topics The emb
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554 21 Miscellaneous Topics various
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556 21 Miscellaneous Topics stress
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560 21 Miscellaneous Topics ampheta
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562 21 Miscellaneous Topics victim
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564 21 Miscellaneous Topics more se
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568 21 Miscellaneous Topics Organ a
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572 21 Miscellaneous Topics region
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574 21 Miscellaneous Topics Regardi
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576 21 Miscellaneous Topics and lar
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578 21 Miscellaneous Topics some wo
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580 21 Miscellaneous Topics Non-ion
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582 21 Miscellaneous Topics Yersini
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584 21 Miscellaneous Topics water (
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586 21 Miscellaneous Topics to gene
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588 21 Miscellaneous Topics Disc Im
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590 21 Miscellaneous Topics Leclair
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Appendix: Additional Resources and
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Index Note: The letters ‘f’ and
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Index 597 Arnold-Chiari malformatio
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Index 599 closed head injuries, 311
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Index 601 immediate, 68 intermediar
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Index 603 liver demonstrating cirrh
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Index 605 Death investigation syste
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Index 607 pressure related processe
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Index 609 bridging veins, 316 dura
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Index 611 brain, serially-sectioned
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Index 613 Gestational DM, 247 Gesta
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Index 615 Homicide(s), 444 by heart
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Index 617 Infant death, 501-502, 50
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Index 619 Material Safety Data Shee
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Index 621 CNS, 223-229 cerebral pal
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Index 623 Over-the-counter (OTC), 2
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Index 625 Pregnancy-related materna
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Index 627 industrial settings, 486
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Index 629 Smoke and soot inhalation
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Index 631 Thrombophlebitis, inflamm
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