COLORATLAS

OFMUSEUM
SPECIMENS

0
 EditedBy

StaffMembersofForensicMedicineandToxicology
Department
FacultyofMedicine-Cairo University

[Link] Salaheldeen Ghaleb

Headof theDepartment

1
(Preface)
The increasing emphasis on improving our student's practical and
applied skills encouraged us to offer medical students an approach
to practical aspects of forensic medicine and clinical toxicology.

This book includes six core subjects with a large number of

faithfully reproduced visual images of the demonstrationspecimens
that are critical to the understanding and application of different
aspects of forensic medicine and toxicology. These subjects are;
analysis of the museum specimens (soft tissues, bones, X-rays,
fire arm specimens and toxic plants), microscopic specimens (hair,
fibers, blood), primary wound report, death certificate, forensic
chemistry (color reaction).

If this wore helps to provide better patient care, raise the

medicolegal insight and stimulates interest in forensic medicineand
clinical toxicology practice by medical students and general
practitioners, then our effort; will have indeed been worthwhile.

[Link] Salaheldeen Ghaleb

HeadoftheDepartment

2
 Identificationof Age fromBones

Skull sutures, ossification centers appearance, union of epiphysis

of long bones and extent of medullary cavity.
ThesefindingsaredetectedbyX-rayinlivingpersonsandby dissection
in dead persons.
l. SKULL:
1. Dimensions:in full term infants, the circumference is 13 inches,
length is 5 inches and width is 4 inches.
2. Fontanels:the posterior fontanel is closed at full term while the
anterior fontanel is 3 fingers at full terms and closes at 18 months
after birth (1 finger every 6 months).
3. Sutures:
● Frontalsuturecloses at2years(30yearsinNegroid).
● Basiocciput-basisphenoidsutureclosesat23years.
● Sagittal suture closes at 25-30 years (starts to close from the
middle of the inner table at 25 years and is completelyclosed at 30
years).
● Coronalsutureclosesat40years.
● Lambdoidsutureclosesat50years.
● At 70 years all sutures are united except the suture between the
parietal and temporal bones which closes at extreme old ages.
4. Themandible:
a) Theangleof themandible:
Obtuseininfants*Rightinadults-Obtuseinoldage.
b) Mentalforamen:
● Ininfant:mentalforamenisnearthelowermargin.

3
● Inadults:mentalforamenismidwaybetweenupper&lower margins
● In old age: Mental foramen is nearer to the alveolar margin due
to its atrophy.

5. Teeth:
Dentition
a. Dentition
I- Milkdentition(20teeth):
Theyaresmall,narrowanddelicate.
They are white in color with serrated
[Link] 6thmonthinthe
followingorder:
a) Thecentralincisorsat6thmonth(thelower beforetheupper).
b) Thelateralincisorsat9thmonth.
c) Thefirstmolarteethat12thmonth.
d) Thecanineteethat18thmonth.
e) Thesecondmolarteethat24th month.
f) Spacebehindthelastmolarincreases at3-5years.

II- PermanentDentition(32teeth)
The permanent teeth are ivory white in color without serrated
edges. They are larger, stronger, and broader than milk [Link]
start to erupt at 6thyear of life in the following order:
1. The1stpermanentmolarsat 6thyear.
2. Thecentralincisorsat7thyear.
3. Thelateralincisorsat8thyear.
4. The1stpre-molars(bicuspid)at9th year.
5. The2ndpre-molars(bicuspid)at10thyear.
6. Thecanineteethat 11thyear.

4
7. The2ndmolars at12th year.
8. Spacebehind2ndmolar……morethan12years.
9. The3rdmolar(Wisdom tooth)at18-25thyears (maynoterupt).

b. Afterfull dentition,theage isestimatedthroughexamination of the

following criteria:
1. Attrition(eatingupofthegrindingsurface).

2. Secondarydentindeposition.

3. Pullingdownofgingivalattachment.

4. Cementumdeposition.

5. Transparencyandresorptionoftheroot

AgingofTeeth:ASPCT [Link]
bones
1-TheExtentofMedullaryCavity
The medullary cavity of the humerus reaches the level of
surgicalneck at 30 years and the anatomical neck at 33 years.
N.B. After pubertythe dates are about 2 years less in females than
males.
[Link](O.C.):
Thebonesofhumanskeletondevelop fromseparateossification
centers that progress till the bone is completely formed.

5
 Fig(1):ProgressionOfBonyOssification

Ossification centers appear by the end of

thefollowinq ages:
A. DuringIntra-UterineLife:
1. O.C.calcaneus5thmonth.
2. [Link] 7thmonth.
3. Thelowerendofthefemur8th-9thmonth
4. The upper end of the tibia, the cuboid bone and that of the lower
end of the femur reaches 5 mm in diameter at 9thmonth (full term
baby).
B. AfterBirth:
1- Theupperendofthehumerus&femur1styear
2- Thelowerendof radius &tibia2ndyear.
3- Theupperend of theradius 6thyear.
4- Thelowerendoftheradius,O.C.reaches2/3rdbreadthat7years.
5- Theupperendoftheulna12thyear.
3-UnionofEpiphyses
Age UnionofEpiphysis
6 years  Pubicramusuniteswithischialramus(hipbone)
14 years  Trochleauniteswiththecapitulum(humerus)

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15 years  Trochleaandcapitulumwithhumeral shaftIlium,ischiumandpubic
bones (Y shaped suture) (hip bone)
16 years  Lateralepicondyleofhumeruswith theshaft
 Upperendofulnawiththeshaft
 Lessertrochanteroffemur withtheshaft
17 years ● Medialepicondyle ofhumeruswith theshaft
● Upperend of radius withthe shaft
● Greatertrochanter offemur with theshaft
18 years ● Distalendsofmetacarpalandphalangeswiththeirshafts
● Distalendsofmetatarsalandphalangeswiththeirshafts
● Distalendsoftibiaandfibulawiththeirshafts
● Head offemurwiththeshaft
20 years ● Head ofhumerus withtheshaft
● Lowerendsofradiusand ulnawiththeirshafts
21 years ● Distalendoffemurwiththeshaft
● Upper endsoftibiaand fibulawiththeirshafts
● Theischialtuberosityunites withtheischium(hiphone)
23 years ● Theiliac crestunites withtheilium(hiphone)
● Sternalendof claviclewithitsshaft
● Basioccipital withbasisphenoidalbonesinskullbase
40 years  The xiphoid processwiththebodyof sternum
 Bodyof hyoid uniteswithits greatercornu
60 years  Thebody ofthesternumunites withthemanubrium

7
 23 y

Fig.(2):Agesofappearanceofossificationcentersandunionof
epiphysis

8
IdentificationofSexfromBones
1- SKULL

Male Female

1. General Bigandheavy Smallandlight.

2. Parietaleminence Lessmarked Wellmarked.

3. Superciliaryridges Prominent Less prominent.

4. Frontonasalangle Angular Smoothcurve.

[Link] Longandnarrow Shortandbroad.

[Link] Longandbulky Shortandsmall.

7. Styloidprocess Long Short.

2- PELVIS
Male Female
1. Iliac crest Higharched Less arched
2. Obturator Oval Triangular
foramen
3. Acetabulum Wide& deep Narrow& shallow
4. Greater sciatic Deep&narrow Shallow&wide
notch
5. Subpubicangle Acute Obtuse
6. Sacrum Long,narrow& curved Short,wide&straight
7. Sacroiliacjoint Occupies3 segments Occupies2 segments
8. Promontory Projecting Notprojecting
9. Pelvicinlet Triangular(heartshaped) Ovoid
10. Pelviccavity Deep&narrow Wide& shallow

IdentificationofRacefromBones
Negroidskullhasthefollowingcharacteristics:
1. Persistentfrontalsuture.
2. Dolicocephaly(increasedantro-posteriordiameteroftheskull).
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3. Flatnasalbridge.

4. Widenasalopenings.

5. Lessarchedpalate(prognathism).

6. Shortmastoids.

7. The pterion (area of union of frontal, parietal, temporal and

sphenoid bones) is one point or X shaped. In non Negroid it is H

shaped.

IdentificationReport
A) Identificationanddescription
● Partgiven
● Humanornot
● 0ne personormore
● Race
● Age RAS
● Sex
● Deformity
● Causeof Death
● TimepassedsinceDeath.

B) Conclusion:
Identification+positivedata

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Specimen8
A) Identificationanddescription:
● AlongitudinalsectioninbothlowerlimbsHuman.
● Oneperson.
●
Full-term (9th intra-uterine month) due to:
Appearanceof ossificcenter ofupper end oftibia (9thIU)
Thediameterof ossificcenteroffemurreaches5mm (9thIU).
● Racecannotbeidentified.
● Sexcannotbeidentified.
● Nodeformitydetected.
● Causeof deathcannotbeidentified.
● Timepassedsincedeathcouldn'tbeidentified.

B) Conclusion:
Longitudinalsectionofbothlowerlimbsoffulltermbaby.

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Specimen47
A) Identificationanddescription:
● AlongitudinalsectionintheupperthirdoftheHumerus.
● Human.
● Oneperson.
● About 30yrs in males or 28 in females because the medullary
cavity is seen reaching up to the level of surgical neck of humerus.
● Nodeformitydetected.
● Racecannotbeidentified.
● Sexcannotbeidentified.
● Causeofdeath:cannot be identified.
● Time passedsince death yearmorethanone year (bones with
no flesh or tendons).

B) Conclusion:
Specimenshowingalongitudinalsectionintheupperthirdofthe
Humerus to explore medullary cavity denoting that the age is about
30yrs in males or 28 years of age in females.

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Specimen20
A) Identificationanddescription:
● Specimen showing the pelvic girdle which consists of paired
hipbones, connected in front at symphysis pubis and behind by
sacrum.
● Human.
● Oneperson.
● Above23 years:United Y-shapedsuture(above15 years),ischial
tuberosity (above 21 years) and iliac crest (above 23 years).
● Nodeformitydetected.
● Racecannotbeidentified.
● Malepelvis:Acutesubpupic angles,higharchediliaccrest,oval
obturator foramen, wide and deep acetabulum as well as deep and
narrow greater sciatic notch.
● Causeofdeath:cannot be identified.
● Time passed since death: >1 year (Bones with no flesh or
tendons).

B) Conclusion:
Specimenshowingthepelvicgirdleofa23yearsoldmale.

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Specimen11
A)Identificationanddescription
● SpecimenshowingSkullcapofaninfantHuman.
● Oneperson.
● Infantage <18months dueto:
Closed posterior fontanel (full term).
Openedanteriorfontanel<18months. Non
united frontal suture < 2 years.
● Racecannotbeidentified.
● Sexcannotbeidentified.
● Nodeformitydetected.
● Causeofdeathcannotbeidentified.
● Timepassed since death: more thanone year (bones with no
flesh or tendons) .
C) Conclusion:
Skullcap ofaninfantagedlessthan 18months.

14
Specimen61
A) Identificationanddescription:
● Specimen showing post mortem mummification of head and
neck of an adult person.
● Human.
● Oneperson.
● Agecannotbe identified.
● Racecannotbeidentified.
● Sexcannotbeidentified.
● Nodeformitydetected.
● Causeofdeathcannotbeidentified.
● Time passed since death was identified between 3-12months
due to exposure to hot dry weather resulting in postmortem
mummification.

B) Conclusion:
Headandneckofanadultshowingpostmortemmummification.

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Specimen65
A) Identificationanddescription:
● Specimen showing adipocere formation in the head of an
infant.
● Human.
● Oneperson.
● Agecannotbe identified.
● Racecannotbeidentified.
● Sexcannotbeidentified.
● Nodeformitydetected.
● Causeofdeathcannotbeidentified.
● Time passed since death about 6 months as there is
adipocere formation in the subcutaneous fat of the face and the
body was recovered from the river Nile.
B) Conclusion:
Head of an infant showing adipocere formation in the
subcutaneous fat.

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 Wounds

A) Identification

● Partgiven
● Race
RAS
● Age
● Sex

B) InjuryDescription(softtissue)
TEN+SAD+CCC+PP
● Type(abrasions-bruises-cut-contused-stab).
● Edge(regularity-surroundedbyabrasionsorbruises-
gapping).
● Number.
● Site,Size,Shape.
● AntemortemorPostmortem(vitality).
● Depth+Base.
● Direction.
● Causativeinstrument.
● Causeof death.
● Condition(homicidalorsuicidaloraccidental).
● Permanentinfirmity.
● Periodbetweentrauma&death(healing-sepsis).

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C) Conclusion
Identification+PositiveData

WoundJars

Specimen115:
A) Identification:
Pieceofskinfrom scalp.

B) Description:

● Type:cutwoundasthesurroundedhairissharplycut.
● Edge:regularwithgapping.
● Number:single.
● Site:scalp.
● Shape:curved.
● Size:about5cminlength.
● Antemortem: antemortem duetogapping.
● Depth:superficial.
● Direction:curved.
● Causativeinstrument:sharpinstrument.
● Condition:homicidal.

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● Causeofdeath:cannot be identified.
● Permanentinfirmity:notpresent.
● Period betweentrauma &death:diedshortly as there is no
signs of healing or sepsis.
C) Conclusion:
Pieceofscalpshowinganantemortemcutwound.

Specimen117:
A) Identification:
Pieceofanteriorchestwallandpartofrightlung.

B) Description:
 Type:stabwound.
● Edge:regularwithgapping.
● Number:single.
● Site:anteriorchestwallandrightlung.
● Shape:transverse.
● Size:about3cminlengthwithsigns ofhealingintheskin.

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● Ante mortem: ante mortem due to gapping and signs of healing
and sepsis.
● Depth:deep.
● Direction:transverse.
● Causativeinstrument:sharpinstrument.
● Condition:homicidal.
 Causeof death:most probablyduetosepsis asthe rightlung
appears yellow in color with empyema.
 Permanentinfirmity:notpresent.
 Periodbetweentrauma& death:thevictimlivedafterinjury
more than one week due to signs of sepsis in the lung and
healing of the skin wound.

C) Conclusion:
Pieceofanteriorchestwallandpartoftherightlungshowingan
antemortem penetrating stab wound with septic complications.

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Specimen122:
A) Identification:
pieceofscalp
B) Description
● Type:contusedwounds.
● Edge: irregular edges, surrounded by abrasions and
contusions.
● Number:multiple.
● Site:scalp.
● Shape:irregular.
● Size:rangesbetween1—5cminlength.
● Antemortem:antemortemduetopresenceofcontused edges.
● Depth:superficial.
● Direction:differentdirections.
● Causativeinstrument:heavybluntinstrument.
● Condition:homicidal.
● Causeofdeath:intracranialhemorrhageorbrainlaceration.
● Permanentinfirmity:notpresent.

21
● Period betweentrauma &death:diedshortly as there is no
signs of healing or sepsis .
N.B:
The jar contains also the larynx and upper part of trachea of the
same victim to show the submucous contusions, due to attempt
throttling.

C) Conclusion:
Scalpofavictimshowingantemortemcontused wounds

Specimen311:
A) Identification:
Partoftheneckofanadultvictim.
B) Description:

● Type:cutwound.
● Edge:regularwithgapping.
● Number:single.
● Site:anteriorpartof theneck belowthelarynx.
● Shape:spindleorfusiform.
● Size:About9cm in length.
● Antemortem: antemortem duetogapping.
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● Depth: deep as the cut wound reached the trachea,
esophagus, carotid arteries down to the vertebral column.
● Caustiveinstrument:sharpinstrument.
● Condition:homicidalasthewoundisdeepandthereisno hesitation
marks and it is below the larynx.
● Causeofdeath:hemorrhage,asphyxiaorembolism.
● Permanentinfirmity:notpresent.
● Periodbetweentrauma&death:diedshortlyasthereisnosigns of
healing or sepsis.

C) Conclusion:
Partoftheneckofavictimwithhomicidalcutthroat.

Specimen340:
A) Identification:
Rightlungof avictim.

B) Description:
● Type:penetratingstabwound.
● Edge:regularwithgapping.

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● Number:single.
● Site:rightlung.
● Shape:triangularwithsingleacuteangle.
● Size:about3cm inlength.
● Antemortem: antemortem duetogapping.
● Depth:deep.
● Direction:transverse.
● Causative instrument: sharp instrument (single bladed
weapon).
● Condition:homicidal.
● Causeofdeath:hemorrhageorinjurytovital organs.
● Permanentinfirmity:notpresent.
● Period between trauma and death: the victim died shortly as
there is no sign of healing or sepsis.
C) Conclusion:
Therightlungofavictimwithpenetratingstabwoundwhodied most
probably from hemorrhage.

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Specimen329:
A) Identification:
Openheartofayoungvictim.
B) Description:
Diffuse subendocardial hemorrhage (i.e. contusions under the
endocardium).

Mayresultfrom:
 Traumatotheprecordialarea.
 Burns.
 Externalhemorrhage.
 Blooddiseases.
 Arsenicorphosphoruspoisoning.
The cause of death could be due to the associated pathological
condition which accompany the subendocardial hemorrhage e.g.
shock from burn or hemorrhage, arrhythmia from trauma to the
precordial area .etc.
C) Conclusion:
Opened heart of a young victim with diffuse subendocardial
hemorrhage due to trauma to the precordial area.

25
 Woundreport
A) INJURYDESCRIPTION:
TENSADC:
 Typeofwound‫الجرحنوع‬
 Edges‫الحواف‬
‫عدد الجروح‬
‫ موضعاألصابة‬Number
 Site
 Size‫حجماألصابة‬
 Shape‫شكلها‬
 Antemortemorpostmortem‫غيرحيوىاوحيوى‬
‫عمق الجرح‬
‫اتجاهاألصابة‬Depth
 Direction
 Causativeinstrument‫المستخدمةاالداة‬
TYPEOFWOUND:

 Bruises‫كدمات‬
 Abrasions‫سحجات‬
 Contused(lacerated)wound‫متهتكجرح‬
 Cutwound‫قطعيجرح‬
 Stabwound‫طعنىجرح‬

26
 ‫( ‪Figure‬‬ ‫‪oveRt eye.‬‬

‫‪3):Showingcutwoundab‬‬
‫‪.1‬وصفاالصابة‪:‬‬
‫‪‬نوعاالصابة‪:‬جرحقطعى‪.‬‬
‫‪‬الحواف‪ :‬منتظمالحوافوالحوافمتباعدةغيرمحاطةبسحجاتوكدمات‪.‬‬
‫‪‬عدداالصابات‪:‬مفرد‪.‬‬
‫‪‬حجماالصابة‪4:‬سم×‪2‬سم‪.‬‬
‫‪‬شكالالصابة‪:‬مغزلىالشكل‪.‬‬
‫‪‬حيوىاوغيرحيوى‪:‬حيوى‪.‬‬
‫‪‬عمقالجرح‪:‬عميقوالقاعدةبهادماء‪.‬‬
‫‪‬اتجاهاالصابة‪:‬مستعرض‪.‬‬
‫‪.2‬موضعاالصابة‪:‬‬
‫‪‬الجهةالحجابيةاليمنى)اعلىالحاجبااليمن(يبعدعنالعيناليمنىحوالى‪2‬سمويبعدعنفتحةاالنف اليمنى حوالى ‪5‬سم‪.‬‬
‫‪.3‬االلةالمستخدمة‪:‬‬
‫‪‬الةحادة‪.‬‬
‫جرحقطعىحيوى‪4‬سم ×‪ 2‬سممغزلىالشكالعلىالحاجبااليمنيبعدعنالعيناليمنىحوالى‬
‫‪ 2‬سم ويبعدعن فتحة االنف اليمنى حوالى ‪ 5‬سم منتظم الحواف والحواف متباعدة غير‬
‫محاطةبسحجاتوكدمات‪,‬عميقوالقاعدةبهادماءمستعرضاالتجاهوقدتمباستخدامالةحادة‪.‬‬

‫‪Figure(4):Showingcontusedwoundinlefthand.‬‬

‫‪.1‬وصفاالصابة‪:‬‬

‫‪27‬‬
 ‫‪‬نوعاالصابة‪:‬جرحمتهتك‪.‬‬
‫‪‬الحواف‪ :‬غيرمنتظمةالحوافومحاطةبسحجاتوكدمات‪.‬‬
‫‪‬عدداالصابى‪ :‬متعددة‪.‬‬
‫‪‬شكالالصابة‪:‬غير منتظماوغيرمحدد‪.‬‬
‫‪‬حجماالصابة‪:‬اكبرالجروححوالى‪2*3‬سم‪.‬‬
‫‪‬حيوىاوغيرحيوى‪:‬حيوى‪.‬‬
‫‪‬عمقاالصابة‪:‬عميقةوالقاعدةبهادماء‪.‬‬
‫‪‬اتجاهاالصابة‪:‬غيرمنتظم‪.‬‬
‫‪ .2‬موضعاالصابة‪:‬‬
‫‪‬اليداليسرىويمتدمنالجهةالوحشيةإليمنتصفظهراليدويبعدعنمفصاللرسغااليسرحوالى‪3‬سم‪.‬‬
‫‪.3‬االلةالمستخدمة‪:‬‬
‫‪‬جسمصلبراض‪.‬‬
‫جروح متهتكهمتعددةحيوىيهفيظهرالجهةاالنسيةمناليداليسرىيبعدعنمفصاللرسغااليسر‬
‫حوالى‪3‬سم‪ .‬غيرمنتظمهالحوافومحاطهبسحجاتوكدماتاكبرالجروححوالى‪2*3‬سم‪.‬عميقة‬
‫والقاعدةبهادماءغيرمنتظمهاالتجاهوقدتمتباستخدامجسمصلبراض‪.‬‬

‫‪Figure(5):Showingcutwoundinleg.‬‬

‫‪Figure(6):Showingcutwoundinleftankle.‬‬

‫‪28‬‬
Figure(7):Showingcutwoundinrightarm.

Figure(8):Showingcutwoundinleftarm.

29
 Figure(9):Showingcutwoundinlefthand.

Figure(10):Showingcutwoundabovelefteye.

Figure(11):Showingcutwoundinrightindex.

30
Figure(12):Showingcutwoundinrightfoot.

Figure(13):Showingcutwoundinface.

31
 Figure(14):Showingcutwoundinrighthand.

Figure(15):Showingcutwoundinrightnostril.

Figure(16):Showingcutwoundinrightfrontalarea.

Figure(17):Showingcutwoundinrightwrist.

32
Figure(18):Showingcutwoundinleftpalmofhand.

Figure(19):Showingcutwoundsinlefthand.

Figure(20):Showingcutwoundinleftwrist.

33
 Figure(21):Showingcutwoundinthechin.

Figure(22):Showinglaceratedwoundinrightbuccalmucosa.

34
 Figure(23)Showingcontusedwoundinscalp.

Figure(24):Showingmultiplecontusedwoundsinscalp.

35
Figure(25):Showing contusedwoundinfrontalarea.

Figure(26):Showingcontusedwoundinscalp.

36
 Figure(27):Showingmultiplecontusedwoundsinscalp.

Figure(28):Showingbruisesinrightarm.

Figure(29):Showingbruisesandabrasionsinnecktakingtheshape of the
ligature.

37
 Figure(30):Showingbruisesinrightarm.

Figure(31):Showingbruisesinrightleg.

Figure(32):Showingabrasionsinbothknees.

38
 Figure(33):Showingabrasionsabovelefteye.

Figure(34):Showingabrasionsandbruisesinleftarm(humanbite).

Figure(35):Showingabrasionsinleftleg.

39
Figure(36):Showingabrasions andbruisesintheneck.

Figure(37):Showingabrasionsinleftfootandankle.

Figure(38):Showingabrasionsinskinofabdomen.

40
 Figure(39):Showingabrasionsinrightleg.

Figure(40):Showingabrasionsinleftsideof neck.

41
 Figure(41):Showingabrasionsinleftsideof back.

Figure(42):Showingabrasionsinleftsideofchestandleftshoulder.

Figure(43):Showingseconddegreeburnoflefthandandarm.
42
 Figure(44):Showingseconddegreeburnofleftforearm.

Figure(45):Showingseconddegreeburnoflefthand.

Figure(46):Showingfirstdegreeburnofleftshoulderandback.
43
 Headinjuries
Skullinjuriesreport
A) Identification:
 Partgiven
 Race
 Age RAS
 Sex
B) InjuryDescription:
TEN+SAD+CCC+PP
 Type(fissure-comminuted-depressed-cut...).
 Edge(smoothitdenoteshealing,whileifitiserodeditdenotes
sepsis).
 Number.
 Site,Size,Shape.
 AntemortemorPostmortem(vitality).
 Depth+Base.
 Causativeinstrument.
 Causeof death.
 Condition(homicidalorsuicidaloraccidental).
 Permanentinfirmity.
 Periodbetweentrauma&death(healing-membrane-sepsis).

C) Conclusion:
Identification+PositiveData.

44
Specimen176:
A) Identification:
Thelowerhalfofthe2cerebralhemisphereswiththecerebellum.

B) lnjurydescription:
● Type:singlepenetratingpuncturedwound.
● Edge:welldefinededges.
● No:single.
● Site&size:intherightfrontallobeofthebrain,about5cmin length
and 1cm in width.
● Shape:tubularinshapetakingtheshapeofthecausativeinstrument
(iron bar).
● Antemortem:Ante-mortemwound.
● Depth:deepwound.
● Causative instrument: caused by blunt object with pointed end
(iron bar).
● Condition:mostprobablyaccidental.
● Causeofdeath:brainlaceration.

45
● Period between trauma & death: died immediately(no healing
or sepsis).
● Permanentinfirmity:notpresent
Notice that the extension of the lesion from the surface of the brain
to inside DD from pathological intra-cerebral hemorrhage in whichit
doesn't reach the brain surface.

C) Conclusion:
A traumatic penetrating punctured wound in the right frontal lobe in
the brain, due to penetration of an iron bar through the right frontal
lobe.

Specimen190
A) Identification:
Lower halves of the two cerebral hemispheres after doing
transverse section in the brain.

B) Injurydescription:
● Type:pathologicalintra-cerebralhemorrhage.
● Edge: irregular

46
● No.:single.
● Site:closetotheleftventricle.
● Shape:oval.
● Size:about2-7 cm.
● Ante-mortempathologicalCerebralhemorrhage.
● Depth:deep.
● Causeofdeath:mostprobablyhypertension.
Notice that the hemorrhage not reaching the brain surface
(pathological from inside to outside).

C) Conclusion:
Pathologicalintra-cerebralhemorrhageintheleftventricleofthe brain
not reaching the surface.

Specimen242
A) Identification:
Askullcapofavictimabout25years(thesagittalsutureisjust starting to
unite).
B) Description:
● Type:localizeddepressedfracture.
● Edge:irregular(boneerosionfromsepsis).

47
● No:single.
● Site:therightparietalbonenearthesagittalsutureandat 4cm
posterior to the coronal suture Shape: triangular.
● Size:about3x2cm.
● Antemortem:Ante-mortem(sepsis).
● Depth:deepoccupyingalldepthofthecranialbone.
● Direction:oblique.
● Causative instrument: heavy blunt instrument having a
triangularlocalizedstrikingsurface&aconsiderablemomentum
i.e. horn of an ox. In this particular caseitwas due to the horn ofan
ox in a farm, which struck the victim's head.
● Condition:mostprobablyaccidental.
● Cause of death: intracranial septic complications (eg.
Meningitis, encephalitis, brain abscess and cavernous sinus
thrombosis).
● Permanentinfinity:present.
● Period between trauma and death: about 4-6 weeks due to
sepsis.

C) Conclusion:
A skull cap of a victim about 25 years, with ante-mortem
localized depressed fracture in the right parietal bone near the
sagittal suture, caused by heavy blunt instrument having a
triangularlocalizedstrikingsurface&aconsiderablemomentum
[Link]

48
Specimen253:
A) Identification:
Askullcapofavictimabove40years(unionofcoronalsuture).
B) Description:
● Type:cutdepressedfracture.
● Edge:regularedge.
● No:single.
● Site:atthebeginningofthesagittal sutureaboutlcmposterior to
the coronal suture.
● Size:about4cm
● Shape:linear.
● Ante-mortem.
● Depth:superficialnotinvolvingthe wholedepthof thecranial
bone, only inner table of the skull so it is called cut depressed
fracture.
● Direction:oblique.
● Causativeinstrument:heavysharpinstrumentasanaxe.
● Condition:mostprobablyhomicidal.
● Causeofdeath:braininjury.

49
● Permanentinfirmity:No
● Periodbetweentraumaanddeath:diedshortlyasthereisabsence
of healing, sepsis & surgical interference.

N.B.
● This cut fracture is accompaniedfrominsideby lowering of the
inner table of the skull i.e. depressed cut fracture.
● Thereisafissurepassingintothelefttemporal&frontalbones due
to falling of victim on the ground after the original injury.
C) Conclusion:
Askullcapofavictimabove40years,withante-mortemcut fracture at
the beginning of the sagittal suture caused by heavy sharp
instrument as an axe.

Specimen261:
A) Identification
Complete skull with a mandible of a male victim >40 years, non
Negroid (non-prominent partial eminences, and the coronal suture
is united).

B) Description:

50
● Type:cutfracture.
● Edge:theupperpartisregularwhilethelowerpartisirregular (bone
erosion).
● No:single.
● Site:theleftzygomaticregionandtheleftangleofthe mandible.
● Shape:linear.
● Size:about5cm inlength.
● Ante-mortem:Antemortem(sepsis).
● Depth:deep.
● Direction:vertical.
● Causativeinstrument:sharpobject.
● Condition:mostprobablyhomicidalCauseofdeath:septic
complications.
● Permanentinfirmity:present.
● Periodbetweentraumaanddeath:duetosepsissoitisabout 4-6
weeks.

C) Conclusion:
Complete skull with a mandible of a male victim >40 years, with
ante-mortem septic cut fracture in the left zygomatic region and the
left angle of the mandible.

51
Specimen298:
A) Identification:
Askullcap of a victim 30-40 years, non Negroid (the sagittalsuture
is united but the coronal did not unit yet) & sex cannot beaccurately
identified from only a skull cap.

B) Description:
● Type: a wide defect covered by fibrous membrane (old
depressed fracture).
● Edge:totallycoveredbyfibrousmembrane.
● No:single.
● Site:intherightparietalbone.
● Shape:oval.
● Size:about5*7cm.
● Ante-mortem:ante-mortem(healingbymembrane).
● Depth:deep.
● Causativeinstrument:heavybluntinstrument.
● Condition:mostprobablyhomicidal.
● Causeofdeath:maybeduetopermanentinfirmityfromthe fibrous
membrane.
52
● Permanentinfirmity:present.
● Period between trauma and death: The defect is completely
covered by fibrous membrane denoting that complete healing ofthe
defect and the victim survived year.
N.B.
● The absence of bone fragments and the presence of healing
denoting that a surgical decompression operation was done to
remove the depressed bone and evacuate the hematoma.
● There is an old fissure radiating from the right side of the
defect downward.

C) Conclusion:
A skull cap of a victim 30-40 years with wide defect covered by
fibrous membranein the right parietal bone denotingthat thevictim
survived year after his depressed fracture caused by heavy blunt
instrument.

53
Specimen305:
A) Identification:
A complete skull without mandible of a male victim >40 years, non
Negroid (non-prominent partial eminences, prominent supraorbital
ridges, and the coronal suture is united).

B) Description:
● Type:localizeddepressedfracturewithsurgicalinterference.
● Edge:irregular(boneerosiondenotingsepsis).
● No:single.
● Site: the left parietal eminence 5cmposterior to the
coronalsuture.
● Shape:circular.
● Size:about6.5cminlength.
● Ante-mortem:Ante-mortem(sepsis).
● Depth:deep.
● Causative instrument: heavy blunt object with localized
striking surface and moderate momentum.
● Condition:maybeaccidentalorhomicidal.

54
● Causeof death:septic complications(eg. Meningitis,
encephalitis, brain abscess and cavernous sinus thrombosis).
● Permanentinfinity:present.
● Period between trauma and death: about 4-6 weeks (due
to sepsis).

C) Conclusion:
A complete skull without mandible of a male victim >40 years, with
localized depressed fracture with surgical interference in the left
parietal eminence with bone erosion denoting that period between
trauma and death about 4-6 weeks.

Specimen267:
A) Identification:
A complete skull without mandible of a female victim <40 years,
non Negroid (prominent partial eminences or prominent
supraorbital ridges, sagittal suture is united but the coronal did not
yet).
55
B) Description:
● Type:cutfracture.
● Edge:regular.
● No.:single.
● Site:startedinthe rightfrontal bone andrunintheleftfrontal and
left temporal bone.
● Shape:horizontalline.
● Size:about7cm inlength.
● Ante-mortem:Ante-mortem(extra-cranialhemorrhage).
● Depth:deep.
● Causativeinstrument:heavysharpinstrument.
● Condition:maybeaccidentalorhomicidal.
● Causeofdeath:braininjury&extracranialhemorrhage.
● Permanentinfinity:notpresent.
● Period between trauma and death: victim died shortly after
theinjury (no signs of healing, sepsis or surgical interference).

C) Conclusion:
A complete skull without mandible of a female victim <40 years,
with ante-mortem cut fracture in the right frontal bone and run inthe
left frontal and left temporal bone, caused by heavy sharp
instrument.

56
 Figure(49):Showingfissurefractureatautopsy.

Figure(50):ShowingfissurefractureinCT.

Figure(51):ShowingdepressedskullfractureinCT.

57
 Figure(52):Showingdiastaticfracture.

Figure(53):Showingpondfracture.

Figure(54):Showingcomminutedfracture.

58
 Figure(55):Showingextraduralhematomavssubdural.

Figure(56):Showingintracerebralhemorrhage:(Hyperdense)incerebral substance in
Rt. tempro-parietal area compressing Rt lateral ventricle.

Figure(57):Showinghematomabehindtheearovermastoid(Battle's
sign).

59
 Figure(58):Showing

1. EDH(Extraduralhematoma)appearsasbiconvexhyperdense lesion.
2. HematomaappearshyperdenseatCT.
3. SDH(subduralhematoma) appearsasconcavo-convexlesion.

Figure(59):ShowingRaccooneyes.

60
 FIREARMINJURIES
Reportoffirearminjuries
A) Identification
● Partgiven.
● Race
● Age RAS
● Sex

B) InjuryDescription:
● TypeofinjuryInlet/exit wound.
● Edge(Powdermarks).
● Number.
● S------------—Site,Size,Shape.
● AntemortemorPostmortem.
● Depth.
● Distanceanddirectionoffiringifcouldbeidentified.
● Causativeinstrument:rifledornon-rifled.
● Condition.
● Causeof death.

C) Conclusion
Identification+PositiveData.

61
Specimen374
A) Identification:
2 pieces of skin, the upper is about 5x3 cm, and lower one is about
15 x 10 cm, Sex, age & race cannot be identified.
B) lnjurydescription:
● Type: rifled firearm injury, the upper piece showed inlet of
abullet while the lower piece showed an exit wound.
● Edge: inlet was regular &inverted while the exit was irregular
hole with everted edge.
● Size & shape: the inlet was small circular around l cm
whilethe exit was larger than the inlet 5 x 7cm and had irregular
shape. Nb.:
The exit was larger than the expecting with loss of substance may
be due to bone smashing.
● Site:cannotbeidentified.
Bothofthemwere:
● Deepfirearminjury&causedbyrifledweapon.
● Causeofdeath:cannotbeidentified
C) Conclusion:
2Piecesofskinshowinginletandtheexitoffirearmarifling weapon
through the skin.

62
Specimen400:
A) Identification:
piecesofskin,Sex:male.
B) Injurydescription:
● Type: firearm injury, the upper piece showed inlet while the
lower piece showed exit of a rifled firearm bullet.
● Edge: the inlet had regular inverted edge while the exit was
Irregular with everted edges.
● No:two wounds(oneinlet andoneexit).
● Site: the upper piece showed non-hairy skin most probably
taken from the back and lower one showed hairy skin and most
probably taken from the anterior chest wall in front of sternum.
● Size & shape: inlet was Small circular hole about lcm while
the exit was irregular hole about 7*5cm.
Nb.:
Theexitwaswiderthanexpected&withmorelossofsubstance
(Smashing of the sternum opposite the exit).

Bothofthemwere:
● Ante-mortem.
● Deepinjury&causedbyrifledweapon.
63
 ● Causeofdeath:injuryofavitalorgan,hemorrhage,etc.

C) Conclusion:
2 pieces of skin showing inlet in the back of a male victim and the
exit in the anterior chest wall which appear wider than expected
due to the fact that the bullet passed in the sternum smashing it
before coming out of the skin.

Figure(60):Showinginletofbullet.

PartoftheskinofaCaucasianperson:
1. Singleroundedwound(inlet)causedbyabullet.
2. 0.5 cm in diameter.
3. Antemortem(bruises).
4. Directionoffiring:perpendiculartoskin.
5. Powdermarks(closedistance offiring)andabrasionringcould
beseen.
6. Rifledweapon(bullet).

64
7. Causeofdeathcouldn’tbedetected.

Figure(61):Showinginletofnon-rifledmissile“shots”Centralholewith dispersion.
Pictureshowing partoftheskinofaCaucasianperson,age and
sex couldn’t be detected
1. Centralwoundsurroundedbymultiplesmallwoundscausedbyshots.
2. Centralwound1-2cmindiameter.
3. Antemortem.
4. Directionoffiring:perpendiculartoskin.
5. Distanceoffiring:2-3meters.
6. Non-rifledweapon(shots).
7. Causeofdeathcouldn’tbedetected.

65
 Figure(62):Showingcontactgunshotwoundwithmuzzleimprint.

Figure(63):[Link] due
to carbon monoxide.

66
 Figure(64):Inletofrifledmissileof“bullet.

Figure(65):Showinginletofnon-rifledmissile“shots”.

67
Firearmspecimen
Cartridge
Youhavetocommentonthefollowing:
1- Type
 Rifled= thecaseis made ofcopper.
 Non-rifled= the caseismadeof plastic orcartoonexcept
Ghaffir cartridge which is made of copper with a trimmed
end.

2- Longorshort
 Rifledcanbeeitherlongorshort(dependingonthesize)
 Non-rifledisonlylong.

3- Automaticornot
Lookatthebaseofthecartridgeandseeifthereisagroove (automatic)
or a rim (non-automatic).
 Rifledcanbeeitherautomaticornon-automatic.
 Non-rifledisonlynon-automatic.

4- Caliber(bore)
 Rifled=caliberequals diameterofthebaseofthebullet.
 Non-rifled=caliberis anumberatthebaseofthecartridge.

5- Firedornot
Lookonthepercussioncapatthebaseofthecartridgefora
depression.
 Depression=fired.
 Nodepression= notfired.

68
6- Loadedorempty
Lookattheupper endofthe cartridgefora bullet(ifrifled) and
external wad (if not rifled).
 Rifledisloadedifthereisabullet,andemptyif not.
 Non-rifledisloadedifthereis an external wad,and emptyif not.

7- lfloaded,commentonthebullet
1. Jacketedornotjacketed.

 Typeofthejacket:madeofcopper (yellow), nickel(silvery) or

alloy.
2. Completeorpartialjacket.

Figure(66):Showing:nonrifledcartridge,brassoutercase(Ghaffir), loaded
not fired (intact percussion cap)

Figure (67): Showing: non rifled cartridge, outer case is made of

cardboardwithbrassbase(sporting)andloadednotfired.(Intact
percussion cap).The caliber=12

69
Figure(68):Showing:nonrifledcartridge,outercaseismadeofplastic with
brass base (sporting) and non-loaded fired (Depression in percussion
cap). The caliber= 12

Figure (69): Showing: long rifled cartridge (service rifle), automatic

(groove),loadedandnon-fired(intactpercussioncap)andthebulletis
jacketed with copper.

Figure(70):Showing:shortrifledcartridge,automatic(groove)[Link] of
automatic pistol, loaded, non-fired (intact percussion cap) and the
bullet is jacketed with nickel (A) copper (B).

70
 Figure (71): Showing: long rifled cartridge case (service rifle), non-
automatic(rim:figureA)andautomatic(groove:figureB)non-loaded and
fired (depression in the percussion cap).
II- Missile
A-Shots
 Thesearethemissileofnon-rifledfirearmweapons.
 Theyaremadeoflead.
 Theymay be:
 Small&sphericalshotsofsportingguncartridge.
 Large&sphericalshotsofgreenerguncartridge.
 SlugsofSchneider&Remingtoncartridge.
 Differentshapes(asymmetrical)ofhome-madeshots.

1- Machine-madeshots;regularandsymmetricalleadballs.

Figure(72):Showing: machine-madeshots

71
2- Home-madeshots;irregular,asymmetricalandmadeoflead.

Figure(73):Showing:home-madeshots

B-Bullet
 Thesearethemissileofrifledweapon.
 Theyaremadeoflead.
 Theycanbenon-jacketedorjacketed(completeorpartially)
(and the jacket is made of copper, nickel or alloy).
 Longorshortbullet.
 Caliberoftheweaponequal diameterofthebaseofthebullet.
 Firedornot(depending whetherthereisriflingmarksor
deformation in the bullet).

Figure(74):Showing:long &shortfiredBullet(riflingmarks)whichisjacketedwith copper.

72
III:Wads

Figure(76):Showing:externalwad Figure(77):Showing:internalwad

1- External wad made ofcartoon andits thicknessis1 [Link]

function is:
 Keepingshotsinplace.
 Determinationofdistanceoffiringasittravelsadistanceof3
meters causing circular abrasion & penetrates up to meter.

2- Internalwadmadeoffeltanditsthicknessis1cm. Its
function is:
 Actingas apiston topushshotsinfront ofit.
 Separationbetweengunpowderandshots.
 Determinationofdistanceoffiringasittravelsadistanceof10
meters causing circular abrasion & penetrates up to 3 meter.

IV. Gun powder

Smokelesspowder:
 ComposedofnitrocelluloseornitroglycerineImpregnatedingun
cotton

73
 Theformsmaybe (a)Cordite , (b)scales,(c)rods or (d)
amorphousof different colors.
 Ignitionofonevol.yields900volumesofgases.
 Theresiduereactionisneutralandcontains nitrites&nitrates.

Infanticideandchildabuse
A) Identification
● Partgiven
● Race
RAS
● Age
● Sex

B) InjuryDescription
TEN+SAD+CCC+FLP
 Type(abrasion,bruises,cut,contusedorstabwound).
 Edge(regularity-surroundedbyabrasionsorbruises-gapping).
 Number.
 S………site,size,shape.
 AntemortemorPostmortem(vitality).
74
 Depth+Base.
 Direction.
 Causativeinstrument.
 Causeofdeath–condition.
PlusFLP
1. Fulltermorpreterm(signsofmaturityasweight,hairlength, nails&
head circumference..etc.)
2. Livebornorstillbirth(anysignsoflifeeitherexternalasvital reaction of
AM wounds...etc. or internal as sings of respiration.)
3. Periodofsurvival(ifcouldbedetermined).
C) Conclusion
Identification+positivedata

Specimen423:
A) Identification:
Thehead,neck,chestand upperlimb newborn,.

B) Descriptionoftheinjuryintheinfant:Type:fingernail abrasions&
bruises,
 No:multiple.
75
 Site:aroundthemouth&nostrils.
 Shape:semilunar.
 Size:averagefrom2-3cm.
 A:Ante-mortem.
 Depth:superficial.
 Causativeinstrument:fingernails.
 Condition:mostprobablyhomicidal.
 Causeofdeath:obstructionofairpassages whichleadsto
asphyxia (infanticide by smothering).
 Thebabywasmature(look to thehairlength about 3cm&hand
nails; beyond the fingers), live birth (vitality of the AM wounds,
cyanosis of the lips& signs of asphyxia in the lung in opened
chest as congestion& Tardieu spots).

NB: the small cuts on the face are PM wounds, made during
autopsy of the case.

C) Conclusion:
Case of infanticide by smothering showing the finger nail
abrasions& contusions on the skin of full term, live born infant
around the mouth and nostrils, with cyanoses of the lips& internal
signs of asphyxia in the lung.

76
Specimen439:
A) Identification:
Thehead,neck,trunkandupperlimbsofnewborn.
B) Descriptionoftheinjuryintheinfant:
 Type:cutthroat.
 Edge:regular.
 No.:singleSite:theneck.
 Shape:linear.
 Size:7cm.
 A:Ante-mortem(woundgaping).
 Depth:deep.
 Direction:transverse.
 Causativeinstrument:sharpinstrument
 Condition:homicidal.
 Causeofdeath:cutthroat(neurogenic shock orhemorrhageas
detected from marked pallor of the infant, or venous air
embolism or asphyxia due to inhalation of blood in opened
trachea).

77
 Thebabywas fullterm (look to the hair length, about 2cm& hand
nails; beyond the fingers), live birth (vitality of the AM wounds&
gaping),helivedfor oneday-periodof survival wasone day- due to
the ring of hyperemia around the umbilical cord stump.

C) Conclusion:
Case of infanticide by cut throat of full term, live born infant who
lived for I day, the baby died from sever hemorrhage, the wound
was AM with gaping

Child abuse

Figure(78):Showinglinear-bruisesontheleftcheekandearofa baby who was

slapped in the face by an abusive parent.

78
Figure(79):Showingsemilunarabrasionontheleftsideoftheface indicating
smothering

Figure(80):Showinglinearbruisesontherightcheekandearofachild who was

slapped in the face by an abusive parent.

Figure(81):Showingmultiplefingernailabrasionsinrightaxilla

79
 Figure(82):Showingbruisesinlowerrighteyelidandrightcheek

Figure(83):Showingtears(andbruises)intheupperlipandfrenulum caused
by forced introduction of feeding bottle

Figure(84):Showingseverelipswelling,lipabrasionandlaceration And
abrasions around the nose.

80
 Figure(85):Showingbruisesaroundrighteye.

Figure(86):Showingcutwoundatforehead.

Figure(87): Showingpatternedburninthe legofachildcausedbyhair

straightener

81
Figure(88):Showingpatternedburninthe backofachildcausedby steam iron

Figure(89):Showingfirst-degreeburncharacterizedbyreddiscoloration of
skin.

82
 ChildSexualAbuse

Figure(90):Showingacutetearoftheposteriorpartofthevestibule after
recent sexual assault.

Figure (91): Showing dilatation of the rectal sphincter, wide funnel

shapedanalopeningandfissurecrossingskinmarginsindicatechronic anal
sexual abuse of young girl.

Figure(92):Showingrecentfimbriatedhymenalrupture,thehymenis red
hyperemic with swelling, bruising and bleeding (tears at 3 and 9
o’clock).
83
 Asphyxia
A) Identification
 Partgiven
 Race
 Age RAS
 Sex

B) InjuryDescription
TEN+SAD+CCC
 Type(abrasion,bruises,cut,contusedorstabwound)
 Edge(regularity-surroundedbyabrasionsorbruises-gapping)
 Number
 S…………site,size,shape
 AntemortemorPostmortem(vitality)
 Depth+Base
 Direction
 Causativeinstrument-causeofdeath-condition.

84
 Signsofasphyxia

Figure(93):Subconjunctivalpetechialhemorrhage(oneofexternalsigns of
asphyxia

Figure(94):Scleralhemorrhage(oneofexternalsignsofasphyxia).

Throttling

Figure(95):Throttling(manualstrangulation)marksontheneckand base of
the mouth

85
 Strangulation

Figure (96): Ligature strangulation with a generally horizontal course for

thetwostrandsofcordthatdivergefromtheskinattheback oftheneck

Hanging

Figure(97):Post-mortemhypostasisinadeathfromhanging

Figure(98):Ropemarksinacaseofhanging.

86
 Drowning

Figure(99):[Link] is a
sure sign of drowning

Figure(100):Markedwasherwoman’sskinonthehandsindicating immersion
under water for 24 hrs

Figure(101):Peelingoftheepidermisindicatingimmersionunderwater for 2
weeks.

87
 Figure(102):Chockingbycauliflowerduringeating

Figure (103):Suffocationbyaplasticbagplacedoverthehead

88
 TOXICOLOGYJARS

A) Identification
B) Injurydescription
C) Diagnosis
D) Conclusion

Specimen634:
A) Identification:
longitudinallydissectedoesophagusandpartofevertedstomach.

B) Description:
 Generalized ulceration of the mucosa of the stomach with
darkgrayishdiscolorationwhichindicatesacuteingestion.
 The esophagus shows stricture in its lower part denoting
survivalformorethan2 weeksafterpoisoning(well-formed
fibrous tissue forming the stenosis.

C) Causeofdeath:
MostprobablyCachexiaduetostrictureofoesophagus

89
D) Diagnosis:
[Link].
E) Conclusion:
Oesophagusandstomacharefromtwodifferentvictimswho suffered
corrosive poisoning most probably caustic potash.

Specimen644:
A) Identification:
Anevertedstomach.
B) Description:
Thegastricmucosaisthickenedwithexaggeratedrugaeand
superficial ulcers.
C) Diagnosis:
Carbolicacidpoisoning(phenol)
D) Causeofdeath:
Respiratoryfailureduetorespiratorycenterdepression
E) Conclusion:
Part of everted stomach from a case of carbolic acid poisoning
(phenol).

90
Specimen673:
A) Identification:
Jarshowingapieceofcartilagefromnasalseptum.
B) Description:
Regular rounded completely perforated ulcer about 2mm in
diameter.
C) Diagnosis:
 ChronicCocainesniffing(cocaineaddiction).
 Addicts use cocaine as a sniff, and due to the presence of
otherirritantpowder(assalicylic acid)mixed withcocaine(as
adulteration) an ulcer will be formed in the mucosa covering
the nasal septum. Repeated use of this sniff will lead to
deepening of the ulcer up to complete perforation.
D) Conclusion:
A nasal septum with complete perforation from a case of
cocaineaddiction

91
 TOXIC PLANTS

I- Capsules

Daturacapsule Colocynthcapsule

Figure(104):Showingdaturacapsule

1- Daturacapsule
● Capsulewiththorns(thornapple)
● Brown(dry);green(injar)
● Activeprinciples:
Atropine,hyoscyamine&hyoscine
● Action:
 Atropineandhyoscyamine:CNSstimulationfollowedby
depression & peripheral anti-muscarinic action.
 Hyoscine:CNSdepressionfromthestart& weak peripheral
anti-muscarinic action.

92
 Figure(105):Showingcolocynthcapsule

2- ColocynthCapsule
 Sphericalcapsule
● Yellowincolor& dry
● Activeprinciple:
Colocynthin
● Action:
Drasticpurgativeandabortificient
[Link]

A-Largesizedseeds
1) Strychnousnuxvomica

Figure(106):ShowingStrychnousnuxvomicaseeds

93
● Brownseedswithcentralumbilicus&radiatingridges.
● Activeprinciple:
Strychnine& brucine(20timeslesspotentthanstrychnine).
● Action:
Convulsant&CNSstimulant.

Figure(107):Showingnutmegseed
2-Nutmegseeds
● Brownseeds,ovalinshape.
● Activeprinciple:
Myristicin oil.
● Action:
Hallucinogen.

B) Mediumsizedseeds

94
 Figure(108):Showingcastoroilseeds

1- Castoroilseeds
● Brown,ovalandmosaic seedswithaluster.
● Active p.:
Castoroil&ricin.
● Action:
Drasticpurgative&abortificientandricincauseshemolysisof RBCs.

Figure(109):Showingcrotonoilseeds

2- Crotonoilseeds
● Brown,ovalseedswithnoluster.
● Activeprinciple:
Croton oil.

95
● Action:Drasticpurgative&abortificient

Figure(110):Showingcolocynthseeds
3- Colocynthseeds
● Oval in shapewith a pointed end, smooth andnon-
lustroussurface.
●
Activeprinciple:
Colocynthin
● Action:
Drasticpurgative&abortificient.
C-Smallsizedseeds

Figure(111):Showingdaturafastiosaseeds

1- Daturafastiosa:
● Brownkidneyshapedseeds withmammillatedconvexborder
with groove in it.
96
● Activeprinciples:
Atropine,hyoscyamine&hyoscine.
 Action:
 Atropineandhyoscyamine:CNSstimulationfollowedby
depression and peripheral anti-muscarinic action.
 Hyoscine: CNS depression from the start and weak
peripheral anti-muscarinic action.

● [Link]:

Figure(112):Showingegg-plantseeds
(1-a)Egg-plantseeds(Ediblenontoxic):
 Palebrownor yellowincolor.
 Kidney-shapedwithanotchatthehilum.
 Noridge attheconvexborder.
 Nomammillatedsurface(smoothsurface).

97
 Figure(113):Showingcapsicumseeds
(1-b)Capsicumseeds(Ediblenontoxic):
● Paleyelloworbrown.
● Flat-kidneyshaped.
● Hasa parrot peak projectionatthehilum.

Figure(114):Showingsesameseeds

(1-c)Sesameseeds(Ediblenontoxic):
Yellow,ovalandnonmammiliated.

98
 Figure(115):Showingdatura stramoniumseeds

2- Daturastramonium:
● Blackkidneyshapedseedswithmammillatedconvexborder.
● Activeprinciples:
Atropine,scopolamine&hyoscine.
 Action:
 Atropine:CNSstimulationfollowedbydepressionand
peripheral anti-muscarinic action.
 Hyoscine:CNSdepressionfromthestart,and weak
peripheral anti-muscarinic action
● [Link]:

Figure(116):Showingonionseeds Figure(117):Showingblackpepperseeds(2-
(2-a)-Onionseeds(ediblenontoxic): b)Blackpepperediblenontoxic):
● Black incolor. ● Black incolor.
● Multiangularwithspikyprojection ● Spherical in shape with irregular
surface

99
 Figure(118):Showingaluminumphosphidetablets
● Aluminumphosphidetablets.
● MechanismofAction:liberationofphosphinegas.
● Mainorgansaffected:Heart,LiverandLung.
● Managementismainlysupportive.

Figure(119):Showingopiumcapsule
● Opiumcapsule.
● Activeprinciples:morphine,codeineandpapaverine.

100
Figure(120):Showingcocainepacketsrecoveredbywholebowel irrigation
from a body packer

Figure(121):Showingcocaplant
Cocaplant(ErythroxylumCoca)
● Activeprinciple:cocaine.
● ActiveParts:leaves.
● Effect:sympathomimetic.

Figure(122):Showingcocainepowder
● Cocainepowder.
● Heatlabilewatersoluble.
● Usedbysniffing(perforatednasalseptum).

Figure(123):Showingcrackcocaine

101
● Crackcocaine.
● Heatstable.
● Used bysmoking.
● Actionofcocaine:CNSstimulation.

Figure(124):Showingcannabissativaplant
● Cannabissativaplant.
● Activeprinciples (presentinallpartsof theplants;leavesand
flowers):Tetra-hydrocannabinol (THC) & cannabidiol (CBD).
● Action:pshychedelics.

Figure(125):Showingcommercialformsofcannabis
 Commercialformsofcannabis
102
  Pureform ofthetetrahydrocannabinolisfromleavesand
flowers

Figure(126):Showingcrystalmethorice

Methamphetaminecrystals(Crystalmethorice).
● Methodofconsumption:smoking.
● Complications: dental caries one of the most common
complications.

Figure(127):Showingkhat
● Khat.
● Activeprinciple:cathinone.
● Effect:hallucinogenic.

103
● Mostabundantin Yemen.

Figure(128):ShowingLSD(acid)

● LSD(lysergicaciddiethylamide).
● Effect:Hallucinogenic(psychedelics).

Figure(129):Showingecstasy(clubdrug)

● Ecstasy(clubdrug).
● Activeconstituent:methylene-deoxymeth-amphtamineMDMA.
● Sympathomimetic.
● Toxicityisassociatedwithserotoninsyndrome.

104
 Figure(130):ShowingPeyotecactus
● Peyotecactus.
● Activeprinciple:Mescaline.
● Effect:psychedelics.

Anticholinergichallucinogens

Figure(131):Showingatropabelladonna(deadlynightshades)

Atropa belladonna (deadly night shades):active principles can

be taken from all parts of the plants.

Figure(132):Showingatropabelladonna(deadlynightshades)

105
 Figure(133):Showingdigitalispurpuraplant
● Digitalispurpuraplant.
● Activeprinciple:digoxin.
● Effect:cardiotoxicity.

Figure(134):Showingmagicmushroom

Figure(135):ShowingAmanitaMuscaria
106
● AmanitaMuscaria.
● Deadlypoisonousfungus.
● Activeprinciple:muscarine.

MICROSCOPICSPECIMENS

SLIDES

Fibers Hair Blood

A-Fibers

1- Cotton fibers: ribbon-shaped 2-Linenfibers:Jointed,

wavy and colorless. Segmentedfibers
(bamboo-shaped) that runs in bundles.

3- Silkfibers:Regular,shiny,refractile,straightandcolored.

107
4- Woolfibers:Irregularfiberswithimbricatedsurface,irregular edges
and wide medulla.

108
 Hair

Tip Shaft Root

-sharplycut -animal -healthy

-crushed -human -atrophied
-tapered
-rounded

B-HairTip

I-Sharplycuthairtip:
● Itdenotesthatthecausativeinstrumentisasharpone.
● Itisseenaroundcut(incised)woundsinhairyskin([Link]).

109
2- Crushedhairtip:
● Itdenotesthatthecausativeinstrumentisabluntone.
● Itisseenaroundcontusedwounds inhairyskin([Link]).

3 4
3- Roundedhairtip:thehairwas cut fewdays ago.
4- Taperedhairtip:wascutmorethan twoweeksago.

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C-Shaft

1- Humanhair:
● Cuticle:Regularandformedofonelayerofcellswithno scales.
● Cortex: Broad without transverse striations (2/3 thickness of
hair).
● Medulla:Thin,interrupted(a)andequals1/3thethicknessof hair
and it may be absent (b).

2- Animalhair

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 ● Cuticle: Irregular and formed of more than one layer of cells
with scales.
● Cortex:Narrowwithtransversestriations(1/3thicknessof hair)
● Medulla:Thick, continuous and equals 2/3 the thickness of
hair.

ROOT

I. Healthyhairroot(pulledbyforce):
The root is rounded and healthy with interrupted sheath denoting
that the hair is pulled by force and hence application of violence or
resistance.

II. Degenerated atrophied hair root: The root is shrunken and

atrophiedwithabsent sheathdenotingthatthe hairis fallenby
itself.

112
D-BloodStains
● Confirmatorytestsforidentificationofbloodstains.
1-Microscopicexamination:
● (I.e. blood film) which is done for identification of a fresh
blood sample.

● (I-a) Human RBCs: (rounded, non-nucleated) stained blood

film shows circular non-nucleated biconcave disc- shaped RBCs
which indicates mammalian blood other than the camel tribe.

● (I-b)Camel'sRBCs:(oval,non-nucleated)
Stainedbloodfilmshowsovalnon-nucleatedRBCswhichindicates
mammalian blood of the camel tribe.

● (I-c)Non-mammalianRBCs):(oval,nucleated)
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Stainedbloodfilmshowsoval,nucleatedRBCswhichindicates non-
mammalian blood.

114
 FORENSICLAB
● X-raysforidentificationofage

Figure(136):ShowingXrayofwristjointandhand,ant/post.

● X-raysofthehandandwrist
 Age is more than 20 years due to ossification of the
epiphyseallinesofthedistalendsoftheulnaandradius with the
shafts of the ulna and radius.
 Note:alsotheossificationoftheepiphyseallinesbetween the
heads of the metacarpal bones with the shafts of the
metacarpal bones that happens at 18 years old.

115
 Figure(137):ShowingXrayofwristjointandhand,A/pview

 Xrayofwristjointandhand
 Age is less than 18 years, due to the presence of the
epiphyseallinesbetweentheheadsofthemetacarpalbones and
theirshafts(notethe presence of the epiphyseallines at the
distal ends of the ulna and radius.

SHOULDERJOINT

Figure(138):ShowingXrayof shoulderjointand elbow joint.

ant/post. View

● X-rayofshoulderjointandelbowjoint.
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● Age is more than 20 years (in male) due to ossification of the
epiphyseal line between the head of the humerus and its shaft.

Figure(139):ShowingX-rayofshoulderjointant./[Link]
● X-rayofshoulderjoint.
● Age is less than 20 years (in male) due to the presence ofthe
epiphyseal line between the head of the humerus and its
shaft.

ANKLEJOINT

Figure(140):ShowingXrayofanklejointant/[Link]
● Xrayofanklejoint.
● Age is less than 18 years (in male) due to the presence
oftheepiphyseal lines at the distal ends of tibia and fibula.

117
 Figure(141):ShowingXrayofanklejointant/[Link]
● Xrayofanklejoint.
● Age is more than 18 years (in male) due to ossification of the
epiphyseal lines at the distal ends of tibia and fibula.

Kneejoint

Figure(142): Showing Xrayant/[Link] knee joint

● Xrayofanklejoint.

118
● Age is above 21 years (in male) due to ossification of the
epiphyseal line of the distal end of the femur with the shaft of the
femur and ossification of the epiphyseal lines of the proximal ends
of the tibia and fibula with the shafts of tibia and fibula.

Figure(143):ShowingXrayofkneejointant/[Link]

● Xrayofkneejoint.
● Age is less than 21 years (in male) due to the presence ofthe
epiphyseal line of the distal end of the femur with the shaft of the
femur and the presence of the epiphyseal lines of the proximal
ends of the tibia and fibula with the shafts of tibia and fibula.

PELVIS

Figure(144):ShowingXrayofpelvisofachildant/[Link]

● Xrayofpelvis.
119
● The age is less than 6 years (in male) due to the presence of
the epiphyseal line between the pubic and ischeal ramii of the hip
bone.

Figure(145):ShowingXrayof pelvisadultpersonNotee
ossification of all epiphyseal lines

 Xrayof pelvis.
 Age is more than 18 ( in male) due to union of the
epiphyseallineoftheheadoffemur withitsshaft

DENTALCASTS

Figure(146):ShowingDentalcastofapersonolderthan12years; because of
eruption of second molar teeth on both sides.

120
 Figure (147): Showing Dental cast of a person older than 11 years and
lessthan12yearsold;becauseoferuptionofthecanineteethonboth sides,
and non eruption of the second molar tooth.

Figure(148):ShowingDentalcastofapersonolderthan18years; because of
eruption of the third molar teeth on both sides.

FINGERPRINTS
● Typesofpatternsandtheirinterpretation.
● Fingerprints may be resolved into three large general groups
ofpatterns,eachgroupbearingthesamegeneral characteristics or
family resemblance.

121
 WHORL
ARCH LOOP WHORL
In an arch pattern the In a loop pattern the ridges In a whorl pattern,
ridges enter from one enter from either side the ridges are
side make a rise in the recurve andpass out ortend circular.
center and exit to pass out the same side
generally. they entered.

122
DNATESTING

123
124
125
126
127
128
129
 TOXICOLOGYLAB
InterpretationoftheArterialBloodGas

StepstoABGAnalysis:
[Link] the pHnormal?
[Link] the CO2normal?
[Link] the HCO3normal?
1. MatchtheCO2ortheHCO3withthepH.

2. Does the CO2orthe HCO3gothe oppositedirectionofthe pH?

3. ArethepO2andtheO2 saturationnormal?

Step1:AnalyzethepHDeterminepHstatus
● NormalpHrange:7.35—7.45
● pH<7.35:Acidosis.
● pH>7.45:Alkalosis.

Step2:AnalyzetheCO2
● Normalrange:PaCO2 35-45mmHg
● Below35isalkalotic.
● Above45isacidic.

Step3:AnalyzetheHCO3
● NormalHCO3levelis22---26mEq/L.
● If theHCO3is below22, the patientisacidotic.
● If theHCO3is above26,the patientisalkalotic.
Step4:MatchtheCO2ortheHCO3withthepH
Isthedisturbancerespiratoryormetabolic?
TodeterminethisyoulookatpHandcompareitwithHCO3and CO2.

130
  If thepH isacidotic, youlook forwhichever value(HCO3or
CO2) is also acidotic
 If thepH isalkalotic, youlook forwhich ever value(HCO3or
CO2) is also alkalotic.
 Inthissense, youmatchthe pHwithHCO3and CO2.
 IfthepHmatcheswiththeCO2,youhaverespiratory.
 IfthepHmatcheswiththeHCO3, youhavemetabolic.
1. MetabolicAlkalosis:IfthepHisalkatoticandtheHCO3 alkalotic.

2. RespiratoryAlkalosis:IfthepHisalkaloticandtheCO2is alkalotic.

3. Metabolic Acidosis:IfthepHisacidoticandtheHCO3acidotic.

4. RespiratoryAcidosis:IfthepHisacidoticandtheCO2isacidotic.

Step5:Isthecausecompensatedoruncompensated?

Compensated: pH is anywhere inside the normal ranges

(Anything between 7.35 to 7.45).
Uncompensated:pHisanywhereoutsidethenormalranges
(greaterthan7.45orlessthan7.35).Also,thevalue(CO2or HCO3) that
does not match the pH will still be in the normal range. Partially
compensated:pHis anywhere outsidethenormalrange
andthevaluethatdoesnot matchthepH(CO2 or HCO3)willbe outside
its normal range.
● This indicates the body is attempting to get the pH back to
normal. Example: A patient is in respiratory failure and his CO2 is
50 (acidotic) and pH is 7.24 (acidotic).

131
● An HCO3 of 27 (alkalotic) means the body is attempting to get
the pH back to normal and this is considered compensation.

Step6:AnalyzethepO2andtheO2saturation.
Evaluate the PaO2 and O2 sat.
● PaO2 is a measurement of the partial pressure of oxygen
dissolved in the plasma only. It is measured in mm Hg.
● The PaO2 does not tell us about the body's total oxygen
content, but it does indicate how much oxygen was available in the
alveoli to dissolve in the blood.
● SaO2 or oxygen saturation, measures the degree to which
oxygen is bound to hemoglobin. SaO2 is expressed as a
percentage.

PaO2 spO2

Normal 80-100 95-99%

MildHypoxemia 60-79 90-94%

ModerateHypoxemia 40-59 75-89%

SevereHypoxemia <40 <75%

RememberROME
ThemnemonicRO-ME.
RespiratoryOpposite
WhenpHisup,PaCO2isdown= Alkalosis
When pH is down, PaCO2 is up = Acidosis
Metabolic Equal
When pH is up, HCO3 is up = Alkalosis
WhenpHisdown,HCO3isdown=Acidosis

132
 EXAMPLE(1)
PH 7.31 Acidotic
CO2 48
PO2 50 LOW
O2 SAT 75% LOW
HC03 24 NormaL

Step1:The pHisacidotic.
● (NormalpHrange:7.35—7.45)
Step2:TheCO2is above45,soitis acidotic.
● (Normalrange:PaCO235-45mmmHg)
Step3:TheHCO3 isnormal.
Step4:TheCO2matchesthepH, because theyarebothacidotic.
● Thereforetheimbalanceisrespiratoryacidosis
Step5:TheHCO3 isnormal,therefore thereisnocompensation.
● If the HC03 is alkalotic (opposite direction) then
compensation would be present.
Step6:thePaO2andO2sat arelowindicatinghypoxemia.
● The diagnosis of this blood gas is: Uncompensated
respiratory acidosis with hypoxemia.
● Thispatienthasanacuterespiratorydisorder.

133
Step1:ThepHis above7.45,soitisalkalotic. Step
2: The CO2 is below 35, so it is alkalotic. Step
3: The HCO3 is normal.
Step4:TheCO2matchesthepH, because theyarebothalkalotic.
● SoTheimbalanceisrespiratoryalkalosis.
Step 5: The HCO3 is normal, indicating no compensation. If the
HCO3 is acidotic (opposite direction) then compensation would be
present.
Step6:the PaO2 and O2 sat are normal indicating normal
oxygenation.
Thediagnosisis:Uncompensatedrespiratoryalkalosis.

134
 EXAMPLE(3)
PH 7.2 Acidotic
PCO2 43 Normal
PO2 92 Normal
O2SAT 95% Normal
HCO3 13 Acidotic

STEP1:The pHisbelow7.35,soitisacidotic.
STEP2:TheCO2isnormal.
STEP3:TheHCO3isbelow22,soit isacidotic.
STEP4:TheHCO3 matchesthe pH, astheyare bothacidotic The
CO2 is normal indicating no STEP compensate on
Note: lf theCO2 is alkalotic (opposite direction) thencompensation
would be present.
Step6:thePaO2andO2satarenormalindicatingnormaloxygenation
and diagnosis of this case is:
Uncompensatedmetabolicacidosis.

Anotherexamplewithpartialcompensation:
Analysis Normal's Value Test
Acidotic(low):Overallstateis(still)anacidosis 7.35-7.45 7.23 pH:
Alkalotic(low):CO2tensionislow(respiratory
35-45mmHg 21mmHg PaCO2:
alkalosis)
Acidotic (low): HCO3- concentration is low 22-26mEq/L 8mEq/L [HCO3-]:
(metabolicacidosis)
The pH and HCO3- levels are both acidotic, so the primary
mechanism is a metabolic acidosis. The respiratory alkalosis is
compensation for the HCO3-, but the pH is not within normal limits,
so it is only partially effective.
135
Trytosolvetheseexamples:
1. pH:7.31,CO2:46,HC03:24
2. pH:7.41,CO2:32,HC03:16
3. pH:7.2,CO2:43,HC03:13
4. pH:7.37,CO2:37,HC03:26
5. pH:7.15,CO2:55,HC03:24
6. pH:7.32,CO2:55,HC03:23
7. pH:7.6,CO2:21,HC03:19
8. pH:7.38,CO2:48,HC03:33
9. pH:7.74,CO2:46,HC03:37
10. pH: 7.24,CO2:21,HC03:19

Answers:
1. pH:7.31,CO2:46,HCO3:24-UncompensatedRespiratory
Acidosis.
2. pH: 7.41, CO2: 32, HCO3: 16 - Fully Compensated Respiratory
Alkalosis.
3. pH:7.2,CO2:43,HCO3:13-UncompensatedMetabolic Acidosis.
4. pH:7.37,CO2:37,HCO3:26–Normal.
5. pH:7.15,CO2:55,HCO3:24-UncompensatedRespiratory
Acidosis.
6. pH:7.32,CO2:55,HCO3:23-UncompensatedRespiratory
Acidosis.
7. pH: 7.6, CO2: 21, HCO3: 19 - Partially Compensated
Respiratory Alkalosis.
8. pH: 7.38, CO2: 48, HCO3: 33 - Fully Compensated Respiratory
Acidosis.

136
9. pH: 7.74, CO2: 46, HCO3: 37 - PartiallyCompensated Metabolic
Alkalosis.
10. pH: 7.24, CO2: 21, HCO3: 19 - Partially Compensated
Metabolic Acidosis.

Electrocardiogram(ECG)inToxicology
AnECGisarecordingoftheelectricalactivitythatinitiateseach heartbeat every
0.8 Seconds:

137
 NormalECG
Howtocalculateheartrate?
● When the cardiac rhythm is regular, the heart rate can be
determined by the interval between two successive QRS
complexes. On standard paper with the most common tracing
settings, the heart rateiscalculated by dividing the number of large
boxes (5 mm or 0.2 seconds) between two successive QRS
complexes into 300. For example, if the interval between two QRS
complexes is two large boxes, then the rate is 150 beats perminute
(bpm) (300 ÷ 2 = 150 bpm). Each large box contains 5small
squares.

Howtodetermineheartrhythm?
● Rhythm: A sequential beating of the heart as a result of the
generation of electrical impulses. It is classified as:
o Regularpattern:IntervalbetweentheRwavesisregular.
o Irregularpattern:IntervalbetweentheRwavesisnotregular.

138
 Figure(149):Regularrhythm(equalintervalsbetweenRwaves)

Figure(150):Irregularrhythm(unequalintervalsbetweenRwaves)

NormalECG

1) SinusTachycardia
Definition:
● Sinus rhythm with a resting heart rate of > 100 bpm in adults,
or above the normal range for age in children.
● Normalheartratesinchildren
o Newborn(110-150bpm)
o 2years:85—125bpm
o 4years:75—115bpm6years+:60-100bpm

139
● Pharmacologicalcauses:
o Beta-agonists: adrenaline, isoprenaline, salbutamol,
dobutamine.
o Sympathomimetics: amphetamines, cocaine and
methylphenidate.
o Antimuscarinics:antihistamines,TCAs,carbamazepineand
atropine.
o Others:caffeine,theophyllineandmarijuana.

Handy Tip: With very fast heart rates the P waves may be
hiddenin the preceding T wave, producing a 'camel hump'
appearance.

Example:

Figure(150):Showingsinustachycardia

2) Supraventricular tachycardia (SVT)

Heart beats > 200 bpm serioustachycardia(SVT)
Pharmacological causes:
 Sympathomimetics:amphetamines,cocaine,theophylline.
 Anticholinergics:antihistamines,TCAs.

140
 Figure(151):Showingsupraventriculartachycardia

3) Sinusbradycardia
Definition: Sinus rhythm with a resting heart rate of < 60 bpm
inadults, or below the normal range for age in children.

Figures(152):Showingsinusbradycardia

Pharmacologicalcauses:
o Beta-blockers.
o Calcium-channelblockers(verapamil&diltiazem).
o Digoxin.

141
o Centralalpha-2agonists(clonidine&dexmedetomidine).
o Amiodarone.
o Opiates.
o GABA-ergicagents(barbiturates,benzodiazepines,baclofen,
GHB).
o Organophosphatepoisoning.

NormalQRS

● Q wave: first negative deflection from the baseline following

the P wave.
● Rwave:firstpositivedeflectionfollowingtheQwave.
● S wave: first negative deflection that extends below the
baseline following the R wave.
● Starting point is where first wave of complex starts to move
away from baseline.
● Ending point is where last wave of complex begins to level
out (flatten) at, above, or belowthe baseline.
● Thenormalduration(interval)oftheQRScomplexis between
0.08 and 0.10 seconds that is, 80 and 100 milliseconds (normally,
each large box represents 0.2
seconds,andeachsmallerboxrepresents0.04seconds).
142
Wide QRS

Figure(153):ShowingwideQRScomplex
● DrugsthatcancausewideORScomplexinoverdose.
● TCAs,Phenothiazines,Betablockers,Anthistaminics.

143
 Instruments

Figure(154):Showing Endotrachealtube

Indication:
1. Depressedlevelofconsciousness.

2. Protectionofairway.

3. Duringgastriclavageifdisturbedconsciouslevel

4. Mechanical ventilation.

5. Drug and toxins require intubation: organophosphates, opioids,

barbiturates, Alcohol.

Figure(155):Showing(RyleTube)Gastricintubation

Indication:
1. Aspirationofgastriccontentfromrecentingestionoftoxic material.

2. Administrationofactivatedcharcoal.

144
3. Drugsandtoxinsrequiregastriclavage(aspirin,paracetamol,

sedative hypnotics, digitalis, and theophylline).

4. Drugs require MDAC (TCA , digitalis , Barbiturate , salicylates ,

Morphine ).
5. Drugs require Whole bowel irrigation (sustained release
preparations, body packer and body stuffers).

Fig(156):ShowingUrinarycatheter

Indication:
1. Urine retention (anticholinergic drugs: (atropine, TCA,
antihistaminic).
2. Comapatientfortoxicologyscreening.

3. Monitorurineoutputincriticallyillpatient.

Figure(157):ShowingOxygenmask

145
Indicationsforoxygendelivery
1. Thetreatmentofdocumentedhypoxiaorinadequateblood oxygen

tensions (PaO2).
2. Achievingtargetedpercentageofoxygensaturation.

3. Thetreatmentofanacuterespiratorydistress.

4. Examples of drug require O2delivery: (CO, organophosphates,

barbiturates , ethanol , opioids ).

Figure(158):ShowingSuctioncatheter

Indication:
1) Patientwithartificialairway.
2) Patient with copious secretion and cannot cough due to loss of
muscle tone or cough reflex.
3) Requiredsputumspecimenforlabanalysis
4) Drug and toxins require suction of secretion (organophosphates,
carbamates, botulinium toxin).

146
 [Link]
1)Serumbilirubin
Total 0.3-1.2mg/dl
Direct 0-0.3mg/dl

147
Indirect 0.2-0.7mg/dl
2)Transaminases
Lactatedehydrogenase(LDH) 60-160u/l
SGOT(aspartateaminotransfrease)AST 0-35u/l
SGPT(alanineaminotransferease 0-35u/l
[Link]
1) pH 7.38-7.44
2)OxygenSaturation 95 % orgreater
3)Oxygentension 80-100mmHg
4) Pc02 35-45mmHg
5) Bicarbonate 23-28mEq/l
[Link] 8-20mg/dl
1)Ureanitrogen(BUN)
2) Creatinine 0.7-1.3mg/dl
[Link]
1)IronBindingcapacity 250-460mg/dl
2) IronTotal 60-160mg/dl
3) Potassium 3.5-5.5mEq/l
4) Sodium 136-145mEq/l
5)Chloride 98-106mEq/l
6)SerumCalcium 9-10.5mg/dl
Ionized,serumCalcium 2.24-2.46mEq/l
7)Glucose(fasting) 70-105mg/dl
8)HemoglobinFemale 12-16gm/dl
HemoglobinMale 14-17gm/dl

Appendix
The data listed in the following table are absolute values. Many of
the figures dependent on intra laboratory variations and sensitivity
of analytical methods used in determination.

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 [Link]
1)Adultrespiratoryrate 12-18/min
2)Heartrate :
 ChildPulse 20-50beats/min
 Adultpulse 60-90beats/min
3)Bloodpressure
 AdultSystolicbloodpressure 100-140mmHg
 AdultDiastolicbloodpressure 60-90mmHg
 ChildSystolicbloodpressure 80+(2xageinyears) 2/3
 ChildDiastolicbloodpressure of systolic
4)Temperature 370C(36-37.40C)

6- PRIMARYWOUNDREPORT:

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1-Abrasions.
2-Contusions&bruises. ‫والرضوض‬
3-Cutincisedwounds
4-Contusedwounds:
a- Laceratedwounds.
b- Torn(flap).
c- Crushwounds.

5-Stabwounds:
a- Puncturedwounds.
b- Penetratingwounds.
c- Transfixingwounds.

6-Firearminjuries. ‫_إصاباتاألعيرهالناريه‬6
7-Burns
a- Dryburn.
b- Wetburn(scald).
c- Corrosion.
d- Electrocution(electricburns).
e- Radiationburns.

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Surface AnatomyoftheBody(FrontView)

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SurfaceAnatomyoftheBody(Dorsal view)

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7- DEATHCERTIFICATE:
Example:
Case scenario (l): A 50 years old bilharzial patient was admittedto
emergency department with severe hematemesis; blood pressure
was 80/50mm. Hg, pulse was 120/min and he was pale & sweaty.
Emergency treatment was given but the condition deteriorated and
the patient died.
Writethedeathcertificate.

Case scenario(2): After abdominal surgery, 50 years old patient

was suffering from jaundice, elevated serum transaminases, low
albumin level, and antibodies against hepatitis C virus (HCV) was
positive. The patient passed into coma and died shortly after. Write
the death certificate.

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