Electric shock therapy uses slides .pptx

For electricity shock

1. Corrosive acids Dr. Narayan Pandey M.D. Agad tantra evum Vidhi Vaidyaka

2. Corrosive poison Sulphuric acid: Physical properties: Colorless, odorless, burning taste, non-fuming Local action: Corrosive nature Indirect action: Shock, perforation of stomach, chemical peritonitis, esophageal stricture Fatal dose:5-10ml Fatal period:12-18hours

3. Sign and symptoms of sulphuric acid Oropharyngeal burns and burning sensation in the throat, epigastric . Dysphagia, dysphonia and dyspnea, vomiting Thirst but drinking causes more vomiting . Vomitus strongly acidic with altered blood and mucous . Teeth is chalky white and brittle Constipation with suppression of urine. Tenesmus pain with mucus containing or altered stool Tenderness over stomach with stiffness of abdomen is present due to peritonitis.

4. Sign and symptoms of sulphuric acid cont.. Abdominal distention is not usually seen. Erosion of skin is seen over mucous membrane of angle of mouth and lips, fingers with blackening, excoriation, perforation of stomach is usually present. Cause of death: Shock, perforation of stomach, peritonitis, laryngeal spasm, malnutrition (due to esophageal stricture) Postmortem finding: Erosion of skin, angle of mouth, lips Corrosion of trachea and larynx Blackish charring (badly burnt and have black) of stomach Perforation of stomach with toxic swelling of the liver and kidneys.

5. Medicolegal aspects Accidental, mistaking it for glycerin Suicidal: common Homicidal: is rare Abortifacient Vitriolage

6. Nitric acid Physical appearance: Colorless. Pungent, choking, burning taste, fuming. Local action: Corrosive, respiratory distress(inhalation) Indirect action: Pain- circulatory failure Fatal dose:10-15ml Fatal period:12-24hours

7. Sign and symptoms of nitric acid Oropharyngeal burns and burning pain in throat, epigastric region Dysphagia, dysphonia and dyspnea Vomiting with strongly acidic vomitus with altered blood and mucous Teeth: yellowish coating, not brittle Constipation, Suppression of urine Tenderness over abdomen with stiffness due to distention (gas in the stomach).

8. Cause of death Shock Perforation of stomach Laryngeal spasm Respiratory distress

9. Postmortem findings: Yellowish discoloration of skin Corrosive skin Laryngeal and trachea congested Stomach wall is soft and ulcerated

10. Medicolegal aspect Accidental and suicide Homicidal is rare

11. Hydrochloric acid poisoning Physical properties: it is colorless, pungent, sour, burning taste, fuming Local action: Blisters Burns Pain Vision loss

12. Symptoms from swallowing Symptoms from swallowing hydrochloric acid may include: Mouth and throat burn, causing severe pain Thirst but drinking causes more vomiting Breathing difficulty due to swelling of throat Vomitus is strongly acidic with altered blood and mucous Severe abdominal pain and stiffness due to distension Severe chest pain Fever Rapid drop in blood pressure (shock)

13. Symptoms from breathing Symptoms from breathing in hydrochloric acid: Bluish color to lips and fingernails Chest tightness Choking Coughing up blood Dizziness Low blood pressure Rapid pulse Shortness of breath Weakness

14. Fatal dose and fatal period Fatal dose: 15-20ml Fatal period: 18-30 hours

15. Cause of death of HCl poisoning Holes (perforations) in the esophagus and stomach may result in serious infections in the chest and abdominal cavities. Laryngeal spasm Pulmonary edema Shock

16. Postmortem findings External Appearances   Clothing – acid burns and stains.  Linear burns- coursing down (in large amounts) the angles of the mouth.  Burns on the lip, chin, front of chest, hands  Swelling of lips and mouth due to inflammation.  Color of burnt areas- firstly grayish-white, then it becomes brown or black and leathery (tough, hard texture).  It stimulates abrasion.

17. Postmortem findings cont.. Internal Appearances Esophagus– Perforation is rare.  Stomach- Mucosal folds are discolored brownish. It contains brownish fluid.  Perforation is rare.  Respiratory passages and lungs: acute inflammation and edema

18. Medicolegal importance Medico Legal Importance  Suicide- It is used in detergent suicides by producing hydrogen sulfide gas.  Accidental- May be confused with antiseptics by negligent medical staff.  Accidental exposures in the chemistry lab include dropping a bottle of HCl, constant inhalation of HCl fumes by chemistry staff, etc.  Homicidal- Very rare due to its corrosive nature.  Abortifacient- Rarely introduced in the vagina to produce abortion.

19. Oxalic acid Physical properties: Colorless, transparent, prismatic crystal and resembles MgSO 4 and Znso 4 . Action: It acts locally as a corrosive on both skin and mucosa, and remotely affects several systems after being absorbed. In CVS : Shock and death In electrolyte system leads to extraction of tissue calcium and that causes hypocalcemia . In Renal system it causes tubular necrosis that leads to uremia and death.

20. Sign and symptoms Poison presents in three forms: Fulminating poisoning : Intake of large doses(>15grams) produces immediate symptoms and death within minutes. There is burning sensation, sour or bitter taste in the mouth with a sense of constriction around the throat and burning pain from the mouth to stomach, radiating all over the abdomen, nausea and eructation are immediately followed by vomiting which contains altered blood, mucous and has coffee- ground appearance (black in color). Severe thirst, diarrhea, electrolyte imbalance and ultimately death occurs. Acute poisoning: All findings are due to hypocalcemia - tingling and numbness of fingers and limbs, weakness, paresthesia, carpopedal spasm ( frequent and involuntary muscle contractions in the hands and feet with associated pain.) , hyperirritability of peripheral nerves (Chvostek/Weiss sign: abnormal twitching of muscles that are activated by the  facial nerve ), tetany, convulsions, coma and death. Delayed poisoning: Characterized by nephritis-uremia , scanty urine, hematuria, albuminuria, oxaluria (envelop shaped calcium oxalate crystals) in the urine.

21. Fatal dose and fatal period Fatal dose: 15-20 grams Fatal period: 1-2 hours.

22. Treatment Gastric lavage with calcium lactate (2tsf/lavage) Antidotes: Lime water , Calcium lactate, calcium gluconate or calcium chloride orally acts as specific antidotes. Calcium gluconate: 10 ml of 10% solution IV frequently. Hemodialysis and exchange transfusion can be helpful. Symptomatic management.

23. Postmortem findings External: No specific findings, Burns may be present on the face and skin. Internal : Mucosa of the mouth, tongue, pharynx and esophagus are corroded. There is desquamation and hemorrhages. Stomach: Mucosa is reddened and punctuate due to erosions, giving velvety red or blackish appearance. Wall of stomach is softened but no perforation and contains gelatinous brown material( due to acid hematin formation) . Kidneys: Swollen and congested. Tubules on histopathology show oxalate crystals. Renal tubules are necroed, primarily the PCT. All other viscera are congested.

24. Medicolegal aspects Usually consumed accidently, mistaken for MgSO 4 , or sodium bicarbonate. Suicidal or homicidal cases are rare due to it sour/bitter taste. Abortifacient to induce criminal abortion.