Divisive Devices and Curious Cuts, Part II: Adventures In Medical Intervention and Other Eye Foolery.

The type, number, distribution, and pathologic effects of injuries seen at autopsy are clues that assist the forensic pathologist in the determination of the manner in which they were acquired whether by accident or at the hands of another. Accurate determination is of vital medicolegal importance with influence on the reconstruction of the death circumstances and any adjudication that may follow in the future.

Certain devices and types of medical intervention leave “injuries” recognized as those resulting from resuscitative efforts and surgical procedures. Unnecessary modification or distortion of injuries makes interpretation complicated. Context (i.e. medical records and EMS reports), is usually helpful and always needed in deciphering “injuries” caused by therapeutic intervention from other types of injury.

And so…

(Caution! Graphic images follow!)

 

Classic patterned abrasions from a mechanical chest compression device, not the bottom of someone’s shoe.

 

Two stab wound-looking injuries next to a thoracotomy incision? On closer examination, turns out that there were two intersecting incisions and ONE bona fide stab wound of the axillary region.

 

Stab wounds and gunshot wounds may present as convenient ports for tube placement or starting points for incisions. This spells NIGHTMARE for the forensic pathologist. Steering clear of the evidentiary wounds is much more preferred as shown below in which the thoracotomy incision was made (nicely)above and not through the nearby 2 stab wounds.

 

Fingernail markings resulting from jaw thrust maneuver and intubation attempt as part of resuscitation efforts, NOT strangulation injuries. Not overcalling these as strangulation injuries saves law enforcement a lot of investigative time and effort.

 

Marks left by suturing can look like stippling abrasions associated with intermediate-range gunshot wounds. Overcalling suture marks as stippling wounds (victim shot within 2-3 feet) could contradict witness statements or other physical evidence that victim was an innocent bystander or otherwise shot from a greater distance. Unsuspecting or uninformed expert consultants who review autopsy photographs in absence of pertinent information risk providing incorrect opinions in regards to the muzzle-to-target distance estimation.

Suturing of gunshot wounds may  confound the determination not only of an approximate muzzle-to-target distance (aka range-of-fire) but also distort characteristics that help identify it as an entrance wound:

It is much more preferred that gunshot wounds of expired patients NOT be sutured or wiped but instead be preserved with bandaging or other wound occluding (but not wound mutilating) material placed and secured over the wound:

And finally, the classic rib spreader laceration ( skin tear) caused by the gear mechanism of the rib spreader device, is virtually always seen in conjunction with thoracotomy incisions so as not to be confused with inflicted injury.

 

 

References:

  1. Armstrong E J. 2017. Therapeutic Devices. In Essentials of Death Reporting and Death Certification-Practical Applications for the Clinical Practitioner p 27.
  2. Armstrong E J. 2017. Injury Types: A Primer for Clinical Practitioners. In Essentials of Death Reporting and Death Certification-Practical Applications for the Clinical Practitioner. pp 82-102.
  3. Harm T and Rajs J. Face and neck injuries due to resuscitation versus throttling. 1983. Forensic Sci Int. 1983;23:109-116.

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