alcohol, drownind and burns

7/28/2019 Alcohol, Drownind and Burns

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Dr. Khalid Y. Mattar


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Ethyl Alcohol is the most widely used drug

in the world.

It is a small, water-soluble molecule which

can distributed easily throughout the body water

and cross easily the blood brain barrier causing

a depression effect on the brain function.


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Concentrations of Some Alcoholic Drinks

Beer, lager, 3-5%

Cider (variable) 5-7%

Table Wine 9-12%

Champagne Wine 18-20%

Spirits

(brandy, gin, whisky, vodka) 37-42%

Liqueurs 15-55%


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Effect on Central Nervous System:

1. Acting on neural cells in a way similar to hypoxiaby reducing their activity.

2. In lower concentrationThis action is confined to the cerebral cortex, with

no effect on the lower brain function.

3. In high concentrationCoursing depression of the function of the midbrain

and medulla affecting the vital centers.

(danger of fatal cardio-respiratory failure)


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Effect on the Heart:

1. The effect is central as well as vasomotor.

2. Tachycardia in low level and bradycardia in high

level.

Effect on the vascular system:

1. Vasodilatation causing marked heat loss

Effect on the Urinary system:

1. Diuretic effect causing electrolyte imbalance.


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Stage of Excitement:

Drunker in this stage is:-

1. felling of well being, pleasure

2. Converses well, laughs and smiles readily

or become angry easily.

3. May disclose secrets.

4. Talk in vulgar language and behave in anobscene manner.

5. Sexual desire may be aroused.


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Stage of Incoordination:


1. Incoordination of thought, speech and action

(confusion, slurred speech and staggering gait)

2. May be untidy in his appearance and sufferfrom hiccups.

3. Euphoric or irritable depending on his

emotions

4. Nausea and vomiting are common.

5. Most offenses and crimes are committed in

this stage.


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Stage of Narcosis:


1. Patient passes into deep sleep and responds

only to strong stimuli

2. Pulse is rapid, temperature subnormal andbreathing stertorous.

3. If recovered from this stage, sign of hang-over

(depression, headache, gastrointestinal irritation)

may continue for 24 hours.


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Blood AlcoholConcentration

General Effect

30 -50 (mg/dL) Impairment of driving and similar skills

50-100 (mg/dL) Reduced inhibition, talkativeness, laughter, and

slight sensory disturbance

100-150 (mg/dL) Inco-ordination, unsteadiness, and slurred speech

150-200 (mg/dL) Obvious drunkenness, nausea and ataxia

200-300 (mg/dL) Vomiting, stupor and possibly coma

300-350 (mg/dL) Danger of aspirating vomit, stupor or coma

350+ (mg/dL) Progressive danger of death due to respiratory

paralysis


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Some Diseases Related to Chronic Alcoholism

Alcoholic Addiction

1. Fatty liver and liver Cirrhosis

2. Pancreatitis3. Varices Veins

4. Coronary Artery Disease

5. Pneumonia

6. Gastric Erosion and Hemorrhage

7. Korsakoffs Syndrome


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1. Smell of alcoholic in breath

2. Loss of self control.

3. Dilated pupils and fine lateral nystagmus.4. Slurred speech

5. Unsteady gait.

6. Confused mental state or impaired memory.


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1. Blood

2. Urine

3. Breath (breath analyser)


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Treatment of Acute Alcoholic Intoxication:


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1. Stomach Lavage with 5% solution of sodium

bicarbonate.

2.Isotonic Saline with 5% Glucose.

3. Patient should be kept worm.

4. If patient come with respiratory depression,

artificial respiration along with O2 inhalation is

must.

5. In very serious cases, peritoneal dialysis or

haemodialysis will be required.


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Dr. Khalid y. Mattar


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Drowning is death through the aspiration of fluidinto the air passages.

Complete submersion of the body is not necessaryfor drowning to occur, death due to drowningcan happened when mouth and nose arecovered by water.


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o Died from natural causes before entering the water.

o Died from natural causes while in the water

o Died from exposure and hypothermia in the water.

o Died of injuries or other unnatural causes before

entering the water.

o Died of injuries after entering the water.

o Died from submersion, but not drowning.

o

Died from true drowning.


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The general identification procedures.

Police investigations.

Medico-legal identification


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1. Maceration of the skin:

Imbibitions of water into the skin, it is seen

first on the fingertips, spreading to the palm

and back of the hand

The skin become sodden, thickened, wrinkled

and white in color (washerwomans skin).

Similar changes are seen in the feet


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From 2-4 hoursit start to appear clearly in the tips of fingers.

In about 24 hours:it covers the hollow of hand In 2 weeks:

the outer layer of the skin may loosen from

the inner layer. In about 3-4 weeks:

nails will start to be loosen

After one month the whole skin may slip offlike a glove

Depending on the water temperature


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2. Formation of Adipocere:

increase the water temperature,faster the adipocere formation

5 - 6 months in North America

5 - 6 weeks in South Europe

Within 2 - 3 weeks in Gulf Area (in summer).


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Mechanism of drowning (3.54 min.)

1. The stage of surprise, lasting for 5 10 sec.

2. The first stage of respiratory arrest, lasting for about1 min (struggle to reach the surface).

3. The stage of deep respiration, lasting for about 1 min.(formation of foam at the nose and mouth).

4. The second stage of respiratory arrest, lasting forabout 1 min (loss of sensibility and hypoxicconvulsions occur).

5. Terminal gasping, which constituted the last external

signs of life.


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Accidental Drowning: Usually associated with alcoholic or drugs

intoxications

Sudden cooling of the body play an importantrole in cold water drowning

(uncontrollable hyperventilation)

Hypothermia is a later danger, but still can beaccepted as cause of death.


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Suicidal Drowning:

Difficult to diagnose if there is no farewellletter, witnesses or circumstantial evidences.

Person is usually more or less fully clothed.

The deceased can be shone to have been under

the influence of alcohol or drugs.


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Homicidal Drowning:

Extremely rare.

If there is evidence of tying or weight attachedto the body or some injuries, homicide may bestrong in such circumstances.


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An exposure of living tissue to high temperatures.

The heat source may be drywhich resulting burninjuries, or it could be wet(hot liquids or

steam) which resulting scalding injuries.


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Classifications:

1. According to the cause:

o Fire flames.

o Exposure to sun.

o Hot liquids.

o Radiation.

o Artificial lights.


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General Features:

1. Usually accidental especially in children and old people.

2. There are certain shape of scald usually sharpdemarcated edge corresponding to the limits of contact of

the fluid.

e.g. :

Horizontal levelcorresponding the fluid level inimmersion case, and

Irregular disruption in case of splashing depending onthe gravity.

3. Death usually results from, fluid and electrolyte

disturbance, shock, and infections.


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1. Classification According to severity

o First degreeerythemia and blistering of the skin.

o Second degree

burning of the whole thickness of theepidermis and exposure of the dermis.

o Third degreedestruction down to the subdermaltissue, maybe associated with carbonization

o +Forth degree

charring of the body


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2. Classification According to thepercentage of coverage (Rule of 9) :


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General Features:

1. Death caused by fire might be:

immediate due to direct thermal injuries(burn), or more commonly smoke inhalation.

Delayed(within first 3 days) due to shock,acute respiratory failure, or fluid loss.

Late (after the first 3 days) due to sepsis orchronic respiratory insufficiency.


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2. On gross Examination:

Impossible to distinguish acute ante-mortemfrom post-mortem burns.

Burned bodies may present with a position called

pugilistic attitudeor boxer position.

Skin might split exposing the underlying musclesand bones.

Burned bone has a gray-white color, oftenshowing a fine superficial heat fracture on itscortical surface and may crumble on handling.


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3. Autopsy findings:

In case ofante-mortemburns, there will be:

o High level of CO in the blood (mostly).

o Soot particles in the lower airway passage,

and in some cases even in the stomach.

o Cherry-Red coloration of the hypostases,blood and internal organs.

o Saver edema of the respiratory system.


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Determination the cause of death as some firecases are used to conceal homicides

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alcohol, drownind and burns

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