legal med final exam

8/12/2019 legal med final exam

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LEGAL MEDICINE EXAM

1. DEATH - is the complete cessation of all the vital functions of the body without possibility ofresuscitation. The ascertainment of death is a medical and not a legal problem.

Death may be either Brain Death (which occurs when there is a deeply irreversible coma, and

absence of electrical brain activity) or Cardio Respiratory Death (which occurs when there is

continuous and persistent cessation of heart action and respiration).Diagnosis and medical examination of death are as follows:

A. Clinical or Somatic Deathoccurs when in the judgment of the physician with the use of hisclinical eye the bodys vital signs of life cease to exist continuously and permanently. The

clinical death is verifiable only by a physician after he observes that the patient no longer

has a heartbeat, no pulse rate, no spontaneous breathing and movement, with the pupils of

the eye widely dilated and not reactive to light and accommodation. When a clinically dead

person is brought to the morgue the generalized contraction of the muscles or Rigor Mortis

of the body within 3 to 6 hours, may simulate a return to life, because of the motion or

movement of the body.B. Brain Deathfollows clinical death almost immediately unless resuscitative procedures are

started promptly, because the human brain under normal conditions cannot survive loss of

oxygen for more than 6 to 10 minutes. Brain Death may occur in the Stage 1Cerebral

Cortex (the highest center of the brain that is most sensitive to changes in the supply of

oxygen and blood to the brain). When the cerebral cortex dies, the patient is in cortical

death. Stage 2 - Cerebellum (deals with the function of equilibrium). It follows the death of

the cerebral cortex. Stage 3Brainstem and Vital centers. These centers controlling

respiration, heart rate and blood pressure, ultimately die. When it does, the patient is Brain

Stem Dead. If the brain stem is damaged, then the vital centers in the medulla maybedestroyed, causing the respiratory center to fail. The occurrence of brain stem death is

equivalent to Legal Death, so that Doctors can now issue a Death Certificate, even though

the heart is still beating, and make arrangements to harvest donor organs and tissues at this

stage. Further, in the presence of brain stem death, artificial respirators only achieve the

maintenance of an oxygenated circulation through a corpse or cadaver.

Criteria for diagnosing Brain Stem DeathPersistent Vegetative State ( PVS ) - This

condition exists, when irreversible destruction of the Cortex of the brain occurs without

damage to the vital centers, and there are permanent eyesopen state of unconsciousness,

but cardio respiratory functions continue, sometimes without respiratory assistance, but most

often with respiratory support. They do not however match the clinical criteria of Brain Death,

in as much as they have elicitable reflexes, spontaneous respirations and reactions to external

stimuli.

Harvard criteria for whole brain deadunreceptivity and unresponsitivity, no spontaneous

movements or breathing, no reflexes, and flat EEG of Confirmatory value.

Whole Brain Deadwhen the brain ceased all functions, even though the heart continues

to beat. As a rule doctors can legally declare whole brain death twelve hours after they have

corrected all treatable medical problems, but the brain still doesnt respond even to induced

pain , they eyes do not react to light and the person doesnt breath without a respirator.

Biological Deathall the components of the brain are dead. There is also permanent

extinction of bodily life. It is cardiorespiratory and brain death altogether with permanent

cessation of all the anatomic and physiological functions of the body organs.


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A. Head Injuries;

B. Spine and Spinal Cord Injuries (the most common causes of severe spinal trauma are motor vehicular

accidents, falls, diving accidents, and gunshot wounds);

C. Chest Injuries

a. Life Threatening Injuries (Pnumothorax Hemothorax Flail chest as in multiple rib fractures Cardiac

tamponade due to penetrating injuries);

b. Potentially Lethal InjuriesPulmonary Contussion with or without flail chest; and Thoracic Aortic Tear or

Rupturethe most common cause of sudden death after a vehicular accident or fall ( major deceleration

injury )

c. Serious Chest Injuries

D. Abdomenal Injuries

a. Penetrating - Gunshot wounds of the abdomen carry 95% probability of significant visceral injury. A bullet

when it hits the abdomen will penetrate the abdominal wall, enter the abdominal cavity and most likely injure

more than one organ. The incidence of abdominal injury is strikingly higher in gunshot wounds than in stab

wounds. The major cause of death is hemorrhage and this occurs within the first 24 hours. In stab wounds of

the abdomen, only 2/3 penetrates the peritoneal cavity; of these only cause significant visceral injury that

requires surgical repair.

b. Blunt - The spleen and liver are the most commonly injured organs due to blunt trauma. Their frequent

incidence also explains why the mortality rate following blunt trauma is higher than that of penetrating injury.

E. Fractures and Dislocations

The word fracture comes from the Latin word fractura which means a break in the continuity of the bone. It

is also a combination of a break in the bone and soft tissue injury.

a. Open Fractures - 90% of open fractures are caused by vehicular accident.

b. Hip fractures are very common in elderly people and are usually caused by minor falls. It is the most

common cause of traumatic death after the age of 75.

F. Urologic

a. Hematuria following trauma;

b. Blunt kidney injuryis usually due to motor vehicular accidents which account for 7090 % of kidney

trauma;

c. Penile injury the erect penis is usually 68 inches long and 1 -2 inches in diameter.

d. Avulsion of the prepucethis may follow accidents where the foreskin called prepuce is detached or

lacerated by a blunt force.

e. Fracture of the penisthis is the traumatic rupture of the corpora cavernosa penis resulting from a forceful

trauma to the flaccid organ.

f. Amputated penisthe penis of an avid womanizer is sometimes intentionally cut or amputated by a jealous

derange wife or lover.

G. Arterial trauma

H. Burns

5. IDENTIFICATION OF HUMAN REMAINSOne of the initial factors to determine when identifying a set of human remains is the sex of the individual.

There are numerous features of the human skeleton that can be studied to help establish this, the most

obvious being the pelvic bone. . .

6. IDENTIFYING THE DECEASED

7. EXAMINATION OF BLOODSTAINS

Once you know that a stain is blood, there is a lot of potential information in a blood stain such as:


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A. Pattern and shape: The shape and pattern of blood drops can reveal important information about thenature of the wound from which the blood came. Was the bleeding person standing still or walking?

What distance did the blood drop fall? Did the blood spatter in all directions? A good investigator

would carefully photograph all blood stains from different angles both so that a forensic scientist could

examine the pattern and to be able to present the evidence to a jury.

B. DNA: Blood contains DNA, and depending on the size of the stain and its condition (old, new, dry, etc.),a forensic scientist may be able to get enough information to obtain a highly probable match of a

suspect with the evidence. Two techniques are heavily used by forensic scientists in evaluating DNA

evidence from blood or other body tissuespolymerase chain reaction (PCR) and variable number

tandem repeats (VNTRs).

C. Type: Blood typing can be used as an initial test to exclude some suspected sources of a bloodstain.For example, if a blood stain at the crime scene contains Type A blood, but the key suspect has Type O

blood, the suspect could be excluded as a source of the blood stainmeaning he or she definitely did

not leave the blood stain. However, blood type alone usually cannot positively identify a suspect

because many people share the same blood type.

Investigators have collected blood samples from each of the suspects in the case. The samples and the

evidence are labeled A-D. It will be the forensic scientists job to type each sample. He shall determine both

the ABO blood type of each sample as well as the Rh factor type.

a. ABO blood group: There are three alleles at the locus that determines an individual's ABO blood

type, and there are four possible types -- A, B, AB, and O. Type A individuals have "A" antigens in their blood.

Antigens are proteins that the body's immune system recognizes and either mounts an immune response to, if

the antigen is from a foreign source, or ignores, if the antigen is part of the body itself. Type A individuals do

not mount an immune response against A antigens. If they did, the immune system would produce A

antibodies that would bind to the A antigens and cause the blood to thicken and clot. Individuals who are type

B don't produce antibodies against B antigens, but they do produce antibodies against A antigens. Individuals

who are type O have neither A antigens or B antigens, so they have antibodies to both types. Individuals who

are type AB, have both antigens and do not have antibodies to either A or B. There are no O antigens. Type O

individuals simply do not produce any antigens in this blood type group.

b. Rh factor:

Another commonly tested blood antigen group is the Rh factor. Individuals who produce Rh antigens are

referred to as Rh positive. Individuals who do not produce Rh antigens are referred to as Rh negative.

8. CLASSIFICATION OF WOUNDSA. As to the depth of wound:

a. SuperficialWhen the wound involves only the layer of the skin;

b. DeepWhen the wound involves the structures beyond the layers of the skin.

b.1 Penetratingthe wound enters the body but does not come out. Punctured, stab and gunshot

wounds usually belong to this type of wound.

b.2 Perforatingthere is a communication between the outside, inner and the outer side. There is

both a point of entry and exit.

B. As to mortality:

a. Deadly Wound- Death results immediately, after the infliction of the wound. Deadly wounds though mortal,

maybe prevented with prompt medical treatment.

b. Non Deadly WoundsDoes not result to death immediately, after the wound is inflicted. A non-deadly

wound may cause death later, due to complications i.e. tetanus, septicemia

C. As to the wounding instruments used:

a. Sharp InstrumentsEx. incised wound, punctured wound, stab wound dagger or kitchen knife;

b. Blunt InstrumentsA block of wood or iron produces contusion, hematoma, abrasions, lacerated wound

when used to strike, attack, wound, beat or assault another


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D. As to the consequential injury after the application of force:

a. Coup Injury

b. Coup Centre Coup Injury

c. Contre Coup Injury

d. Locus Minoris resistancia

e. Extensive injury

F. As to the integrity of the skin:

a. closed woundspresents no break in the integrity or continuity of the skin. There may be only outward

manifestations of injury internally. (Ex. of closed wounds:petechiaea circumscribe extravasation of blood in

the subcutaneous tissue; contusioneffusion of blood into the tissues underneath the skin as a result of a

blunt force, i.e. black eye, hematoma, blunt injury, musculoskeletal injurieslike sprain, dislocation, fracture,

strain)

Cerebral Concussionthere is a brief loss of consciousness and sometimes memory after a head injury that

doesnt cause obvious physical damage.

Cerebral Contusionthey are bruises to the brain, usually caused by a direct, strong blow to the head. They

are more serious than concussions.

B. open wounds - There is a break in the continuity of the skin.

a. AbrasionScratch, friction mark;

b. Bruisecause by a blunt injury to the tissues which damage blood vessels beneath the surface, allowing

blood to extravasate or leak into the surrounding tissues.;

c. Incised wound;

d. Stab wound;

e. Punctured wound;

f. Perforating wound;

g. Lacerated woundresult of an injury from a blunt instrument. In cerebral laceration, the brain tissue is torn

often with an accompanying visible head wounds and skull fractures;

h. Bitesthey maybe abraded, bruised or rarely lacerated. They are usually seen in sexual assaults and in child

abuse and also by animal bites;

i. Gunshot wounds

9. FIREARM WOUNDSThe type of wound produced by a firearm depends on several factors including:

a) Nature of the weapon

b) Composition of the missile

c) Range

d) Tissues traversed by the missile

e) Direction of fire

Ballistics is the study of firearms and ammunition. It is a very highly specialized and complex science and

cannot be fully discussed here, but certain basic principles can be considered.

There are two main types of guns:

a. Those firing single missiles, e.g. rifles and pistolsb. Those firing a mass of small missiles (shot) -shotguns.

I. Bullet Wounds

A. Entry Wounds


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The features vary depending on the range from which the weapon is firedcontact, close (intermediate)

range or longer (indeterminate) range. A gunshot wound is a controlled explosion and the bullet is accompanied

from the gun by a jet of flame, a cloud of gas, burning and unburnt grains of gunpowder and soot from burnt

gunpowder. Entry wounds may show the stigmata of the explosion to a lesser or greater extent.

a. Contact wound

The muzzle is pressed against the skin. The heat of the discharge causes scorching or charring of the wound. The

gases produced by the explosion of the cartridge enter, stretch and split the skin producing a stellate or cruciform

tear. The tissue at the margin of the wound may contain soot and powder.

b. Close range (Intermediate range)The wound is inflicted at less than arm's length i.e. < 2 -3 feet. The particles of partly burnt or unburnt powder

from the muzzle are driven into the skin around the entrance wound giving a stippled appearance called "powder

tattooing" or "powder burns". The area may be blackened by soot. Soot may be wiped off the skin, but powder

tattooing cannot be wiped off. The bullet hole may be round or split, the latter being relatively common when

there is underlying bone.

c. Longer (Indeterminate) rangeThe range is > 2 -3 feet. The gun is too far from the skin for the products of the explosion to have any effect.

Therefore the appearance of the wound is due entirely to the bullet. The wound is usually round (but may be

split by "tail-wag" if the gun is fired from the extreme of its effective range causing the bullet to lose its

gyroscopic spin and start to tumble).

Marginal abrasion/Abrasion collar/Abrasion ring

The margin of the entry wound in some close range and longer range injuries may be abraded (marginal

abrasion, abrasion collar or abrasion ring) as the bullet inverts the skin and abrades the epidermis as it

enters. The shape of this abrasion may help in determining trajectory.

Grease ring

The inner edge of the abrasion collar may be black due to grease or lubricating oil and metal particles from thebullet.

B. Exit woundsThese show none of the stigmata of the explosion or soiling seen in the entry wound. An exit would may

be the same size as the entry wound, but may be smaller or larger depending on the range, type of weapon, type

of bullet, the tissues being traversed by the bullet, etc.

In a contact shot the entry wound is split by the explosive gases and is therefore usually larger than its

corresponding exit wound. However, if the bullet comes out carrying bone e.g. a shot to the skull, the exit wound

may be larger than the entry.

In a distant shot the exit wound may be the same size or slightly smaller than the entry. In general, exit

wounds tend to be split with irregular, everted edges. As a rule, exit wounds DO NOT show an abrasion collar, but

exceptionally, this may occur if the skin was pushed up against a hard surface, e.g. concrete wall or floor at the

time the bullet exited. This is known as a shored exit wound.

Bullet wounds of the skull are peculiar in that they produce entry and exit wounds in the bones of the

skull as well as the skin. The entrance wound to the skull is bevelled (angled) inward (i.e. the hole gets bigger as it

goes into the skull!), because the hole in the inner table of the skull has a greater diameter than that in the outer.

This happens because the bone fragments from the outer table travel inward with the bullet, amplifying its

effect.

In contrast, the exit wound from the skull is bevelled outward (i.e. the hole gets bigger as it goes out of

the skull), because the hole in the outer table now has a greater diameter than that in the inner. This is also

caused by the amplifying effect of bone fragments travelling with the bullet. In a close range shot to the head the

exit wound may be quite large.

Shotgun wounds cause massive destruction with contact or close injuries. There is accompanying

blackening and singeing of the wound. As the range increases, many tiny separate holes will be seen. Exit wounds

are uncommon, except at relatively close range, as the shot tend to scatter within the body.

II. Blunt Trauma to the Skull


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This can result in a variety and combination or injuries, including: -

A. Skull fractures -may be compound, depressed, single, multiple etc.Remember that fatal head injury can occur without skull fractures.

B. Intracranial haemorrhage -extradural (epidural), subdural, subarachnoid. Subarachnoid haemorrhage isquite common but is not usually the only injury found in trauma. When it is the only finding it is more

likely to be the result of spontaneous rupture of a berry aneurysm.

C. Brain damage -contusion and laceration may occur. The latter may cause intracerebral haemorrhage.Cerebral oedema is common and may lead to fatal raised intracranial pressure. Concussion producesunconsciousness without gross brain damage, but microscopic examination may show neuronal injury

with demyelination.

10. ASPHYXIATYPES:Seven major types of mechanical asphyxia:

A. Environmental

B. Suffocation

C. Traumatic or crush asphyxia

D. ChokingE. Strangulation

F. Hanging

G. Inhalation

11. POST-MORTEM APPEARANCES IN ASPHYXIAThe general features (signs) of asphyxia are not dependable alone in the diagnosis, but they must be

associated with the specific signs of each type of asphyxia by its different methods.

Anatomical findings in cases of asphyxia:

A. Congestion of the dead body internally and externallya. Presence of petechial hemorrhage on the corpse internally and externally which are called (tardieu spots).

They will be present under the serous membranes which are the: pericardium, pleura, peritoneum

b. Cyanosis of the extremities

c. Hypostasis

d. Increased blood fluidity because of increased CO 2, increased fibrinolysin, increased fibrinolysis

B. Changes in the organs and tissues

a. The heart blood fluidity, tardieu spots

b. The respiratory system congested, froth, congestion of lungs and increase in their size

c. CNS increased petechial hemorrhageC. Biochemical changes:

a. Oxygen deficiency

b. CO 2 increases

c. Pathological changes

12. STRANGULATION3 TYPES (HANGING, STRANGLING, THROTTLING)Violent asphyxia of the airways: (from outside)

A. HangingI. Causes of death:

1. Asphyxia

2. Cerebral congestion

3. Cerebral ischemia


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4. Sudden cardiac arrest

5. In legal hanging (fracture of the odontoid process of the axis vertebra)

II. General examinations:

1. General signs of asphyxia

2. Neck examination

a. Externally rope signs site (above the thyroid cartilage)

Partial OR complete

The depth depend on the amount of pressure and type of the rope

b. Internal signs in the neck:

Hemorrhage

Hemorrhagic bruising in the internal tissues

Rupture in the platysma muscle

Rupture of arteries

Fracture of the axis

Fracture of the hyoid bone

iii. Hanging maybe:

1. Accidental in children and workers

2. Suicidal

a. presence of a chair

b. The way the rope was tied

c. Other (previous) suicide attempts d. No signs of struggle (fight)

3. Legal

4. Homicidal (rare) mostly the victim was killed by another way then was hanged to appear as

suicide

B. Ligature strangulation

I. Causes of death:

1. Airway blockage

2. Reflex cardiac arrest

3. Anemia

II. Findings

1. Struggle signs

2. Congestion of the face

3. Protrusion of the eyes


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4. Conjuctival congestion

5. Subconjuctival hemorrhage

6. Bloody froth in the mouth

7. Bleeding from the nose and ears

III. Neck examination:

1. Ligature marks which surround the neck completely

2. Differentiated from hanging by the type of the ligature (its length) and by the direction of the

pressure caused by the ligature (or rope)

3. Internally bruising and contusions in neck muscles

4. Fractures in neck cartilage (thyroid cartilage)

5. (Rarely) fracture of the hyoid bone iv.

It maybe: 1. Accidental

a. Workers (who carry things by ropes)

b. Children

c. During birth (by umbilical cord)

2. Suicidal mentally retarded patients

3. Homicidal most common

a. Struggle marks and injuries are seen on the body

b. Causes maybe: stealing, revenge, shame, illegal pregnancies

c. Sometimes the murderer burn the dead body to cover the crime

C. Manual strangulation (throttling): Pressure on the airways from outside by hands

I. Causes of death:

1. Air deprivation in the trachea

2. Reflex cardiac arrest

3. Cerebral ischemia

II. Findings

1. Cyanosis in the face and lips

2. Petechial hemorrhage

3. Abrasions and bruisings around the nose

4. Struggle marks (signs)

5. Asphyxia signs

III. Neck examination:

1. Externally


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a. a hand or 2 hand marks with forearm mark on the skin from the front or back of the neck

b. Bruisings and nail marks (abrasions) on sides of the neck

2. Internally (on autopsy) bleeding from the tissues, muscles and vessels

a. Fracture in the hyoid bone

b. Fracture of the thyroid cartilage

c. Contusions in the upper 3 rings of the trachea

IV. It maybe: 1. Homicidal in all ages (including children and elderly), Under effect of narcotics

2. Accidental in fights

3. Suicidal not common

13. CHOKING AND ASPIRATIONOF FOREIGN BODIESViolence upon the airways (from inside) (choking)

A. Blockage of the airways from inside by a foreign body.

E.g.:

Vomitus

Food

Teeth

Blood

Saliva

Amniotic fluid (in fetuses)

B. Site of blockage Larynx, Trachea, Bronchi

C. Causes of death:

Blockage of the laryngeal inlet by a large object

Blockage by a small object + edema

D. Death may be delayed when there is

Aspiration pneumonia

Pus in the lungs

Bronchiectasis

E. Findings:

General signs of asphyxia

Abrasions and bruisings in the airways

F. It maybe: A. Accidental


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1. In children (by buttons or coins)

2. In elderly and drunks (by food like bones of fish or chicken)

3. In surgeries (blockage by base of the tongue)

4. After surgeries (forgetting a gauze inside)

B. Homicidal

1. In children (by pushing a piece of tissue, cotton or gauze inside the mouth)

2. When there is rupture or bleeding from the gum and mouth as a result from any violence against

them

14. MECHANISM OF TRAUMATIC ASPHYXIAViolence upon the chest (traumatic or crush asphyxia):

A. It happens when

There is a pressure on the chest or the abdomen by a heavy object

A person is buried alive under a collapsed house

Children or elderly are stepped on by a crowd

B. Findings on autopsy:

Facial congestion with severe cyanosis in upper body parts

Pallor in the lower body parts

Bruises and abrasions in the neck

Fractured ribs and contusions in the inner organs

C. It may be: Accidental (commonly), Homicidal (rarely)

15. DROWNING AND IMMERSIONA. Death from asphyxia as a result of immersion of the body into a liquid, not necessarily completely

because death happens if only nose and mouth were immersed.

I. Causes of deatha. Instantly (in 2-5 minutes):

Air replaced by water

Fatal hypothermia

Aspiration of air into the larynx

Laryngeal spasm (dry drowning)

Fatal head traumas

b. Late (in those who survive the drowning):

Aspiration pneumonia


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Bronchitis

Edema

Renal failure (as a result of hemolysis)

II. Findings on autopsy:

a. Indefinite signs:

Signs of immersion of the body in water

Quick hypothermia (as it happens 2 times quicker in water than in air)

Hypostasis is in the head, neck and anterior of the chest

Color of hypostasis is pink-red

Congested conjunctiva with petechial hemorrhage in them

- Washerwomans hands

Skin slippage

Wrinkled skin because of contraction of erector pili muscles

Slow putrefaction

When the body floats or taken out, putrefaction happens quickly because of increased humidity

b. Definite signs:

i. Depending on the duration the person lived after falling in water and when he/she was saved,

divided into:

ii. External signs

1. Drowning froth on the mouth and nose, which is white colored, odorless, if removed it forms again and it

comes out more by pressing on the chest.

2. Cadaveric spasm, when the drowning person holds anything to survive. It is a definite sign of drowning,

helps to know the location of drowning.

3. Abrasion on the fingers and contusions on the nails

III. Internal signs:

1. The lungs

a. Presence of froth, sand and sea weeds (plants) in the airways

b. Laryngeal congestion

c. Bleeding under the pleura

d. Hemothorax

e. Enlarged lungs surrounding the heart

f. Imprintings of the ribs on the lungs

g. Pale color of the lungs


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h. On microscopic examination diatoms and plankions are seen

2. The heart

a. Congestion inside the heart, filled with a dark colored blood which is very liquidy

b. Difference in the (NaCl) level in the heart, salty water is more in the left side, and fresh water is less in the

left side.

c. Wall of the aorta becomes red colored because of hemolysis

3. The stomach

a. Filled with fluids

b. Contains sea weeds and plants

c. A definite sign is presence of salty water (when drowning in sea)

All these definite signs may not be evident inspite of being sure that its a drowning case, this mayhappen in:

1. Death due to reflex cardiac arrest

2. Occurrence of a heart attack at the time the person fell in water

3. Head injuries

4. Quick laryngeal spasm (in dry drowning)

B. Drowning maybe

a. Accidental

Swimming in the sea

Fishing

Epilepsy attack

Bloats (or ships) sinking

To distinguish it from other types, what is important are:

1. The witnesses

2. Circumstances of drowning

3. When the body is taken out with its full clothing may imply accidental drowning

b. Suicidal

Mainly in people who lived next to seas or rivers

When the body is taken out, previous wounds of suicide attempts are seen, and before drowning he/she may

tie his/her hands or legs

c. Homicidal (rare)

Can be proved by investigations

In children and newborns


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In adults after drugging them

- In those who cant see the perpetrator (blind people)

Drunk people

In adults after being tied by weights

C. Immersion after death:

1. To hide a homicide.

2. The body is tied by heavy rocks so it stays under water and the crime is not revealed.

3. There isnt any definite sign of drowning.

16. NATURAL DEATH

17. VIOLENT DEATH18. TYPES OF HEAD INJURIES:

A. HematomaB. ContusionsC. Skull fracturesD. Hemorrhage

19. SPINE AND SPINAL CORD INJURIESThe most common causes of severe spinal trauma are motor vehicular accidents, falls, diving accidents,

and gunshot wounds.

PHARMACOLOGIC CLASSIFICATION OF DANGEROUS DRUGS 1.Hypnotics 2. Sedatives and Tranquilizers 3.

Hallucinogens and Psychomimetics 4. Stimulants 5. Depressants 6. Deliriants and Intoxicants

A.Hypnotics: Opiates and Their DerivativesOpium is obtained from the milky exudates of the unripe seed

capsules of the poppy plant, Papaver Sornoiferum.

Derivatives of opium commonly used are morphine, heroin, and codeine.

Its synthetic preparation are Demerol and Methadone.

Narcotics that have a legitimate medical used as powerful pain relievers are called Opioids, and include

codeine, oxycodone, meperidine, morphine and hydromorphone.

Heroin which is prohibited is a very strong pain reliever and narcotic

Signs and Symptoms of Opium Administration: 1. Stage of Excitement 2. Stage of Stupor 3. Stage of Narcosis

B. SEDATIVES: Barbiturates: - are the products of malonic acid and urea, synthesized on St. Barbara day. - Used

to treat anxiety and to induce sleep can cause both psychologic and physical dependence.


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C. HALLUCINOGENS OR PSYCHOMIMETIC DRUGS: Marijuana( Cannabis Sativa ) is a Mexican term for

pleasurable feeling. Marijuana is not addictive. Physical dependence and dose tolerance do not develop with

its use. Psychic dependence may occur.

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Subjective effects of Marijuana: - There is a feeling of lightness of the extremities followed by rushes of

warmth and well being that eventually lead to a sense of relaxation, mild euphoria and a dreamy state whereideas are disconnected. Objective Effects of Marijuana: - Moderate increase in resting pulse rate, reddening of

the eyes due to dilatation of the conjunctival blood vessels. Difficulty of speech and of remembering of the

logical trend of what was being said.

Lysergic Acid Dsethylamide ( LSD ) - These drugs are false hallucinogens. - It produces impaired judgement so

that a user might think that he can fly, and may even jump out a window to prove it, resulting in severe injury

or death.

D.STIMULANTS: Amphetaminesmethamphetamines ( Shabu, speed ); methylenedioxymethamphetamine (

MDMA, ecstasy or Adam ) - Acts on the cerebral cortex causing alertness, excessive self confidence and feelingof well being. Physical performance may to some degree temporarily improve.

Untoward Effects: - They increase the blood pressure and heart rate. Fatal heart attacks have occurred even in

healthy, young athletes. The blood pressure maybe so high that a blood vessel in the brain ruptures causing a

stroke.

Coccaineis an alkaloid from the leaves of the coca shrub cultivated in Bolivia and Peru. - It produces effects

similar to amphetamines, but is a much more powerful stimulant. - Is used to excite the undersexed. - Is a

euphoriant and readily relieves fatigue

Untoward Effects: - Same as amphetamine

E. DEPRESSANTS: - Angel dust - Depresses the brain and abusers usually become confused and disoriented

shortly after taking the drug. - Can be combative and because they dont feel the pain they may continue

fighting even when hit hard.

24. PROFESSIONAL RESPONSIBILITY. NEGLIGENCE.

Liabilities of a Physician Which May Arise from His Negligent or Wrongful Acts or Omissions:

A. Administrative Liability - A complaint under oath can be filed before the Professional Regulation

Commission Board of Medicine, for reprimand, of the license to practice medicine.B. Criminal Liability - When an act or omission constitutes a crime, the physician can be imprisoned or fined or

both, as any other profession.

C. Civil Liability - The aggrieved party can be awarded monetary damages for any wrongful or negligent act or

omission, when the professional is found guilty.

Medical malpractice is a particular form of negligence which consists in the failure of a physician or

surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the

profession generally, under similar conditions, and in like surrounding circumstances

There are Four Elements involved in medical negligent cases: Duty, Breach, Injury, and Proximate

Causation. It has been recognized that expert testimony is usually necessary to support the conclusion as tocausation.

References:

Legal Medicine, Dr. Pedro P. Solis, copyright 1987.

legal med final exam

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