INTRODUCTION TO FORENSIC MEDICINE Robert C. Bux, MD Coroner/Medical Examiner El Paso County.

INTRODUCTION TO INTRODUCTION TO FORENSIC MEDICINEFORENSIC MEDICINE

Robert C. Bux, MDRobert C. Bux, MD

Coroner/Medical ExaminerCoroner/Medical Examiner

El Paso CountyEl Paso County

DUTIES OF THE MEDICAL DUTIES OF THE MEDICAL EXAMINEREXAMINER

Determine the cause and manner of Determine the cause and manner of deathdeath

Positively identify the deceasedPositively identify the deceased Determine the time of deathDetermine the time of death Collect evidence from the bodyCollect evidence from the body Document injuries and natural Document injuries and natural

diseasesdiseases Provide expert testimony in courtProvide expert testimony in court

CASES REQUIRING CASES REQUIRING INVESTIGATIONINVESTIGATION

Sudden, unexpected deathsSudden, unexpected deaths Suspicious deathsSuspicious deaths Trauma related deathsTrauma related deaths Deaths in custodyDeaths in custody Deaths in the work placeDeaths in the work place Deaths in less than 24 hours after Deaths in less than 24 hours after

admission to an institutionadmission to an institution

CAUSE OF DEATHCAUSE OF DEATH

Any injury or disease that is Any injury or disease that is responsible for initiating a train responsible for initiating a train of events, brief or prolonged, of events, brief or prolonged, that result in the individual that result in the individual

dying.dying.

MECHANISM OF DEATHMECHANISM OF DEATH

The physiological The physiological derangement produced by derangement produced by the cause of death which the cause of death which

results in death.results in death.

MANNER OF DEATHMANNER OF DEATH

An opinion based on known An opinion based on known facts concerning the facts concerning the

circumstances leading up to circumstances leading up to and surrounding the death in and surrounding the death in conjunction with the findings conjunction with the findings at autopsy and the laboratory at autopsy and the laboratory

tests.tests.

NATURAL DEATHNATURAL DEATH

Death resulting from a Death resulting from a natural disease process.natural disease process.

SUDDEN DEATHSUDDEN DEATH

Cardiac arrhythmia (25% of all Cardiac arrhythmia (25% of all A.M.I.’s present with a sudden death)A.M.I.’s present with a sudden death)

Pulmonary embolusPulmonary embolus Seizure disorderSeizure disorder Berry aneurysm or CVA (rarely Berry aneurysm or CVA (rarely

sudden)sudden) Drug overdose (cocaine or heroin)Drug overdose (cocaine or heroin)

ACCIDENTAL DEATHACCIDENTAL DEATH

An unexpected death which An unexpected death which results from a lawful act results from a lawful act

performed under a reasonable performed under a reasonable belief that no harm is possible.belief that no harm is possible.

““GOOD JUDGMENT COMES FROM GOOD JUDGMENT COMES FROM EXPERIENCE; AND EXPERIENCE – EXPERIENCE; AND EXPERIENCE – WELL, THAT COMES FROM POOR WELL, THAT COMES FROM POOR

JUDGMENT.”JUDGMENT.”

Anonymous Surgeon, VietnamAnonymous Surgeon, Vietnam

ToxicologyToxicology

Blood:Blood: Alcohols -Alcohols - 0.111 g/dl Ethanol0.111 g/dl Ethanol Acid & neutral screen -Acid & neutral screen - None detectedNone detected Alkaline screen -Alkaline screen - None detectedNone detected Cannabinoids - Cannabinoids - None DetectedNone Detected Volatiles -Volatiles - 0.23 mg/l Toluene0.23 mg/l Toluene

Vitreous:Vitreous: Alcohols -Alcohols - 0.205 g/dl Ethanol0.205 g/dl Ethanol

SUICIDESUICIDE

The deliberate termination of one’s The deliberate termination of one’s existence.existence.

HOMICIDEHOMICIDE

The killing of one human being by the The killing of one human being by the act or omission of another.act or omission of another.

UNDETERMINEDUNDETERMINED

Autopsy and investigation fail to Autopsy and investigation fail to provide sufficient information to provide sufficient information to

establish a manner of death.establish a manner of death.