 injuries observed on the patient’s body during the initial scene investigation.  includes any and all resuscitative efforts by trained and untrained personnel, which may have caused injury to the body.  “IATROGENIC COMPLICATIONS”

◦ Laryngeal abrasions from traumatic intubation ◦ Skin & soft tissue lesions, rib & sternum fractures from chest decompression

 Surgical stab wounds for insertion of tubes & drains  Laparotomy, tracheostomy, & thoracotomy incisions  Incisions for peritoneal lavage  Cutdowns of wrists, antecubital fossa, & ankles

 May be misinterpreted!  Therapeutic tubing (i.e. IV lining, respiratory tubes, catheters, tracheostomies) should never be removed prior to sending a body to the coroner  Chart should be reviewed prior to autopsy  Treating physicians should be consulted

 Physicians, Fire Personnel, and Law Enforcement ◦ resuscitative treatments often cause external or internal injuries to patients – documentation necessary ◦ resuscitative artifacts and any associated equipment visible on the body should be documented in the investigative report and photographed.  agency and contact name and number of the individual who attempted resuscitation should also be documented in the report for follow-up as necessary.

 Relatives, Neighbors, Good Samaritans the investigator needs to document resuscitative efforts by photographing any artifacts or injury visible on the patient. include the name and contact information of the individual who attempted resuscitation and their relationship to the patient.

Trauma Any visible trauma to the patient should be documented by the investigator and photographed for the pre-autopsy report to the pathologist. Poisoning or Intoxication Any suspected blockage of the patient’s respiratory tract from poisoning or intoxication should be investigated, collected, documented, and reported to the pathologist before autopsy. Any suspected poison or toxicant, including medication bottles with pills, cleaning agent bottles should be collected.

 AUTOLYSIS ◦ the breakdown of cells and organs through an aseptic chemical process caused by intracellular changes  PUTREFACTION ◦ post- mortem destruction of soft tissues of body due to action of bacteria & endogenous enzymes

Autolysis Putrefaction Black putrefaction Butyric fermentation Skeletonization/Dry decay

 first few days after death  no physical signs of decomposition yet, but homeostasis has stopped  cellular and soft tissue changes  body enters algor mortis  reduction in body temperature following death

 When the body’s cells reach the final stage of autolysis, an anaerobic environment is created allowing the body’s normal bacteria to break down the remaining carbohydrates, proteins, and lipids. The products from the breakdown create acids, gases, and other products which cause volatile organic compounds and putrefactive effects.

 Odor, color changes, and bloating of the body.  BACTERIA’S ROLE ◦ Activity in the cecum turn the lower part of the abdomen green ◦ break down hemoglobin into sulfhemoglobin which causes the green color change. ◦ enter the venous system causing blood to hemolyze (formation of red streaks in the vein)  formation of gases ◦ enters the abdomen which forces liquids and feces out of the body ◦ enter the neck and face, causing swelling of the mouth, lips, and tongue.

 skin also fragile, leading to skin slippage, making it difficult to move a body. Body hair comes off easily.  discoloration from green to brown  transition of the early stage of putrefaction to the advanced decompositional stages.

 the body cavity ruptures, the abdominal gases escape and the body darkens from its greenish color. ◦ These activities allow for a greater invasion of scavengers, and insect activity increases greatly.  ends as the bones become apparent, which can take anywhere from 10 to 20 days after death depending on region and temperature.  dependent on the degree to which the body is exposed.

 body begins to dry out  human carcass is first mummified, and then goes through adipocere formation ◦ Adipocere (grave wax) formation  loss of body odor and the formation of a cheesy appearance on the cadaver. ◦ Mummification  post-active stage because there is less definite distinction between changes and they are indicated by reduced skin, cartilage, and bone. It is also indicated when all of the internal organs are lost due to insect activity.

 Occurs when the last of the soft-tissue has been removed from the body  more highly dependent on soil type and pH, along with presence of groundwater.

 Greenish discoloration of the lower quadrants of the abdomen  Greenish discoloration of the head, neck, & shoulders  Swelling of the face due to bacterial gas formation; “marbling”  Bloating  Purge fluid

 Hemolysed blood leaks out into the tissues  Tissues and organs soften and degenerate into a mass of unrecognizable tissue  Adipocere ◦ firm greyish-white to brown wax-like material composed of oleic, palmitic and stearic acids