Death by drowning (1).pptx

Death by drowning

1. DEATH BY DROWNING Ms. Gokul Gawas Lecturer Department of Forensic Science

2. Introduction Types of drowning Autopsy Findings Diatiom test , Gettler test Table of contents Causes of death in drowning Medico- legal Importance 02 01 03 04 05 06

3. Introduction 01

4. Introduction Form of violent asphyxial death Caused by aspiration of fluid into air passages, caused by complete or partial submersion in water or other fluids. Death occurs either due to entry of the fluid in the respiratory passages or due to effects of severe water and electrolyte imbalance.

5. 02 TYPES OF DROWNING

6. Wet drowning The commonest form of drowning Water is inhaled into the lungs

7. A. Freshwater Drowning Causes Dilution of the blood up 70% with in couple of minutes. This causes haemodilution resulting in lysis of RBCs – leads to hyperkalaemia and hyponatremia Circulation is overloaded.

8. Fresh water Denatures surfactant, which causes decreased lung compliance. Fall in systolic blood pressure Myocardial anoxia occurs Death results from ventricular fibrillation Death takes 2-3minutes

9. B. Sea water Drowning Seawater is hypertonic solution Due to haemoconcentration – 40% of water from circulating blood is withdrawn into the lungs and massive pulmonary oedema is produced

10. Increased serum sodium concentration (hypernatremia) Pulmonary oedema and myocardial anoxia cause death Delayed death up to 4-5minutes in seawater

11. Refer to acute lung injury resulting from underwater accidents. Water is inhaled through the nose and mouth causing the vocal cords to spasm and shut, preventing air from entering the lungs. It is called "dry drowning" because the victim's lungs do not have water in them. Dry Drowning

12. Delayed drowning was Also known as post-immersion syndrome. When water builds up in the lungs, where it can irritate its lining, causing edema or swelling. Occurs after a gap of half an hour or 48hrs Death due to cerebral anoxia, irreversible brain damage Secondary Drowning

13. Blood vessels dilated by the heating contract suddenly, when cold water is applied to the skin, leading to cardiac arrest. Hydrocution (Immersion Syndrome)

14. Causes of death in Drowning 03

15. Asphyxia Ventricular Fibrillation Myocardial Anoxia Laryngeal Spasm Vagal Inhibition Exhaustion Head injuries Causes of Death in drowning

16. Autopsy findings 04

17. External Appearence Clothing is wet Skin is wet, Cold and clammy. It appears pale due to the contraction of superficial blood vessels. Body temperature falls to the temperature of the water in a few hours.

18. Postmortem lividity is seen over the face, head and neck, and front of the chest as the body floats in an upside-down position and is usually bright pink in color due to the imbibition of oxygen through the water. If the body floats in the water in an upside-down position for a quite longer duration, then the color usually becomes dusky and cyanotic.

19. In turbulent water where the body is in continuous movement, then post-mortem lividity may not develop at all. Cutis anserine or goose fleshings, usually occurs due to contraction of the erector pillae muscles. It appears as a puckered appearance of the skin with hair standing.

20. The rigor mortis sets in early and passes of early due to exhaustion of the muscles. Conjunctivae may be congested with sub-conjunctival ecchymosis present. The hands show cadaveric spasm with grasping of weed, straw, hay etc.

21. After 48 to 72 hours, where the skin of the palms and soles becomes beached, wrinkled and saddened. The epidermis separates from the dermis in glove and stocking fashion from the hands and feet.

22. The froth in drowning is characteristically called as foam and is described as fine, white, copious, tenacious, lathery and persistent frothy foam in the shape of a balloon, seen oozing out from the mouth and nostrils and comes again after being wiped off. Froth formed by the water inhaled into the lungs which causes irritation of the mucosa, leading to secretion of the mucus.

23. Airways contain stiff foam, frothy fluid, gritty gravel, or mud from dirty water. The lungs show large subpleural hemorrhages produced due to rupture of the intra-alveolar partitions beneath the pleura which are called Paltauf’s hemorrhage. Prominent over the lower lobes and interlobar surfaces. INTERNAL APPEARENCE

24. shining pale pink or bluish-red patch usually observed on the anterior surface and margins of the lower lobes of the lung.

25. Lungs are ballooned up, edematous, heavy, and boggy. Rib markings can also be seen over the boggy and voluminous lungs.

26. In saltwater drowning, lungs are much more edematous than in freshwater drowning and appear purple. Water may also be detected from the middle ear resulting from violent respiratory excursions. There may be associated hemorrhage from the middle ear as well.

27. 05 Diatom test, Gettler test

28. Most samples of the water contain microscopic unicellular algae or plankton called diatoms. Diatoms possess salicaceous cell membranes and vary from size 10 to 80 microns. Diatom Test these hard shells, micro-organisms are heat and acid resistant

29. In wet drowning, these micro-organisms get aspirated along with the inhaled water and then pass into the circulation through ruptured pulmonary capillaries or alveolar walls and finally get distributed to various organs of the body and bone marrow.

30. Test for Diatom- Bone Marrow Sample

31. Test for Drowning Medium

32. If both the medium and the marrow contain the same type of diatoms, then it is conclusive evidence of death due to drowning in that medium. Tissue like lungs, kidney, brain etc can also be subjected to this test. The most advantage of this test is, diatoms resist putrefaction. However, a negative diatom test doesn’t rule out the possibility of drowning

33. Gettler Test Also known as the Chloride test. 10ml of blood id drawn from each ventricle of the heart and subjecting it to the estimation of chlorides. The normal value of chlorides in each chamber is 600mg%.

34. In sea water drowning, there is said to be 30 to 40% increase of the chloride level in blood in left ventricle while in freshwater drowning, The chlorides get reduced by 50%. This change is not seen in dry drowning.

35. Medico- legal Importance 06

36. Points that favor antemortem drowning Presence of froth, which is copious, tenacious, lathery exuding from mouth and nostrils. Cadaveric spasm of hands Paltauff’s hemorrhage on the surface of the lungs. Voluminous lungs with crepitus like feel on cut section and rib markings and with rib markings. Presence of sand or mud particles in the larynx. Water in the middle ear and in the stomach. Positive diatom test

37. Accidental drowning is the commonest manner of death followed by suicidal drowning. The former is more common in children, elderly individuals, and persons who cannot swim properly. Suicidal drowning is more common among females. Homicidal drowning is rare but if occurs, will be associated with other findings like associated injuries or poisoning, etc.

38. Death occurring in shallow water should be considered as homicidal unless otherwise proven. In homicidal drowning, the hands and feet of the victim may be tied with weights, etc., any associated injuries found should be evaluated properly and if necessary, a crime scene visit should be done. A good swimmer can also tie hands and feet by himself to commit suicide by drowning.

39. THANKS!