HUMAN ANATOMY
Human
Anatomy is the structure of the human body, its Cells ,
Tissues, Muscles, Organs, Blood Vessels and Skeleton.
Cells:
Cells are the basic atom of our body structure. The cell contains the
nucleus and the cytoplasm. This is responsible for the endless
chemical processes that occur in our body to keep it functioning.
This is referred to as metabolism.
Tissues:
Tissue is composed of a group of specialized cells of similar
structure that are united for the performance of a particular
function.
Muscles:
Muscles are the tissues whose cells have the ability to contract,
producing movement or force.
Organs:
Organs are composed of tissues from the four
major tissue groups. Each tissue serves a specialized function within
the organ and all tissues work collectively for a common purpose.
Blood
Vessels: Blood Vessels
are carriers of blood to the various tissues of the body.
Skeleton:
The infrastructure and backbone on which various
structures are laid down.
PHYSIOLOGY
Physiology
is the study of the FUNCTION of the various parts of the
body:
Chapter
2 Anatomy of the Human Body
Anatomy
is the study of the structure of plants, animals, and human beings.
The term “anatomy” comes from the Greek words meaning to
cut up, because knowledge of anatomy was first obtained through
dissection. The bodies of human beings and animals are so complex
that scientists divide anatomy into many branches. Gross anatomy is
the study of structures that can be seen with the unaided eye.
Microscopic anatomy, or histology, is the study of tissues under a
microscope. Comparative anatomy compares the structure of different
animals. Embryology is the study of the development of plants and
animals during their earliest stages.
Human
anatomy includes the study of the structure of the skeleton, muscles,
nerves, blood vessels, and the various organs of the human body.
Knowledge of the structure of the human body is essential for an
understanding of its function in health and disease.
To study the human
body, the body has been divided into:
Head
Thorax
Abdomen.
HEAD:
The Head in turn
includes the Skull containing the brain, the face, the neck & the
structures in them.
The
Skull:
Occupying the skull
cavity (cranium), the adult human brain normally weighs from 2 1/4 to
3 1/4 lb. (1-1.5 kg)
By
means of electrochemical impulses the brain directly controls
conscious or voluntary behavior, such as walking and thinking. It
also monitors, through feedback circuitry, most involuntary
behavior—connections with the autonomic nervous system enable the
brain to adjust heartbeat, blood pressure, fluid balance, posture,
and other functions—and influences automatic activities of the
internal organs.
ANATOMICALLY THE
BRAIN HAS THREE MAJOR PARTS:
-
The
Midbrain, and
The
Forebrain (including the diencephalon and the cerebrum).
Every
brain area has an associated function, although many functions may
involve a number of different areas. The cerebellum coordinates
muscular movements and, along with the midbrain, monitors posture.
The
brain stem, which incorporates the medulla and the pons, monitors
involuntary activities such as breathing and vomiting.
The
thalamus,
which forms the major part of the diencephalon, receives incoming
sensory impulses and routes them to the appropriate higher centers.
The
hypothalamus,
occupying the rest of the diencephalon, regulates heartbeat, body
temperature, and fluid balance.
Above
the thalamus extends the corpus callosum, a neuron-rich membrane
connecting the two hemispheres of the cerebrum.
The
cerebrum, occupying the topmost portion of the skull, is by far the
largest sector of the brain. Split vertically into left and right
hemispheres, it appears deeply fissured and grooved.
Its
upper surface, the cerebral cortex, contains most of the master
controls of the body. In the cortex ultimate analysis of sensory
data occurs, and motor impulses originate that initiate, reinforce,
or inhibit the entire spectrum of muscle and gland activity.
The
entire brain is enveloped in 3 protective sheets known as the
Meninges, continuations of the membranes that wrap the spinal
cord.
The
two inner sheets enclose a shock-absorbing cushion of cerebrospinal
fluid.
The Cranial
Bones
The
bones present in the skull are:
The Facial
Bones
The
face is extending from the scalp to the jaw. The bones present in the
face are:
The
vertebral column is situated in the median line, as the posterior
part of the trunk; its average length in the male is about 71 cm. Of
this length the cervical part measures 12.5 cm., the thoracic about
28 cm., the lumbar 18 cm., and the sacrum and coccyx 12.5 cm.
The
female column is about 61 cm. in length.
The
Vertebral Column is sub divided into :
In
humans, it lies between the neck and abdomen and is also called the
chest. The sternum (breastbone) and ribs in front and the dorsal
vertebrae in back form the skeletal frame of the thorax. Within the
thoracic cavity are the pharynx, larynx, esophagus, trachea, heart
covered by pericardium, lungs covered by pleurae, and thoracic
vessels & nerves.
The
Abdomen: Abdomen, in humans and other
vertebrates, portion of the trunk between the diaphragm and lower
pelvis. In humans the wall of the abdomen is a muscular structure
covered by fascia, fat, and skin.
ABDOMEN
is divided into NINE QUADRANTS:
They
are:
Right
Hypochondrium
Epigastrium
Left
Hypochondrium
Right
Lumbar
Umblical
Left
Lumbar
Right
Inguinal
Hypogastrium
Left
Inguinal.
The
abdominal cavity is lined with a thin membrane, the peritoneum,
which encloses the liver, gall bladder, pancreas, portal vessel &
mesenteries, the stomach, intestines, colon, caecum, rectum &
anal canal; lower abdomen contains kidneys, ureters & urinary
bladder along with urethra & ureathral meatus (pelvic organs),
and spleen.
THE
UPPER LIMB:
The
Bones of Upper Limb include:
The
Carpus (OssaCarpi)
The carpal bones, eight in
number, are arranged in two rows. Those of the proximal row, from
the radial to the ulnar side, are named the navicular, lunate,
triangular, and pisiform; those of the distal row, in the
same order, are named the greater multangular, lesser
multangular, capitate, and hamate.
The
Metacarpus : Meta carpus means behind or distal to
the carpus (hand)
-
Proximal
phalanges
Middle
Phalanges
Distal
Phalanges.
THE
BONES OF THE LOWER EXTREMITY:
THE
KNEE JOINT: containing the upper bone Femur, lower Tibia and
fibula with the capsule and membranes:
-
Calcaneous
bone.
Talus
Navicular
Cuboid
Cuneiform,
First
Cuneiform
second.
Cuneiform
third
Proximal
phalange
Middle
phalange.
Distal
phalange.
Chapter
3 HUMAN ANATOMY AND PHYSIOLOGICAL SYSTEMS.
To
understand the Human functioning and various structures involved in
our body, the physiology is divided into broad categories known as
Systems.These systems are mainly classified as follows:
SKELETAL
SYSTEM OR THE OSSEOUS SYSTEM:
Our body is
constituted of 208 bones, which form the basic skeleton of our body,
connected by ligaments & tendons to form a strong framework. This
is known as the Skeletal System of our body, the crux on which we
stand.
LOCOMOTION
SYSTEM:
The
joints between the bones give the power of movements or locomotion.
The System is known as the Locomotion System, which includes the
structures of the various types of joints & their respective
complex movement mechanics.
MUSCULO-
SKELETAL SYSTEM:
These are
strengthened by the muscles interconnected by tendons, fascia,
cartilages & connective tissues. This constitutes the Musculo-
skeletal System of our body. These help in coordination &
movements along with reflexes to varied stimulus from the external
environment.
INTEGUMENTARY
SYSTEM:
A layer of skin or
integument that protects our internal body from the external
environment covers these in turn. Skin not only helps in the first
line of defense, but also functions as a sensory organ due to the
fine peripheral nervous innervations on it, as a thermostatic organ,
and an excretory organ. This constitutes the Integumentary System of
our body.
The Muscles &
Skin along with tissues & organs are supplied by complex
intricate connections of nerves & blood vessels.
CARDIOVASCULAR
SYSTEM:
The
blood vessels constitute the Circulatory system, which start &
end at the heart, the pumping machine of the body, The Cardiovascular
System. This includes the heart as the central pumping machine with
branches of vessels, the veins & the arteries to the various
organs of the body. The veins carry impure blood from the peripheral
parts & other tissues & organs of the body to the heart. The
arteries carry pure blood from the heart to various parts of the
body.
RESPIRATORY
SYSTEM:
The
Lungs (Right & Left Lungs) constitute a special role in the
purification of the blood in the heart besides the oxygenation of the
body cells & tissues for survival. This constitutes the
CARDIOPULMONARY SYSTEM.
The
Respiratory system includes the Nose, the pharynx, the larynx, the
trachea, the lungs, the bronchus & the bronchioles that end up as
air sacs known as alveoli.
This system not
only helps in breathing but also helps in exchange of gases between
external environment & our lungs & tissues.
Two
types of respiration: EXTERNAL RESPIRATION also known as breathing,
and
INTERNAL
RESPIRATION which is the actual diffusion of gases between the lungs
and the tissues.
DIGESTIVE
SYSTEM:
The
digestive system consists of the organs of the gastro intestinal
tract, which include:The Mouth, tongue, & teeth: Swallowing &
mastication: breaking down solid foods to smaller particles.
Pharynx
& esophagus: Help swallowing & propulsion of food to the
hollow organ stomach by peristalsis.
Stomach:
digestion.
Small
& large intestines: digestion, absorption & assimilation of
food.
Rectum
& anus: absorption of water & excretion of waste products.
The
accessory glands & organs that contribute to the digestive
process are the
Salivary
glands: Lubrication & digestion.
Liver:
the largest gland in the body: digestion, metabolism &
detoxification, regulating lipid & cholesterol, synthesis of
proteins & carbohydrates, reservoir for blood & produce &
store clotting factors, conversion of carbohydrates to glycogen.
Gall
bladder: bile secretion: secreting bile for digestion &
assimilation of fats.
Pancreas:
Exocrine: pancreatic Juice helps in digestion of fats, proteins &
carbohydrates; Endocrine :
The
digestive system mainly helps to provide nutrition to the cells, the
body.
EXCRETORY
or THE RENAL SYSTEM or URINARY SYSTEM:
Group of organs
that produce & excrete urine.
The
most important function is to:
remove the soluble
wastes from the body (excretion),
maintain
proper water & electrolyte balance in the body (acid- base
equilibrium of body fluids) &
maintain
blood pressure, regulate blood volume & osmolarity,
Preservation
& concentration of vital substances to the body.
The Kidneys are the
filter organs that filter the blood fluid & concentrate the
filtrate so obtained to from urine.
Besides
the Kidneys we have the ureters entering into the Urinary bladder, (a
bag where urine is collected) & the urethra, the excretory duct.
In males it opens at the urethral meatus at the tip of the penis. In
females it opens in front of the vaginal opening.
THE
LYMPHATIC SYSTEM:
The Lymphatic
system includes a fluid known as lymph which bathes the tissues, the
fluid derived form blood and is drained by the lymphatic vessels.
This
lymph passes through a series of filters called the Lymph nodes &
is ultimately returned to the blood stream via the thoracic duct.
THE
IMMUNITY SYSTEM:
Besides
lubrication to the tissues, it acts defends the body system by
immunological responses.
These immunity &
the immunological responses are due to presence of Lymphocytes, the
white blood corpuscles; which are the soldiers to fight & evade
any foreign agent entry into our body system.
NERVOUS
SYSTEM:
The nerves
innervate the skin, the muscle spindle, the tissues & organs;
joining at the pivot of the body, the spine that has the spinal cord
& entering or leaving the brain eventually. This forms the
Nervous System of the Body.
The
AUTONOMIC NERVOUS SYSTEM has the two sympathetic trunks that extend
vertically through the neck, thorax, and abdomen, one trunk on
either side of the vertebral column. This system prepares for
“Fight” or “flight” reaction of an individual.
REPRODUCTIVE
SYSTEM:
Reproduction
is a process involving Procreation or generation of species of its
own kinds.
The male
reproductive system organs are the penis, the testes, the epidydymis
& vas deferens, the accessory glands including the seminal
vesicles & the prostate glands.
The
Penis is mainly a urinary excretion organ, the major portion being
the urethra, through which semen and urine are discharged.
Due
to excessive vascularisation of the penis, sexual stimulation causes
penile erection due to vascular engorgement.
The
female reproductive organs are the Uterus, Ovaries, & the
fallopian tubes (Internal reproductive organs) with vagina &
vulva (external genitalia).
Uterus
a hollow pear shaped muscular organ is mainly for childbearing.
The
Ovaries are two oval sexual glands in which ova or eggs are formed.
The
ovaries are located on each side of the uterus, connected by
fallopian tubes: which transfer the ova to the Uterus.
The
vagina is a hollow elastic muscular tube that functions as a birth
canal, passageway for menstrual fluid & receptacle for the semen
during intercourse.
The
vulva is the external genitalia having the labia, clitoris &
hymen: a protective function along with sexual stimulation.
ENDOCRINE
SYSTEM:
The endocrine
system is the group of glands and other structures in the body that
create hormones and release the hormones directly into the
circulatory system.
The
various functions of these hormones are:
Salt
& water balance in the body.
Blood
pressure maintenance.
Metabolism.
Reproduction.
Blood
sugar level regulation.
Nerve
impulse transmission.
Digestion.
The
glands are:
PITUITARY
GLAND: rests at the base of the brain: growth hormone secretion.
HYPOTHALAMUS:
area at the base of the brain interconnected with the pituitary:
THYROID
GLAND: in front of trachea below the Adam’s apple: Right &
left lobes connected by isthmus: T3, T4, TSH: tissue & organ
metabolism with formation of bones. These hormones stimulate the
various target organs, the adrenal glands, the reproductive glands,
& organs of nervous system.
PARATHYROID
GLANDS: 4 oval discs on the back of Thyroid gland: regulation of
blood calcium, phosphates & utilization for bone development,
normal nerve & blood vessel functioning.
SUPRARENAL
OR ADRENAL GLANDS: flattened cup shaped structures on upper part
of each kidney: Steroid production like the glucocorticosteroids
(regulate body’s sugar metabolism & other functions) & the
mineralocorticosteroids (maintain sodium & potassium levels in
body. Also estrogen, and androgens such as testosterone. Adrenaline,
another hormone: stress related release.
PANCREAS:
Insulin for sugar metabolism. Produced by a collection of cells
called as islets of langerhans.
Chapter
4. Bodily
Injuries
Injury
or a wound: means a solution or disruption of the
anatomical continuity of any tissue of the body.
Under
section 44 IPC, an injury is defined as any harm whatever illegally
caused to any person, in body, mind, reputation or property.
Injuries
caused by the application of physical violence to the body are known
as Mechanical injuries.
SIMPLE
INJURY: which is neither extensive nor serious, and which heals
rapidly without leaving any permanent deformity or disfiguration.
HURT:
under section 319 IPC, any bodily pain, disease or infirmity
caused to any person.
GRIEVOUS
HURT: Any injury causing physical, mental continuous
incapacitating pain for more than 20days during which period the
injured person is in severe bodily pain or unable to follow his
ordinary pursuits. Defined under section 320 IPC.
INJURIES
TO THE BRAIN:
CEREBRAL CONCUSSION: Injury to the brain
sometimes resulting in unconsciousness. Sometimes there may be
Concussive head injury or Non -Concussive head injury. There is no
loss of consciousness in Non- Concussive injury. If cerebral
concussion is severe it may lead to Cerebral Edema, means the
Swelling of the brain. In cerebral
concussion there may be mild swelling.
CEREBRAL CONTUSION OR ODEMA: An injury,
which is a direct blow to any part of the brain and this injury is
severe than the cerebral concussion. An
injury to any part of the brain tissue directly is called Cerebral
Contusion. Cerebral
contusion always leads to Cerebral Odema & Capillary Hemorrhages
(bruises) around the brain region. Sometimes Cerebral Oedema may
result in extra dural haematoma, which means collection of the blood
within the brain membrane.
CEREBRAL
LACERATION: A severe form of cerebral contusion
and it may; lead to multiple neurological deficiencies and most of
the time it is irreversible.
CEREBRAL COMPRESSION WITH EXTRA DURAL
HAEMATOMA:
Injury,
which results in collection of blood within the brain membrane.
Sometimes an injury
of this nature keeps the patient for confinement for a period of one
month.
CLASSIFICATION
OF INJURIES:
For
convenience, injuries are discussed under the following heads:
Mechanical
Injuries.
Firearm
injuries.
Traffic
injuries.
Thermal
injuries including chemical injuries, lightning, electricity, and
explosions.
ABRASION:
abrasion is defined as injury involving only the skin & the
superficial surface of the body. E.g. Scratch, Graze, Imprint and
impact abrasion. Heals within a week to 10 days. These are usually
blunt trauma related injuries. Example: Hitting against a
stone or a hard flat surface causing a bruise or abrasion.
Types
of injuries under abrasion are:
Imprint
abrasion (takes the signature or mark of the object.),
Graze
abrasion: some hard object just grazing or scratching across the
skin surface.
CONTUSION/
BRUISE:
A
bruise is an infiltartion of blood into the tissues, following the
rupture of vessels, usually capillaries, as a result of the
application of the blunt force, eg. A stick, astone or a fist.
Usually
it is subcutaneous, and there is no solution in the continuity of
the skin.
It
varies in size from a pinhead bleeding to a large collection of
blood known as Haematoma, e.g. extradural haematoma from injury to
the middle meningeal artery.
Haematoma
is due to rupture of vessels by trauma with subsequent coagulation
blood.
Bruise
is an injury on the surface of the body produced by a sharp blow or
fall. Usually the skin is not torn.
If
the skin breaks and bleeds, the injury is called a laceration. Pain
and redness occur with the swelling. Then the bruise becomes black
and blue within 1-2 days of injury because blood seeps from injured
blood vessels into the flesh. Later, the skin changes to
greenish-yellow on the 3rd or 4th day post
injury and finally to its normal color as the blood breaks down to
pigments that are absorbed gradually into the bloodstream. Ice
packs help relieve painful bruises. A doctor should treat a severe
bruise. Heals with a scar in 7-15 days depending on the extent of
the injury.
CONTUSED
LACERATED WOUNDS: along with a tear on the skin, accumulation of
blood or fluid around the subcutaneous area of the injured tissue is
known as Contused lacerated wound.
LACERATION:
a tear or split or stretch on the skin surface causing a linear tear
injury with extravasation of blood & fluid around the injured
surface. The length is more than the depth of the injury in this type
of injury. E.g. Knife cut superficially over the leg or thigh.This
can be subdivided into:
Split
Laceration/ stretch laceration: truck over any bony part of the
body, causing stretch due to pressure on the skin causing stretch or
a split tear.
INCISED
WOUNDS/ STAB WOUNDS: These are injuries in which the depth is
more than the length of the injury. Generally caused by a knife, a
sword, etc.
PUNCTURE
WOUNDS: wounds caused by pointed objects. The Length of the wound
being minimal but depth can vary depending on the force & length
of the object or weapon causing injury. Can appear superficially like
a punch mark or a needle point mark. At times the injury mark may
forgo the observation of the naked eye. E. g. : Snake bite, Needle
puncture.
PENETRATING
WOUNDS: caused mainly by pointed objects, which have a greater
length than the breadth. The injury is generally through and through
the entire body length. E.g.: has a capacity to penetrate abdominal
viscera or enter through the abdomen & exit through the back.
PERFORATING
WOUNDS: The injury causes an abdominal or thoracic or any organ
to rupture causing the contents of the sac or the organ to spread &
cause infection. E.g. Peritoneum of the abdomen gets ruptured due to
injury. This can cause Perforative peritonitis due to extravasation
of fluid inside the peritoneum, out into the abdominal cavity causing
inflammation & or infection of the contents.
CUT
THROAT INJURIES: These are due to injury across the throat either
due to assault or due to accident. Death is due to rupture of major
blood vessels or vagal shock of nerve Injuries.
FIREARM
INJURIES: These are injuries caused due to gunshot or rifle
injuries. Depending on the range of bullet shot, or type of weapon
used, the injuries can be studied in detail. These can be homicidal,
suicidal or accidental.
CHAPTER NO: 4.
FRACTURES
DEFINITION OF FRACTURES: DEFINED AS ANY BREAK IN
THE CONTINUITY OF A BONE OR CARTILAGE.
SOME
OF THE COMMON TERMINOLOGY USED IN FRACTURES:
Avulsion
Fracture – occurs when a sudden severe muscle pull that tears
the ligaments and muscles from the bone.
Buckle
fracture - when the bone bends but does not suffer a break. This
type of fracture typically occurs in children.
Comminuted
Fracture - when a bone breaks into two or more fragments, or is
crushed.
Compound
Fracture – The overlying skin and soft tissues are disrupted
and parts of the broken bone surfaces penetrate to the outside of
the body. May also be called an Open Fracture.
Greenstick
Fracture - when the bone suffers a crack to only one side,
leaving it injured but intact.
Hairline
Fracture - when the bone is cracked, but the bones are still
connected.
Single
fracture - when the bone is fractured in only one location.
Multiple
fracture: is a break that involves two or more lines of fracture
that are not physically connected each other in the same bone.
Colle’s
fracture - a fracture in the main bone in the radius or the
ulna, both located in the lower arm.
Impacted
fracture: A break that involves two bone fragments that are
firmly driven into each other in the same bone.
Crack
line fracture: A crack like fracture without any break in the
continuity of the bone.
Spiral
fracture: fracture occurs in a spiral manner around short axis
of the bone shaft.
Transverse
fracture: is one that occurs at a right angle to long axis of
the bone.
Oblique
Fracture: occurs at a slant to the long axis of the bone.
Pathologic
fracture: occurs when a bone weakened by tumour or disease,
breaks during normal daily activities or minor trauma.
Fracture
with or without displacement: Along with the break in the bone,
there could be displacement of the bones.
DEPENDING
ON THE EXTENT OF BONE INVOLVEMENT:
Simple
Fracture - when the bone is cracked and then separates, causing
little damage to the soft tissue.
Partial
fracture: involving only ½ or ¼ th or ¾ th of the shaft of
the bone.
Total
Fracture: Complete through & through fracture of the shaft
of the bone.
DEPENDING
ON THE INTEGRITY OF THE OVERLYING TISSUE:
OTHER
TYPE OF INJURIES:
Sprains:
Sprain is an injury to a ligament or to the tissue that covers a
joint caused by sudden over stretching.
Ligaments
are bands of stringy fibers that hold the bones of a joint in proper
position.
The
tissue that covers the joint is called the capsule.
Most
sprains result from a sudden wrench that stretches or tears the
tissues of the ligaments or capsule.
Sprains
of the ankle and wrist are most common, but a person may sprain any
joint. As the ligament is not severed it gradually heals, but this
may take several months.
A
sprain is usually extremely painful.
The
injured part often swells and turns black and blue.
Sprains
should be treated by cold compresses (ice packs) at the time of
injury, and later by restriction of activity Doctors may prescribe
rest, elevation of the injured part, or the application of cold
compresses or elastic bandages to reduce swelling.
Special
types of exercise also may help reduce swelling and speed recovery.
CHAPTER
NO: 5.
BURN
INJURIES/THERMAL INJURIES:
Burns
and scalds rank among the most serious and painful injuries. Most
burns result from contact with burning clothing or other materials or
with electricity or chemicals. Burns caused by hot water or other
hot liquids or by vapors are called scalds.
Burns
can affect all the systems of the body. A serious burn destroys much
of the skin. But it also upsets the circulation of the blood, the
function of various organs, and the body's ability to fight
infection.
RULE
OF NINE: This is a rule made to assess or measure the extent of
burn on the body. Sections 324 and 326 of the IPC deal with
punishments to be awarded for such injuries. The estimation of the
surface area of the body involved is usually worked out by the rule
of nine:
9%:
For the head and each arm.(total 27% only of the anterior or
posterior side)
18%
for the front or back of the trunk.
9%:
for the front or back of each leg.
1%:
for the perineum, thus making a total of 100% for the body.
CLASSIFICATION
OF BURNS. Burns are classified as first-degree,
second-degree, or third degree, depending on the depth of the
burn and the degree of tissue injury.
A
first-degree burn, such as mild sunburn, affects only the surface of
the skin. The burned area is red and tender.
A
second-degree burn involves blistering and swelling, and a watery
liquid may ooze from the wound. Many second-degree burns are caused
by deep sunburn or by contact with hot liquids, or with burning oil
or other flammable substances.
A
third-degree burn penetrates the entire thickness of the skin and
usually part of the tissue underneath. The skin appears white, very
red, or even charred. Most victims have no feeling in the area of a
third-degree burn.
FIRST-AID
TREATMENT: is vital for a victim of almost any burn.
Many
burns are more serious than they seem.
Therefore,
a doctor should examine all burns except the smallest ones.
Even
small burns on the hands and face should receive medical attention.
Any
large burn may cause severe shock.
To
avoid shock, the victim should be kept in a horizontal position.
He
or she also should be covered to prevent as much loss of body heat
as possible.
Small
or moderate burns should be bathed in cold water to ease the pain.
Wrapping
the burned area in a dry, sterile bandage will help prevent
infection.
Burns
that cover a large area should not be treated with cold water.
Wrap
the burned area in a dry, sterile dressing.
Burns
caused by chemicals should be bathed with cold flowing water.
The
water dilutes the chemical and washes it away.
Electrical
burns sometimes cause respiratory failure.
If
this happens, artificial respiration should be administered.
HOSPITAL
TREATMENT:
Emergency
treatment consists of replacing the lost fluid, preventing
infection, and minimizing pain.
Victims
are given a diet high in protein, calories, and vitamins to help to
heal the injuries.
However,
most large third-degree burns do not heal naturally.
Removing
destroyed skin and replacing it with skin grafts treats these burn
injuries.
Victims
of severe burns also receive extensive physiotherapy.
These
injuries cause terrible pain when such parts of the body as the arms
and legs are affected. Physiotherapy can help restore the use of
these body parts.
Treatment
also includes activities designed to ensure the victim's emotional
well being after he or she returns to an active life.
CHAPTER
NO: 6.
INJURIES
DUE TO POISONS:
POISONS
are substances or drugs, which in excessive doses cause harmful
effects on the body.
CLASSIFICATION
OF POISONS:
CORROSIVES:
Organic:
Hydrocyanic
acid.
Carbolic
acid.
Potassium
Cyanide.
Inorganic:
Mineral acids like Sulfuric acid, Hydrochloric acid, and Nitric
acid.
IRRITANTS:
INORGANIC:
(Metallic
Poisons): Mercury, lead, arsenic.
(Non
Metallic poisons): Phosphorus, Iodine & Bromine.
ORGANIC:
Plant/
Vegetable Poisons: Capsicum seeds, Abrus precatorus, Semicarpus
anacardium known as Bhilawanol causes false Blisters; etc.
Animal
Poisons: Snake poisons, Scorpion bites, Bees/ Wasp bites.
NEUROTICS:
Alcohol,
Petrol/
Kerosene,
Pesticides,
Dhatura,
Cocaine,
Cannabis,
Barbiturates,
LSD, and anesthetics, Strychnine, Arrow poisons like Curare &
Conium.
RESPIRATORY:
CARDIAC
POISONS:
Aconite,
digoxin,
Nicotine
(Tobacco).
INJURIES
DUE TO POISONS:
Vitriolage:
is known as throwing of acid or irritant chemicals on the victim
with malicious or ill intent.
The
Chemical burns or irritant burns can also be caused in industrial or
chemical plants where workers are working with such hazardous drugs
or chemicals.
The
injuries possible mainly are accidental or suicidal or homicidal or
assault.
The
chemicals thrown commonly are Sulfuric acid, nitric acid, bhilawanol
juice, and organic acids.
Chemical burn generally involves carbonization and
corrosion of the tissues. Irritants cause burns, irritation &
infection.
Vitriolage
falls under Grievous injury and as per IPC 320, it is a punishable
offence.
Snake
bite/ Scorpion bites: This can be mainly accidental, rarely
homicidal or suicidal.
Insecticide
poisons/ Kerosene are mainly suicidal or accidental Injuries.
Alcohol
or neurotic poisons do not cause any bodily injuries but cause
accidents due to loss of muscular coordination after intoxication.
Deaths have been reported to be also due to suicidal injections or
ingestion of heavy doses of these poisons.
Respiratory
& cardiac poisons can be accidental or suicidal or
homicidal.
Irritant
Poisons are mainly environmental hazards or industrial hazards.
Most
ailments fall under Occupational hazards for industrial workers.
Phossy jaw, an infection of the bones with suppuration leading to
deterioration of the Jaw to the extent of surgical removal, is seen
in Phosphorus factory workers.
Mercury or lead poison can be an environmental hazard
or industrial hazard. Mercury causes a MAD HATTER’S SHAKE disease.
The
fall of Roman Empire was because of Lead Poisoning.
Bangladesh
has an epidemic of Arsenic poisoning since the earth levels of
Arsenic are more & people use ground water for consumption.skin
or inhalation injuries are common.
CHAPTER
NO: 7.
DRUNKEN DRIVING
As
per the Insurance policies, the injuries or accidents as a result or
under the influence of alcohol are exclusion. Let us get an insight
into the basic modes for diagnosing a drunken driver/ intoxicated
person.
DRUNKENNESS:
a condition which results from excessive alcohol and the person
concerned is so much under the influence of the alcohol that
He
loses control over his mental faculties.
He
is unable to perform the duties on which he is engaged at a
particular time, and
He
may be a source of danger to himself or to others.
WHY
THE CRIME OF "DRUNKENNESS:
1.
A Moral Hazard: to be or not to be: to delineate and to find a
perfect example of how the law reaffirms the moral boundaries of
drunkenness.
2.
About 40% of all traffic deaths and over 2,000,000 automobile
injuries are alcohol-related.
Alcohol
abuse, despite signs of decline, is still at epidemic proportions.
3.
Family or wife abuse with assault or battery.
4.
Physical and moral deterioration.
5.
Crimes like Rape/ sexual Murder.
MOTOR
VEHICLE ACT:
Under
Section 185 of the Motor Vehicle act, Whoever, while driving, or
attempting to drive, a motor vehicle-
Has,
in his blood, alcohol-exceeding 30mg per 100ml. Of blood detected in
a test by a breath analyzer, or
Is
under the influence of a drug to such an extent as to be incapable
of exercising proper control over the vehicle,
Shall be punishable for the first offence with
imprisonment for a term which may extend to 6 months or with fine
which may extend to Rs. 20,000/- or with both, and for a second or
subsequent offence, if committed within 3 years of the commission of
the previous similar offence, with imprisonment for a term which may
extend to 2 years, or with fine which may extend to Rs. 3000/- or
both.
Explanation:
For the purposes of this section, the drug or drugs specified by the
Central Government in this behalf by notification in the official
Gazette, shall be deemed to render a person incapable of exercising
proper control over a motor vehicle.
ALCOHOL INTOXICATION
TESTING:
THE OTHER TESTS BESIDE Drunkometer are
CLINICAL TESTS like:
(Horizontal
gaze nystagmus) testing / eye gazing/ Eye jerks following an
object moved laterally.
Eye
jerks trying to use peripheral vision
Point
at which jerking first occurs estimates BAC:
Evidentiary
tests: Tests that require the suspect to do
something:
Blow
into a tube,
give
blood,
stand
on one leg,
walk
a line, and
Touch
their nose.
Preliminary
tests: Test that don't require the suspect to do
anything:
Erratic
driving
staggering,
Memory,
Reflexes,
slurring,
Erratic
Writing.
having
bloodshot eyes,
The
odors associated with alcohol.
BLOOD
TESTS:
The
BEST MEDICO-LEGAL SCIENTIFIC METHOD for determining anything
close to "impaired judgment" is an estimate of the amount
of alcohol that has flowed through the blood vessels of the brain.
URINE
TESTS
(1)
Chemical tests;
(2)
Biochemical tests; and
(3)
Gas chromatography.
Gas chromatography is the most widely used because
it can distinguish alcohol from ketones and aldehydes (a problem that
exists with diabetics and people with other disorders that blood
tests are not capable of controlling for)
DUTIES OF A MEDICAL OFFICER:
If a police brings an accused for examination
due to alcohol intoxication, the police examines the patient with
preliminary details and identification marks, with or without
consent.
Based on general examination as mentioned in
preliminary and evidentiary tests, he makes his diagnosis and
interpretation.
Blood sample, with urine sample sent to the
chemical analyzer for alcohol detection.
He retains one copy, another handed over to
the investigating officer and third is given to the executive
magistrate.
CHAPTER
NO: 8.
Snake Bite
"She
died because she never knew
These simple little rules and few:
The
snake is living still"
- H. Belloc.
OPHITOXAEMIA
is the rather exotic term that characterizes the clinical spectrum of
snakebite envenomation.
Elapidae
which includes common cobra, king cobra and krait,
Viperidae
which includes Russell's viper, pit viper and saw-scaled viper and
Hydrophidae
(the sea snakes).
KING
COBRA,
COMMON
COBRA,
RUSSELL'S
VIPER,
KRAIT AND
SAW-SCALED
VIPER.
Neurotoxic,
Vasculotoxic
And
Myotoxic.
First
Aid For Snakebites:
Many
health-care professionals embrace just a few basic first-aid
techniques.
Wash
the bite with soap and water.
Immobilize
the bitten area and keep it lower than the heart.
Get
medical help.
If
a victim is unable to reach medical care within 30 minutes, a
bandage, wrapped two to four inches above the bite, may help slow
venom.
A
suction device may be placed over the bite to help draw venom out of
the wound without making cuts.
Suction
instruments often are included in commercial snakebite kits.
Allow
bite to bleed freely for 15-30 sec.
Cleanse
and rapidly disinfect area with Betadine.If bite on hand, finger,
foot or toe, wrap leg/arm rapidly with 3" to 6" Ace or
crepe bandage past the knee or elbow joint immobilizing it.
Leave
area of fang marks open. Apply Extractor immediately as well. Wrap
no tighter than one would for a sprain. Make sure pulses are
present.
Apply
Sawyer Extractor until there is no more drainage from fang marks.
Extractor can be left in place 30 min or more if
necessary.
It
also aids in keeping the venom from spreading by applying a negative
pressure against the tissue where the venom was initially deposited
and creates a gradient, which favors the movement of venom toward
the Sawyer's external collection cup.
If
extractor not available: Apply hard direct pressure over bite using
a 4 x 4-gauze pad folded in half twice.
Tape
in place with adhesive tape.
Soak
gauze pad in Betadine(tm) solution if available and not allergic to
iodine’s
Strap
gauze pad tightly in place with adhesive tape
Overwrap
dressing above and below bite area with ACE or crepe bandage, but
not too tight. No tighter than you would use for a sprain.
A
good rule of thumb is to make the band loose enough that a finger
can slip under it. Make sure pulses are present.
Immobilize
bitten extremity, use splinting if available.
If
possible, try and keep bitten extremity at heart level or in a
gravity-neutral position. Raising it above heart level can cause
antivenom to travel into the body.
Holding it down, below heart level can increase
swelling.
Antivenom
is the only and best treatment for snakebite and you must get as
much as is necessary as soon as possible. Antivenom administration
should not be delayed.
What
Not to Do if Bitten by a Venomous Snake
Contrary
to advice given elsewhere DO NOT permit removal of pressure
dressings, Sawyer or ACE bandage until you are at a facility ready
and able to administer antivenom.
As
soon as the dressings are released the venom will spread causing the
usual expected problems of venomous snakebite.
The
hospital at this time must be prepared to administer the antidote
(antivenom)*
Do
not eat or drink anything unless Okayed by medical sources
Do
not engage in strenuous physical activity
Do
not apply oral (mouth) suction to bite
Do
not cut into or incise bite marks with a blade
Do
not drink any alcohol or use any medication
Do
not apply either hot or cold packs
Do
not apply a narrow, constrictive tourniquet such as a belt, necktie
or cord
Do
not use a stun gun or electric shock of any kind.
Do
not remove dressings/elastic wraps until arrival at hospital and
antivenom available.
Do
not waste time or take any risks trying to kill, bag or bring in
offending snake
Remember
ACE or other wide bandaging must not be wrapped so tight as to cut
off systemic venous or arterial circulation.
Properly
applied such bandages will NOT compromise the systemic circulation.
No
ice or any other type of cooling on the bite. Research has shown
this to be potentially harmful.
No
incisions in the wound. Such measures have not been proven useful
and may cause further injury.
TREATMENT:
Medical
professionals sometimes disagree about the best way to treat
poisonous snakebites.
Procedures
such as fasciotomy, a surgical treatment of tissue around the bite,
have some supporters.
But
most often, doctors turn to the antidote to snake
venom--antivenin--as a reliable treatment for serious snakebites.
There
are two types of antivenin (sometimes called "antivenom")
in use today.
They
are derived from antibodies created in the blood of a horse or sheep
when the animal is injected with snake venom.
In
humans, antivenin is injected either through the veins or into
muscle, and it works by neutralizing snake venom that has entered
the body.
Because
this antivenin is obtained from horses, snakebite victims who are
sensitive to horse proteins must be carefully managed.
The
danger is that they could develop an adverse reaction or even a
potentially fatal allergic condition called anaphylactic shock.
The
enzyme treatment also allows the antivenin to be cleared from the
body more rapidly, so that additional treatments may need to be
given.
POST
MORTEM APPEARANCES:
Two
bite marks about 1 cm deep in cases of elapids and 2.5 cm deep in
case vipers may be found.
These
should be searched for with a magnifying lens if not visible to the
naked eye.
There
is swelling and cellulitis about the bitten part and in case of
viper, the local appearances are more striking due to considerable
oozing of blood from the site of puncture.
The
blood is generally fluid and haemolysed causing early staining of
the blood vessels.
If
the venom is predominantly neurotoxic, there are no definite
appearances indicating cause of death except the signs of asphyxia
(decreased air/oxygen supply demand to the lungs).
If
the venom is predominantly vasculotoxic, there are hemorrhages in
the lungs and also extravasations of blood in the serous membranes
such as pleura and pericardium.
Hemorrhages
are noted under the cardiac tissue walls (Endocardial) in the left
ventricle, septum and papillary muscles.
Petechiae
are also found within the kidney pelvis and mucosa of the urinary
bladder stomach and intestines.
The
regional lymph nodes are swollen and haemorrhagic.
Blood
fails to clot normally even after addition of thrombin because of
the extremely low level of fibrinogen.
Arterioles
and capillaries are characterized by blurred walls and swollen
endothelial cells.
Other
findings include necrosis and desquamation of the renal tubules and
cloudy swelling and granular changes in the cells of other organs.
PRESERVATION
OF VISCERA:
Mainly
the skin and subcutaneous tissue at the site of bite is taken 2” x
2” x2”. A Control sample should also be taken from the opposite
limb or bite site for comparative study.
Routine
viscera as in case of any poisoning or unnatural death.
MEDICOLEGAL
ASPECTS:
Generally
accidental, rarely homicidal and still rarely suicidal (Cleopatra
had killed herself by an asp letting her bite the left breast).
Sometimes
allegations of death due to snakebite are made after killing a
person by throttling or poisoning.
CHAPTER
NO: 9.
CRITICAL
ILLNESSES
SIX
MAJOR CRITICAL ILLNESSES ARE:
MYOCARDIAL
INFARCTION.
CORONARY
ARTERY DISEASE.
STROKE/CVA.
RENAL
FAILURE: ACUTE & CHRONIC.
CHRONIC
OBSTRUCTIVE PULMONARY DISORDER.
CANCER.
I.
MYOCARDIAL INFARCTION:
Commonly
called as a HEART ATTACK, is the death or necrosis, of the cardiac
muscle tissue resulting from inadequate blood supply.
This
is a condition arising due death or necrosis of the cardiac muscles
due to insufficiency or lack of blood supply to the cardiac tissue.
The main cause for a heart attack or MI is an Ischaemic heart
disease.
Ischemic
heart disease is caused by an imbalance between the Cardiac blood
flow and the metabolic demand of the cardiac muscle. Reduction in
heart vessel blood flow is related to progressive fatty plaque
formation & thickening of the arteries (atherosclerosis) with
increasing occlusion of coronary arteries. Blood flow can be further
decreased by superimposed events such as sudden vessel spasms,
formation of blood clot in the vessels, or circulatory changes
leading to decreased organ perfusion.
Myocardial
infarction occurs when a fatty atherosclerotic deposit or a blood
clot suddenly blocks one of the coronary arteries cutting off blood
supply and oxygen from a section of the heart thus causing death of
that portion of heart supplied by that particular artery.
CLINICAL
PRESENTATIONS: severe crushing pain in the chest, mainly in the
center with or without radiation to the left upper limb, neck, back
and the jaw. May also present with severe perspiration, nausea.
DIAGNOSIS:
Electro
Cardiogram Changes ECG changes.
Creatinine-Phosphokinase
– MB enzyme levels, CPK-MB in the blood stream.
Holter
Stress test or TMT (Treadmill Test), after complete recovery from
infarction.
Cardiac
enzyme levels in blood.
Echocardiography
(color Doppler)
Coronary
Angiography.
PROGNOSIS:
If
come out of the first four hours of MI, prognosis is good.
If
severe/ massive infarction affecting the vital areas of the heart
may cause death.
If
recovered continuous follow up & control of risk factors is a
must with diet control.
A
BRIEF NOTE ON DIAGNOSTIC TESTS IN HEART FUNCTION EVALUATION:
1.
Electrocardiogram: recording of electrical impulses or current
generated due to cardiac muscle motion on a graph paper. The changes
generally found are:
ST-changes
correlate best with ischemia
Rhythm
disturbances (ectopy or block) do not correlate well
Abnormal
ST-segment response
V.
EXERCISE TOLERANCE TESTING - PHYSIOLOGIC RESPONSE TO
EXERCISE:
A
Conventional test- Progressive workload until the patient
demonstrates ischemia or reaches limiting fatigue. The electrocardiac
monitoring done on TV (ultarsonography), Blood pressure and
respiratory rate or other parameters are noted.
The
various Parameters measured in the test are:
Heart
rate.
Blood
pressure.
Symptoms.
ECHOCARDIOGRAPHY:
a tool second to ECG. Consists of
an ultrasound machine that directs high frequency sound waves into
the patient’s body and a mechanism that records the sound waves as
they reflect off the patient’s heart walls, chambers, valves, and
red blood cells. Viewing the patient’s heart during Echo is done in
“real view” on an oscilloscope, and the image is also recorded
for further viewing and study. The recorded image is called as
Echocardiogram.
SCINTIGRAPHIC
EXERCISE TESTING:
Perfusion imaging (e.g.
thallium-201)
Thallium
is taken up my myocardium in direct proportion to local blood flow.
Thus a marker of perfusion. Thallium images allow comparison of
relative Cardiac Blood Flow between different segments of the Left
Ventricle. Thallium redistributes with time.
Comparing
stress and redistribution images allows one to find reversible
defects and deduce the heart status and effectivity in it’s
functioning. The impaired blood flow is seen as a cold spot on the
Radionuclide image.
RADIONUCLIDE
TECHNIQUES:
Radionuclide
Technetium is used to locate abnormal coronary blood flow or damaged
heart tissue.
The
imaging follows an intravenous injection of technetium into the
patient.
Technetium
concentrates in the dead myocardial tissue, a person with Myocardial
infraction will have increased accumulation of radioactivity, called
a hot-spot in the area of myocardial injury.
CARDIAC
CATHETERIZATION:
Allows
visualization of the lumen of the artery
Precise delineation
of extent and severity of disease "road map" that helps in
planning therapy.
More
invasive and expensive than exercise stress testing.
The
cardiac catheter Judgkin’s catheter is inserted through femoral
vein into the heart, angiographic dye is injected and the blood flow
through the cardiac vessels and walls is visualized on the TV
monitor and pictures are taken for further reference.
PERCUTANEOUS
TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA):
A
form of corrective surgery, Uses balloon catheter to squash plaque
against lumen and restore blood flow.
Does
not require anesthesia or thoracotomy.
Here
the catheter is used to dilate partially occluded coronary arteries
by introducing a balloon tipped catheter into the large artery in
the patient’s thigh and advancing the catheter into patient’s
aorta and then into the narrowed coronary artery.
An
elongated balloon at the tip is inflated, pressing the
atherosclerotic plaque in the coronary artery against the arterial
wall.
The
widening of the vessel channel allows for an increase in the
patient’s blood flow.
Greatest
drawback is high rate of restenosis.
CORONARY
ARTERY BYPASS GRAFTING (CABG):
Surgical
procedure Indicated for certain groups.
Involves
incision into the patient’s chest to allow for insertion of a
graft, usually consisting of a segment of leg vein, from the
ascending aorta to a coronary artery.
The
graft bypasses a stenotic segment in the coronary artery.
Surgeons
attempt as much as many bypass grafts as possible, to ensure the
optimum revascularisation of the myocardium.
II.
STROKE: (Cutting off of blood supply to part of brain.)
A
Cerebral Vascular accident (CVA), which is more commonly called a
stroke is a leading global health problem and predicted to grow.
It
is the second most common cause of death and major disability
worldwide.
Any
disease of the cerebral vascular system that results in cerebral,
cerebellar, or brain stem anoxic (cessation of oxygen supply)
damage.
It
is characterized by decreased or sudden stoppage of blood supply to
the brain causing loss of consciousness with or without paralysis.
Deprived
of oxygen and nutrients supplied by the blood, brain cells quickly
die, the parts of the body controlled by these cells stop working.
Thus,
A stroke victim may thus lose the ability to speak (Dysarthria) or
Understand.
He
may become paralyzed or stop breathing altogether.
The
location of the loss of function and its severity depend on the part
of the brain that has been injured and how badly it has been
damaged.
Aggravating
factors or Conditions such as
Hypertension,
Diabetes
mellitus,
Elevated
blood cholesterol, and
Certain
type of heart diseases, which produce or aggravate arterial disease,
predisposes individuals to CVAs.
Hypertension
is the greatest contributing factor.
CAUSES:
immediate causes are like
A
CEREBRAL THROMBOSIS which means actual blocking of a blood vessel to
the brain.
E.g.:
a blood clot which breaks in any artery mainly cardiac and then
travels to the brain artery, an embolus or a thrombus: a blood clot
in the vessels which ruptures.
CLINICAL
PRESENTATION:
DIAGNOSIS:
CT SCAN Brain, MRI angiography Brain.
PROGNOSIS:
Complete
recovery if Transient Ischaemic attack involving only a small brain
artery: many a times no manifestations or if present are so mild
that patients do not take much notice of it.
Partial
recovery: paralysis or Permanent partial disability/ Total
disability depending on severity and extent of brain damage.
III.
CORONARY ARTERY DISEASE:
It
is a disease that affects the coronary arteries, the vessels that
supply the heart itself with blood.
There
are two coronaries, Right and left which branch out from the aorta
(the body’s main artery) as it leaves the heart.
In
coronary artery disease, these vessels become clogged with fatty
deposits. This process is known as atherosclerosis.
Such
deposits can interfere with, or block, the blood supply to the
cardiac muscle, causing angina or a heart attack.
RISK
FACTORS:
DIAGNOSIS:
ECG.
Echocardiography.
Coronary
Angiography.
Stress
test/TMT.
PROGNOSIS:
A
sudden myocardial ischaemia or angina can cause death.
Can
be controlled by controlling the risk factors.
IV.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
COPD
is a varied group of chronic respiratory disorders that are
associated with varying degrees of obstruction to the flow of air
during expiration.
COPD
results from
Chronic
bronchitis,
emphysema
(increased size of alveolar sacs, an irreversible damage due to
destruction), or
Combination
of both, and is closely associated with cigarette smoking.
COPD
is a major cause of disability in old people and an important cause
of mortality.
FOLLOWING
ARE THE DEGREE OF OBSTRUCTIONS SEEN:
LOW
DEGREE OF OBSTRUCTION: Increased airway resistance, which
results from increased mucus secretions.
HIGHER
DEGREE OF OBSTRUCTION: A thickened bronchial wall from edema
causing airway obstruction.
SEVERE
OBSTRUCTION: A Constricted bronchial wall from chronic
inflammation with fibrosis causing airway obstruction.
CLINICAL:
PRESENTATION:
Laboured
breathing/ Dyspnea.
Productive
Cough.
Wheezing.
Morning
tightness in chest.
Difficulty
breathing except in an upright position.
Weight
loss.
Recurrent
respiratory infections.
Right
heart failure in end stage COPD.
DIAGNOSIS:
PROGNOSIS:
Death
In cases of sudden airway obstruction due to acute increase in
bronchial secretions.
Heart
failure causing death/ is a bad prognosis.
Progressive
Cerebral Oxygen Deficiency, which is manifested by drowsiness,
disorientation and Coma.
Tachycardia
with weight loss is a negative prognostic indicator.
RENAL
FAILURE is
a condition in which the kidney is unable to normally excrete the
substances produced by metabolism.
IT
IS CHARACTERIZED BY:
A
decrease in the rate of filtration by the glomerulus, manifested by
oliguria,
which is reduced excretion of urine, and
A
rise
in blood
urea
levels along with serum
creatinine
concentrations.
Uremia or Azotemia is end stage of
renal failure.
1.
ACUTE RENAL FAILURE:
Sudden development of renal failure within a day or a week is known
as Acute Renal failure.
Commonest
cause is Acute
Tubular Necrosis
causing death of the cells of the renal tubules.
This is due to
DIAGNOSIS:
1.
Increased
Serum Urea & Serum Creatinine levels.
2. Decreased Urine outflows.
PROGNOSIS:
2.
CHRONIC RENAL FAILURE:
The
clinical condition resulting from chronic derangement and
insufficiency of renal excretory and regulatory function (uremia).
Development varies from months to years.
Chronic
renal failure (CRF) may result from any major cause of renal
dysfunction.
The
most common cause of end-stage renal disease is diabetic nephropathy,
followed by
DIAGNOSIS:
The
functional effects of CRF can be categorized as
diminished
renal reserve,
renal
insufficiency (failure), and
Uremia.
With
diminished renal reserve, there is a measurable loss of renal
function, but homeostasis is preserved at the expense of some
hormonal adaptations (e.g., secondary hyperparathyroidism, and
intrarenal changes in glomerulotubular balance).
PROGNOSIS:
VI.
BRAIN TUMOURS:
Tumors
are abnormal growths that can cause severe brain damage.
The
effects of a tumor depend on its size and location.
A
tumor may destroy brain cells in the area surrounding it.
As
the tumor grows, it also creates pressure, which may damage other
areas of the brain or at least interfere with their normal function.
CLINICAL
PRESENTATIONS:
DIAGNOSIS:
PROGNOSIS:
Surgery
cures some tumors. For cancerous tumors, doctors may combine
surgery with drugs or radiation. One type of radiation, called
stereotactic radiosurgery, is sometimes used as an alternative to
traditional surgery.
In
stereotactic radiosurgery, doctors use computers and a CT scan or
MRI to produce a three-dimensional image of the brain.
Beams
of radiation are then focused precisely on a target, which may be a
tumor or a blood-vessel malformation.
The
individual beams are either too brief or too weak to harm areas of
the brain in the path of the radiation.
But
their combined effect will destroy the target. These procedures are
quick and painless and allow patients to resume moderate activity
the same day.
CHAPTER
NO: 10.
INQUEST
Inquest (in = in;
quasitus= to seek) means a legal or judicial inquiry to ascertain
matter of fact. In forensic, an Inquest generally means an inquiry
into the cause of death, which is apparently not due to natural
causes. In cases of sudden, unnatural deaths or suspicious deaths, an
urgent investigation into the cause of death (inquest) is obviously
necessary to apprehend and punish the criminal. The body cannot be
disposed as in natural deaths.
The
following are the examples of such deaths:
Sudden
death, unknown cause.
Suicide,
homicide and infanticide.
Custodial
death: police, Borstal schools, mental asylums or certified school.
Dowry
deaths.
Anesthetic/
Medical negligent deaths.
Types of Inquest:
The
Coroner’s Inquest (No longer prevalent in India.)
Police
Inquest.
Magistrate’s
inquest.
The
Medical Examiner System. ( In USA)
POLICE INQUEST:
(PANCHNAMA)
(Cr.
P. C 174) inquiries by an officer in charge of a police station into
the cause of any unnatural death.
The
police officer making the preliminary inquiry is known as the
investigating officer.
On
receipt information of any unnatural or accidental death, the police
officer informs about it to the nearest magistrate of the same area
and proceeds to the place of offence.
Here,
he holds inquiry into the cause of death in presence of two or more
respectable witnesses of the locality who are panchas, panch
witnesses or panchayatdars. He prepares a report about the probable
cause of death as judged by him and the panchas from the appearance
of the surroundings of the body including the nature of injuries
thereon.
This
report is known as the Panchanama or Inquests report, and is then
signed by the witnesses present.
In
case where no foul play is suspected the dead body is ordered for
disposal.
In
Further enquiry and trail of the case is conducted in the usual
manner by the concerned magistrate to whom entire case records are
then transferred by the investigating police officer.
The
Head constable along with the inspector in Chief visits the scene of
crime to investigate and make an FIR/ Panchanama.
In
Case where foul play is suspected, the dead body sent for autopsy to
the nearest medical officer, after performing the autopsy, gives his
opinion about the cause of death in the post mortem report which is
written in triplicate using carbon copies.
One
retained by himself, other handed to the police officer in charge &
third to the executive magistrate.
Further
enquiry and trail of the case is conducted in the usual manner by
the concerned magistrate to whom entire case records are then
transferred by the investigating police officer.
The
Inspector in Chief records the state at the scene of crime along
with 2-3 witnesses’ evidence about the circumstances leading to
the particular offence along with their thumbprints or signatures.
Of
these witnesses at least two should be disinterested witnesses.
These witnesses can be called as alibi or hearsay evidences in the
court of law.
Besides
noting down the details present at the scene of crime, any suspicion
or suspect if present related to the case can also be noted down.
The
FIR with these observations, dates, time & address of the
incident with his interpretations; duly signed by the constable and
the police in charge is filed.
In
cases of Burns or poisonings or accidents or suicide, if the victim
is alive his or her statement is recorded and taken to the hospital
immediately.
If
the victim is about to succumb to the injuries even after utmost
care and treatment, a dying declaration is taken.
MAGISTRATE’S INQUEST:
This means an inquiry conducted
by the magistrate to ascertain certain matters of fact. It is
commonly held in the following cases:
Insanity
cases before person admitted into asylum.
Death
of a convict in jail.
Death
of a person in police custody or during police interrogation.
Death
in police firing.
Exhumation
cases.
Main
intention is to ensure:
No
person is unjustly deprived of his liberty and his rights as
citizen.
Check
the neglect or brutality of Police officers or persons incharge.
Already
buried body, where doubt lingers regarding identity or cause of
death, it will be settled by judicial inquest and not by police
inquest.
FIRST
INFORMATION REPORT/FIR:
The information given to a police
officer and reduced to writing required by the following sections is
known as the “First Information”; the corresponding report is
understood to mean the First Information Report (FIR).
The FIR is generally done in cases of a
crime or an offence.
Section
154 (1) of the code of Criminal Procedure provides that the
information relating to the commission of a cognizable offence if
given orally to an officer in charge of a police station. Even a
telephonic information is recorded as FIR.
The
police reduces the information in writing.
It
should be read over to the informant.
Every
such information whether given in writing or reduced to writing
shall be signed by the person giving it, substance thereof shall be
entered in a book in a prescribed manner.
S
154 (2) Provides that copy of the information as recorded under
the sub section (1) shall be given free of cost to the informant.
S
154 (3) provides that if the information is not recorded by the
police officer, the informant can approach the Superintendent of
Police by sending him the information by post. In such cases, the
officer can carry out the investigation himself or direct an
investigation by his subordinate. Where any information disclosing
the cognizable offence is laid before the officer-in-charge of a
police station, he has no option but to register the case and
thereafter start the investigation.
[COGNISABLE
OFFENCE: (i.e. an offence for which a person may be arrested
without the need of a warrant) examples: - Murder, Rape, red-handed
catch amidst robbery/ Theft.]
Th
principal object of the FIR from the point of view of the informant
is to put the criminal law in motion and from the point of view of
the object of the investigating authorities is to obtain information
about the alledged criminal activity so as to able to take suitable
steps to trace and bring to book the guilty.
DYING
DECLARATION is a statement given by the victim before death, of
the circumstances leading to his or her present condition, in
presence of the Inspector in Chief, the treating doctor and one dis
interested witness. Oath is not taken in a dying declaration since in
India it is assumed that a dying person always speaks the truth.
Ideally,
DYING DEPOSITION is more superior to Dying Declaration. In
deposition, an Executive Magistrate or a Magistrate with lawyers for
both the accused and the victim along with a dis interested witness,
the statements are recorded with a trial at the site itself. The
report so recorded is direct evidence in the court of law. If the
declarant dies, the Dying declaration report is documentary evidence
and carries weightage. If the declarant survives, it becomes
corroborative evidence. Dying deposition retains its value even after
survival of the victim. A police officer is not allowed during Dying
deposition or declaration to avoid intimidation or fear during
declaration by the victim.
DUTIES
OF A MEDICAL OFFICER IN CASES OF OFFENCE OR POISONING
When
a patient comes to a doctor in wounded state, or when there is any
suspicion of foul play or assault, the doctor should He should
continue with the treatment and Immediately intimate the police for
FIR. If the patient is about to die and the police or the magistrate
has not reached for the dying declaration, the doctor can record the
declaration in presence of a dis interested witness.
The
declaration is recorded in the patient’s own language and should be
verbatim along with the colloquial words. The statement so recorded
should be complete. If the patient is unable to communicate, he
should record the gesticulations or signs of the patient. If the
patient dies amidst the recording of the statement, the doctor should
record the complete statement as per his interpretation of the entire
case.
This
signed by the declarant if alive or his thumb impression; with the
witnesses signature & doctor’s own signature duly stamped shall
complete the Dying declaration report.
In
medico legal cases, the doctor should arrange for MLC/FIR. A copy of
the FIR or MLC should be attached to the case sheet of the injured
person.
In
cases of death, a death certificate is issued only in case of a
natural death. In cases of foul play or suspicion, police should be
intimated.
A
Medico legal autopsy is conducted only after receipt of the following
documents:
The
First Information Report.
The
Dead body Challan from the police.
Authority
letter from the Executive Magistrate.
Identification
of the dead body by the police and or relatives.
In
cases of poisoning, if it was a suicidal (Killing oneself) case, the
doctor may or may not inform the police at his own discretion.
If
the case was a homicidal (Murder) one, he should treat the patient
and simultaneously intimate the police.
He
should also take due care that another attempt can be made on the
victim.
Thus,
He should take into confidence a nurse or a confidante relative, and
should allow food made by the nurse or the relative only.
The
patient should be isolated and strangers should not be allowed to
visit the patient.
The
first stomach wash along with vomitus, clothes soiled with vomitus
or bedsheet soiled with the vomitus should be wrapped and sent to
the chemical analyzer.
If
visits the patient at the scene of crime, should check out for any
empty bottle, pills or food remnants near the bed side or the lying
patient; collect and send it for Chemical Analyser.
If
the patient is dead, in case of autopsy, the following viscera is
preserved and sent to the chemical analyzer: (Selection of viscera
for Chemical analysis)
Since
many poisons are ingested and after absorption pass through liver
and spleen, and are excreted through the kidneys in the urine, the
following material should be routinely preserved in all cases,
irrespective of the nature of poison.
Whole
Stomach with 300ml of stomach contents.
Small
intestines 100cms in adults, 200cms in children and whole in
infants, preferably tied at short lengths.
Small
intestine contents 100ml. If less, whole quantity.
(500
gms ) Part of liver and gall bladder and its contents.
Blood
about 5-10ml preferably in a plain bulb from the veins.
Urine
sample 100-200ml if present, or soiled cloth of urine.
Spleen
half in adults and whole in children.
Half
of each kidney and both kidneys in children.
Brain
taken only in cases of Neurotic poisonings.
Spinal
cord only in case of Neurotic Poisonings.
Skin
about ½ x ½ inch only in case of snake poisoning.(100gms)
Muscle
tissue bit near the site of bite only in snake bite or scorpion
bite.
These
samples are preserved, noted down, numbered and marked off; packed
with labels and duly sent to the Chemical analyzer in the FSL.
The
Post mortem preliminary report is given with a final report pending
after the Chemical analysis. A Copy of the P. M. report is enclosed
for the perusal of the analyzer.
SICKNESS
/ FITNESS CERTIFICATE
The
Sickness or Fitness certificate issued by a Registered medical
Practitioner is significant in cases of
Leave
or Sickness Leave authenticity in employee’s organization.
Sickness
absenteeism.
Attendance
of court of law as a witness or any important business meets.
In
cases of accident or injuries causing temporary total disability.
Fitness
certificate is crucial in employee’s handling critical job
profiles. E.g. a bus driver suffering from color blindness.
Recruitment
of personnel in Military: e.g. Fitness of a person contesting for
Air Force Officer or a pilot.
SICKNESS
CERTIFICATE.
Name:
Ms. Pallak Shah; Age: 26yrs. Dated: 13/3/04.
Signature
of the Patient: XYZ.
This
is to certify that Ms. Palak Shah was suffering from Malaria since
12/3/04 to 15/3/04. She is fit to resume her duties from 16/3/04.
Signature:
Dr. Sonal Gandhi.
Registration
No: 60548.
FITNESS
CERTIFICATE.
Name:
Mr. Sudip Sen, Age: 25yrs. Dated: 12/3/04.
Signature
of the Patient: MNO.
This
is to certify in that Mr. Sudip Sen, 25year old male has been
completely examined by me and is found to be medically fit to join
the Air force. His vitals along with systemic examination were
without any clinical findings.
Signature:
Dr. Sonal Gandhi.
Registration
No: 60548.
DEATH CERTIFICATE
DEATH:
is defined as a complete irreversible cessation of important
functions as to respiration, cardiac circulation & brain
functions. A continuous plain irreversible ECG till 5 minutes is
clinically considered to be dead.
Any
registered Medical practitioner can issue death Certificate. In a
hospital set up, the treating physician issues the certificate. It is
issued only when the death is natural & without any suspicion. In
case of a suspicion as to suicide or homicide or a case of poisoning,
the RMP informs the police and an FIR is lodged along with Post
mortem authorization to ascertain the cause of death & any foul
play involved. Issuance of Death certificate signifies that there was
no doubt of foul play & the person died a natural death.
According to Births & Death Registration Act, Death should be
registered. Only after getting a Death certificate, a relative of the
demised can take custody of the body & take for burial.
Any
Death Certificate has the name, age, and sex heading, with complete
address of the deceased. Important aspects of the certificate, the
cause of death; any morbid or immediate cause of death; and any other
morbid cause that is unrelated to the death.
If
a female, Pregnancy related death inclusion is a must along with the
immediate cause.
Death
Certificate is a Standard format prepared by WHO & is
statistically very important. Death certificates not only give data
as to the common causes of death among various age groups & sexes
of the country but also are an indicator of the health services
efficiency in a country. The data is used to study & plan for
betterment of the health services of a country. Also it has academic
significance by way of retrospective or prospective studies of
diseases, Prevalence & their etiologies.
Example:
INJURY CERTIFICATE
The
certificate is issued when a police officer with a FIR report brings
a victim/ an accused for examination of his wounds in cases of
offence.
Besides
his age sex, name and address and date and time details,
Two
identification marks superficially seen on the body should be
written. Along with confirmation from the police officer of the
identification of the accused or victim is confirmed.
After
getting the consent of the victim duly signed, the examination of
wounds or injuries is carried out.
History
of the victim or accused noted as per the statement given.
Injury/
Injuries noted in serial order, with the site, type of wound length
and depth, along with the type of weapon causing the injury,
grievous or simple with homicidal, suicidal, defence or fabricated
wound opinion.
The
final opinion given duly signed by the medical officer.
A
copy of it handed over to the police, another retained by himself
and a third sent to the executive magistrate.
The
significance of the injury certificate is:
In
cases of assault or battery, becomes documentary evidence by a
skilled witness. Here, the skilled witness is the doctor.
It
helps in justice by proving a person guilty or innocent based upon
the facts at time of injury.
If
the injury was accidental, homicidal; or suicidal.
If
grievous injury, can get compensation from the accused.
THE MEDICO-LEGAL
AUTOPSY
AUTOPSY
LITERALLY MEANS “AUTO” IS “TO CUT OPEN” AND “OPIS” IS TO
“SEE/VIEW”.
A
medicolegal autopsy or postmortem examination is a special type of
scientific examination of a dead body carried out under the laws of
the state for the protection of its citizens and to assist the
identification and prosecution of the guilty.
The objects
of a medicolegal autopsy are:
1. Identification of the person
2. Determining the cause of
death, whether natural or unnatural, if unnatural whether
suicide, accident or homicide, and if homicide, any trace
of evidence of the accused.
3.Determining time since death.
4.
In newborns determining the question of live birth and viability of
a child.
5. Determining whether mutilated or skeletal
remains are human and if human probable case & time
of death.
An
unnatural and sudden Death, with a suspicion for foul play,is an
Executive Magistrate’s case, a legal case, if it is unexpected,
Sudden & unnatural or if there is any possibility that a law has
been broken. Not every death that occurs outside a hospital is an
executive’s case.
If
the deceased had a physician who is reasonably certain of the cause
of death and is willing to sign a death certificate, further medical
examination may not be required.
The
time of death or the angle of gunfire may determine whether the
person committed suicide or was murdered.
The
percentage of deaths that are autopsied has been falling for many
years. Autopsies benefit society by providing information about
hidden pathologies and about the accuracy of medical diagnoses.
But
they do not benefit the patient, and physicians who do not want the
accuracy of their diagnoses challenged sometimes oppose them.
Because of these factors, there is little money
available to pay for autopsies.
Even
when it is feasible to do an autopsy, many physicians do not know
how to obtain CONSENT.
Physicians
should be familiar with the state law in their jurisdictions
governing the persons who may consent to an autopsy.
If
there is any question of criminal activity, the autopsy may be
ordered by a court, an Executive Magistrate.
AIM:
The purposes and administrative aspects of death investigation are
dealt with in the lecture notes on Death
Investigation. Here, the practical
aspects will be considered.
The
aims of death investigation are to answer the following questions:
These
are the 5 wise men that pave way to all puzzles.
Who
died? (identification of the deceased)
Where?
(place of death)
When?
(time of death)
Why?
(cause of death)
How?
(manner & mechanism of death)
Autopsy
is only one part of death investigation.
BODY,
HISTORY AND SCENE are equally important (diagnostic triangle).
Each
of the three aspects of the death investigation process are equally
important (like a three legged stool, which will fall over if one leg
is removed or even shortened!)
SCENE:
Attendance
by police officers, CID, family doctor, police surgeon, forensic
pathologist, forensic scientists.
The
aim is to collect the maximum of information with the minimum of
disturbance.
Potential
for professional conflicts.
Photography,
videos, trace evidence.
HISTORY:
Social
- from relatives, friends, police.
Medical
- from General Physician, hospital notes. Often indicates the likely
cause of death
Psychiatric
- from General Physician, hospital notes. May indicate possibility
of suicide.
THE
MEDICO-LEGAL AUTOPSY:
Purpose: - What happened? To Who,
When, Where, Why, and How.
Technique:
- The external examination assumes much greater importance,
special dissection techniques and examinations, evidential
materials, report formulation or commentary.
AUTOPSY
AUTHORITY:
Instruction/consent
for autopsy is derived from a law officer having jurisdiction, i.e.
the Executive Magistrate.
Authority
for autopsy is permanently recorded: how received, from whom, and
when:
1. Two doctor case if legal proceedings likely {homicide
(murder) , road accident}.
2. One doctor examination in most
non-suspicious cases (accident, suicide).
3. Autopsy or external
examination only (death obviously natural) at the discretion of the
pathologist.
IDENTIFICATION
OF DECEDENT:
The
body must be identified to the Pathologist as the decedent for whom
autopsy authority has been given. Identification in 2 doctor
autopsies is performed in front of the 2 doctors performing the
autopsy.
Initial
(provisional) identification may be:
Circumstantial
(address, car, papers, cards, keys, clothes),
Medical
(scars, teeth, x-rays, DNA).
Permanent
record is made of the method of formal identification:
personal
(name, title, address),
body
tag (record all details),
Accompanying
documentation.
PERSONAL
EFFECTS AND CLOTHING:
The
examination of personal effects and clothing is an integral part of
the medico-legal autopsy providing information on life style, events
leading to death, and often the actual cause of death.
List
of jewelry, valuables, and personal effects.
Listed description
of the clothing: - type of garment, color, fabric type, location, if
disarranged, wet/moist/dry, stains (blood, vomit, feces, urine,
semen, dirt, oil, soot, etc.), damage (holes, cuts, and tears).
Clothing
findings are correlated with historical and scene information, e.g.
appropriateness of clothing, source of stains, trace materials.
Clothing
findings must also be correlated with other autopsy data, e.g.
injuries, source of bloodstains.
IN
A MEDICOLEGAL AUTOPSY THE FOLLOWING POINTS ARE NOTED ON EXTERNAL
EXAMINATION
Identification
data
Clothing
and whole body examined to find evidence pointing to cause
of death
Photographs
or sketches of evidence found on examination
Data
that indicates time since death
EXTERNAL
EXAMINATION:
This
is a detailed head to toe examination of the naked body, documenting
stains and soiling, general and specific individualising
characteristics, post-mortem changes {temperature, lividity (post
mortem staining of the body), rigor mortis ( Contarction of the
muscles of the body), and putrefaction (decomposition changes in
body), cadaveric spasm}
The
location, extent and type of staining or soiling of the body are
described e.g. dual flow pattern of blood from a wound, high
velocity impact blood spatter from gunshot wound, coffee grounds
vomitus and melaena (reddish black stools /black stools)(upper
gastrointestinal hemorrhage), antiseptic from medical intervention.
General
body characteristics are recorded, namely:-
Racial
group, height, weight, head hair (colour, dyed, length, style,
balding),
eyes
(colour, pupil size, conjunctival congestion or petechial
haemorrhages, jaundice, prosthesis),
nose
and ear canals (blood, pus), earlobes (piercing, earlobe creases),
face (hirsute woman, clean shaven, beard, moustache),
mouth
(vomit, blood, tablet debris, teeth, dentures), breasts (normally
developed, atrophic, hirsute),
Genitalia
(pubic hair pattern, circumcised, palpable testes), feet (general
hygiene, bunions, ingrowing nails).
More
specific identifying characteristics are described fully: tattoos
(location, design, colour, names), scars (surgical and non-surgical,
needle tracks, striae), skin lesions (naevi, senile keratoses, other
skin diseases), prosthesis, pacemaker.
Post-mortem
changes are documented, namely: - body temperature to touch
(alternatively state if the body has been refrigerated), rigor
mortis (extent and degree), hypostatic lividity (distribution, dual
pattern, color, contact pallor), putrefactive changes.
INJURIES
(EVIDENCE OF INJURY):
All
injuries are described systematically either by grouping them
according to anatomical location, e.g. right arm, anterior chest,
left leg (as in multiple injuries in vehicular collisions), or in
numerical order (e.g. where the number of injuries is few or where
each and every injury is particularly important as in multiple stab
wounds).
If
numbered, it is stated that the order of numbering does not imply
sequence of infliction or degree of severity.
INJURIES
ARE DESCRIBED AS TO THEIR TYPE, e.g. bruise,
abrasion, laceration, incised wound, puncture or stab wound, gunshot
wound, burn, fracture.
Injuries
should be described with regard to their location, size,
shape and colour.
The
location of the wound is given by general description (e.g.
on the left side of the face, or over the rib cage, immediately
below the left breast) and by precise location in relation to fixed
anatomical landmarks (analogous to latitude and longitude).
Suitable
vertical landmarks are the heel, superior margin of the pubic
symphysis, superior anterior iliac crest, supra-sternal notch,
orbital ridge, and crown.
Suitable
horizontal landmarks are any midline structures, e.g. umbilicus,
midline of the sternum and glabella.
The
size of an injury is measured in two dimensions.
The
shape can be related to a geometric shape or common object,
often supplemented with drawings, sketches or by tracing patterned
injuries onto acetate sheets.
Internal
injuries are described in continuity with the related externally
apparent injuries, e.g. the bruising and abrasion to the chest, then
the fractured ribs, then the lacerated lung and haemothorax.
This
organisation of the final report frequently does not correspond with
the order of dissection and dictation of findings.
In
the final report remote injuries are segregated from recent injuries
under separate subheadings.
SIGNS
OF MEDICAL INTERVENTION:
Medical
intervention is described under a separate heading.
This
includes all medical equipment attached to, or accompanying, the
body, e.g. urinary catheter, endotracheal tube, oral airway, rods
for external fixation of fractures, arterial and intravenous lines,
intravenous solutions or blood (with details of contents).
External
surgical incisions are described in continuity with the internal
evidence of surgery.
INTERNAL
EXAMINATION:
After
a detailed external examination of the body is done, the three major
cavities of the body, viz. skill, thorax (chest) and abdomen are
opened and examined.
All
parts of the body are examined and dissected in detail.
The
internal examination is systematic description of natural disease
and does not include recent injuries, all of which have been
previously described under the appropriate heading.
A
Systematic examination of the various organs & systems of the
body is done.
THE
HEAD: is opened if accidental or sudden death cause unknown.
Head
is opened from mastoid to mastoid process by a saw.
The
skull cut down & brain removed & cut in transverse sections
at various levels of the brain and the injuries or blood clot or
hemorrhages noted.
Extra
dural, Subarachnoid, Sub dural hemorrhages can be seen if head
injury present. Pathological findings if any are also noted.
Tubercular
meningeal or edematous changes or congestion may give clues as to
nature of disease or injury.
THE
THORAX:
Chest
is opened by an incision from the mid sternum to the xiphisternum.
Lungs
& heart along with their coverings, the pleurae & the
pericardium respectively are checked for any pathology or injury.
If
any rib fracture noted or not. If haemothorax or pericardial
effusion noted.
Heart
& lungs are dissected separately to see for any pathology or
injury.
Mainly
congestion with or without petechial hemorrhages or pale organs is
findings worth noting.
These
give a clue as to the immediate cause of death. Special importance’s
given to lungs & heart in case of drowning, asphyxial deaths
like strangulation, hanging, etc.
THE
ABDOMEN:
Opened
up from xiphisternum to pubic symphysis.
The
stomach & its contents, liver, gall bladder & pancreas are
note.
Kidney
along with spleen is cut open for any injury, congestion or
pathological changes.
The
contents in stomach & intestines tell the time since death.
(P.S.:
- The contents of the stomach t6aken in case of ingestional
poisoning)
THE
SPINAL CORD:
Negative
observations are included, e.g. no pulmonary thrombo-emboli, no
significant coronary artery atherosclerosis, no skull fracture, etc.
OTHER
EXAMINATIONS:
Any
special dissections, e.g. neck dissection, or further examination of
organs e.g. brain after formalin fixation, together with
microscopic, biochemical, and toxicological studies should be
described at this point.
When
naked eye examination fails to determine the cause of death,
appropriate samples are taken for laboratory tests and chemical
analysis.
In
cases of suspected poisoning the following things are preserved for
further study - whole stomach, 300 ml of stomach contents, part of
small intestine, 100 ml of small intestine contents, liver spleen,
kidneys, 200 ml of urine and 10 ml or more of blood.
In
special cases brain, cerebrospinal fluid, blood from the heart,
skin, female genital organs, bone marrow lungs, bones, scalp hair,
nails, or fatty tissue may also be preserved.
After
examination is over body is sutured and handed over to police. The
history of the case, and visit to the scene of crime can help in
arriving at a proper cause of death and manner of death, whether
natural, suicide accident or homicide.
CAUSE
OF DEATH:
Manner
of death: the fashion in which the cause of death came into
being; i.e. whether natural, accident, suicide, homicide,
unclassified (alcohol/drug deaths) or undetermined
Cause
|
Mechanism
|
Manner
|
Atherosclerotic
coronary
artery disease
|
Electrical
arrhythmia
or heart failure
|
Natural
|
Stab wounds
|
Internal or
external blood loss
|
Homicide, Suicide
or Accident
|
Stab wounds
|
Internal or
external blood loss
|
Homicide, Suicide
or Accident
|
Hanging
|
Asphyxia
|
Suicide
|
Strangulation
|
Asphyxia
|
Homicide
|
OPINION
(CONCLUSION OR COMMENTARY):
This
section is interpretative and subjective, It includes the cause of
death as appearing on the death certificate.
The
commentary is in simple English and brings together all the relevant
information obtained from examination of the body, the scene of
death and the history of the decedent.
Information
obtained second-hand (hearsay) may be included e.g. from police
reports, medical records, fire investigation reports.
The
relevant issues are addresses i.e. what happened, to whom, when,
where, why and how.
It
may be as brief or as detailed as the need dictates It is directed
to the law officer investigating the death and any other legally
interested parties who may obtain access to the report subsequently.
SIGNATURE:
All
medico-legal reports require the original signature of the author.
Relevant degrees and other qualifications are given. Occupational
titles, e.g. Lecturer in Pathology, Head of Dept. forensic Medicine,
Police Surgeon, etc. may be included.
A
copy of it handed over to the police, another retained by himself
and a third sent to the executive magistrate.
CHAPTER
No: 11.
DISABILITIES:
TEMPORARY
TOTAL DISABILITY: For a temporary period of time, the patient
will be totally disabled. E.g.: Fractures.
TEMPORARY
PARTIAL DISABILITY: For a temporary period of time, the patient
will be partially disabled from performing usual functions.
PERMANENT
PARTIAL DISABILITY: Person is partially able to perform usual
activities, but is not expected to ever be completely able to perform
his pre injury activities.
A
permanent partial disability which results from an accidental bodily
Injury to an Insured Person which will probably continue for the rest
of their life and certified to that effect by a competent and
qualified Physician as appointed by Us. (As per policy wordings)
PERMANENT
TOTAL DISABILITY: Patient will never be able to perform his pre-
injury vocation.
IMPAIRMENT:
Medical factor which is included as part of the disability
evaluation. Any abnormality, which remains after the treatment, is
concluded and which is not expected to improve.
DISABILITY
When
we say a person is disabled, we mean that the person has lost all or
some ability to use a part of the body in the same manner as in the
past. This use may involve employment as well as other activities.
Disabilities are classified as one of the four types:
Temporary
Total disability.
Temporary
partial Disability.
Permanent
partial disability.
Permanent
Total Disability.
TEMPORARY
TOTAL DISABILITY: A temporary total disability means that, for a
period of time, the patient will be totally unable to perform any
activity, either at work or anywhere else. Temporary Total Disability
usually refers to the disability during the recovery period after an
accident.E.g. Any fracture of one of the limb bones causes a
Temporary total disability for around 4-6 months.
TEMPORARY
PARTIAL DISABILITY: With a Temporary partial disability, the
patient is, for a temporary period, only partially able to perform
usual activities; however, it is expected that the patient will
eventually be completely able to perform these activities. This
disability classification usually applies to the patient’s
occupation. For example, a waiter fractures his radius; while in cast
he can perform all his usual duties except carrying a tray. So the
disability is Temporary & partial. In addition, he might be only
partially able to perform his usual personal activities, such as
driving or cleaning his house.
PERMANENT
PARTIAL DISABILITY: This type of disability is often found in the
lawsuits. This means a person is partially able to perform his usual
activities, but is not expected to ever be completely able to resume
pre-injury activities. Permanent Partial disability usually involves
a patient’s job but not always. For Example, Ten months after his
leg is broken, Fred was back at work as a truck mechanic. However,
his job duties are limited because his leg permanently lost its
mobility and he is no longer able to work underneath the trucks.
PERMANENT
TOTAL DISABILITY: In this type of Disability the patient will
never be able to perform his or her pre-injury vocation. This type of
disability might also involve activities in other areas of the
person’s life in addition pursuing a livelihood. An injury that
results in a permanent total disability must be extremely severe and
will probably involve several parts of the body. Example: a brain
surgeon whose fingers are permanently immobilized.
The
Civil Surgeon issues a disability certificate after thorough
examination of the type and extent of disability caused. The
disability certificate is of great significance in Reservation of the
Physically disabled for employment and the benefits available to them
thereunder.
