Hypothermia rs

Presentation on forensic significance of hypothermia

1. Rijen Shrestha 20-08-2068

2. Introduction Definition: Hypothermia is the condition of the body where the core temperature of the body is below 35 o C Indifferent temperature: Ambient Temperature at which basal metabolic rate is sufficient to maintain normal body temperature.

3. Epidemiology Winters as well as during spring or autumn in colder periods. Outdoors as well as indoors

4. 4 clinical phases of hypothermia

5. Mechanism

6. Guidelines for examination

7. Guidelines for examination

8. Morphological changes

9. Morphological changes

10. Blood changes Mechanism : Mechanism :

11. Skin changes Skin changes in general hypothermia are different from those in local hypothermia Local Hypothermia Mechanism: Freezing of tissue and obstruction of blood supply to the tissue Microscopically: Damage of endothelial cells Leakage of serum into tissue Sludging of red blood cells

12. Three grades of local hypothermia

13. Skin Changes in General hypothermia Frost-bite like injuries Swelling over the nose, ears, hands Red or purple skin lesions and violet patches on knees and elbows or at outside of the hip joint Mechanism: Capillary damage and leakage of plasma along with hemoglobin Frost erythema differs from hemorrhage due to lack of erythrocytes.

14. Gastric mucosal changes

15. Wischnewsky spots

16. Frequency of Wischnewsky spots in studies Author of study N % Wischnewsky, 1895 40/44 90.9% Krjukoff, 1914 44/61 72 % Mant, 1969 37/43 86% Gillner and Waltz, 1971 22/25 88% Hirvonen, 1976 10/22 45% Thrun, 1992 21/23 91.3% Birchmeyer and Mitchell, 1989 15 60% Takada et al. 1991 17 88% Dre β ler and Hauck, 1996 29 86% Kinzinger et al. 1995 30 40% Mizukami et al. 1999 23 44% Bonn and Greifswald, 117/145 80.7%

17. Other Gastro-intestinal lesions

18. Pancreatic changes in hypothermia Focal or diffuse pancreatitis Hemorrhagic pancreatitis Patches of fat necrosis over organ surfaces Increased serum amylase Hemorrhages and focal or diffuse interstitial leucocytic infiltration At autopsy, Hemorrhages into the pancreas parenchyma as well as under the mucosa of the pancreatic duct may be seen.

19. Hemorrhage into core muscles Dirnhofer and Sigrist (1979) Hemorrhages into muscles belonging to the core of the body can be used as a diagnostic criterion of death due to hypothermia . Histology Vacuolated degeneration of subendothelial layers of the vascular walls with a lifting of epithelial cells Misbalance of reduced perfusion and normal oxygen requirement causes hypoxic damage of epithelial cells with resultant raised permeability

20. Lipid accumulation Fatty changes in heart, liver, and kidneys have been described in fatalities due to hypothermia Lipid accumulation in epithelial cells of proximal renal tubules seem to be of high diagnostic significance

21. Grade 0 (x200) Grade +2 (x200) Grade +1 (x200) Grade +3 (x200)

22. Grade 0 Grade +1 Grade +2 Grade +3

23. Grade 0 Grade +1 Grade +2 Grade +3

24. Endocrine glands

25. Conclusion

26. THANK YOU © Rijen Shrestha