INTRODUCTION TO INTRODUCTION TO FORENSIC MEDICINE FORENSIC MEDICINE Robert C. Bux, MD Robert C. Bux, MD Coroner/Medical Examiner Coroner/Medical Examiner El Paso County El Paso County
Mar 26, 2015
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.