Forensic Exam PDF

22A - Medicolegal sexology (sexual deviations, rape) - skoða dumb ways Sexual offense Sexualo deviation -​ Sexual activities that deviate from human biology + natural behavior -​ 1. Fetishes = Se...

22A - Medicolegal sexology (sexual deviations, rape) - skoða dumb ways Sexual offense Sexualo deviation -​ Sexual activities that deviate from human biology + natural behavior -​ 1. Fetishes = Sexual arousal from objects + body parts not typically associated w. Sexual attraction -​ 2. Sadism + Masochism = Pleasure from inflicting pain (Sadism) + Receiving pain (Masochism) -​ 3. Necrophilia = Sexual attraction or intercourse w. Corpse -​ 4. Transvestite = Dressing in clothes typically for the opposite sex -​ 5. Exhibitionism = Exposing oneself to others → Flashing -​ 6. Voyeurism = Sexual pleasure from watching others have sex -​ 7. Pedophilia = Sexual attraction towards children < 18yo Natural sex offenses -​ Rape = Sexual intercourse wo consent → Vaginal + anal + oral penetration by penis or foreign object -​ Statutory rape= Sexual intercourse w. Minor → Even with their consent -​ Marital rape= Non-consensual sex act forced by a spouse -​ Pedophile rape= Between adult + child -​ Incest= Sexul relation betw. Family members Unnatural sex offense -​ Sexual activities considered against natural order -​ Bestiality = Seuxal acts involving animals Examination of victims -​ Question 20 → Tala um biological traces + investigation on live victim Proof of rape -​ Loss of virginity = Damage to hymen w. Fresh injuries → Easily identifiable -​ Injury to genitals = Can also occur in normal intercourse → Elderly women sustain more serious injuries often leading to significant hemorrhage -​ Penetration and ejaculation = determine if either occurred -​ Presence of sperm = Detected via vaginal swab → Sperm remain in vagina for 2-3 days + up to 1 week in cadavers -​ Pregnancy Signs of violence -​ Grip mark on arms + bruises on breasts + bite marks -​ Signs of struggle = Injuries to face + neck + hemorrhage on sclera/conjunctiva Other -​ STD testing -​ Victims condition = if they have cleaned themselves or changed clothes or there was violence Judgment of defenselessness -​ Unconsciousness (Drugs + alcohol) + Age (< 12yo) + Psychopathology (mental conditions that impair victim‘s ability to resist) + Physical restrictions Photographs -​ A certain minimum number of photographs is essential: -​ Undisturbed scene -​ For identification of body -​ To document injuries -​ To demonstrate any important observation ​ ​  22B - Diving accidents (indirect influence of pressure, decompression sickness) Phases of dying Phase 1 1)​ 1.Compression phase (Descend) = When diver goes deeper under water experiencing ↑ pressure vont í eyru t.d. With ↑ pressure = Gasses (mostly nitrogen) dissolve into blood + tissues (bc gases are more soluble in ↑ pressure) a)​ The deeper you go the more gases dissolve into your body especially fat tissue where nitrogen accumulates (vanalega vill nitrogen ekki fara í blóðið, við öndum flestu út aftur en undir miklum þrýstingi getur það þrýst í blóðið - farið í organs) b)​ Nitrogen buildup: During the dive, this dissolved nitrogen doesn't cause issues. However, it becomes a problem during the ascent (decompression phase) if it comes out of solution too quickly, forming bubbles, which can lead to decompression sickness (also known as “the bends”). c)​ Pressure ↑ by 1 atmosphere for every 10m of descend Effect on body cavities (like the lungs and sinuses) = ↑ pressure causes gasses in body cavities to compress → ↓ volume of air-filled spaces → Discomfort or tissue damage if not managed e.g equalizing ear pressure (Positive pressure in lungs) d)​ Body cavities (like the lungs and sinuses) compress as the air in them gets squished, which can lead to discomfort or tissue damage if pressure is not properly equalized (such as clearing your ears). Phase 2 -​ Isopression phase -​ Diver remains at constant depth Here, the body is under a steady pressure and there is no further increase or decrease in pressure. No significant physiological changes happen during this phase as long as the diver remains stable. Phase 3 -​ Decompression phase (Ascend) = When diver ascends back to surface experiencing ↓ pressure -​ Recommended ascend rate = NOT exceed 10m per minute -​ During gradual ascend = Ambient pressure ↓ slowly allowing dissolved gasses to come out of solution gradually and exhaled through lungs -​ During rapid ascend = Gasses come out of solution too quickly and are not able to be exhaled leading to formation of gas bubbles → Obstruction of blood flow = Decompression syndrome -​ Affect on body cavities = ↓ pressure causes previously compressed gasses to expand → Rapid expansion can cause barotrauma (pressure related injury) → e.g. Lung overexpansion + lung rupture + sinus pain (Negative pressure in lungs) Key during ascend -​ Breath-hold ascend → Pulmonary barotrauma as diver ascends w. Air trapped in lungs (Divers are trained to continuously breathe in and out during the entire ascent. This ensures that expanding air in the lungs is constantly released as the external pressure decreases.) -​ Failure in decompression procedure → Decompression sickness where disolve gases form bubbles in tissues -​ Other = Failure in gas switch + Premature gas consumption (running out of gas) + Equipment failure -​ Common ascend problems = Sinus problem + Ear problem + Pulmonary barotrauma + Arterial gas emboli (AGE) General -​ → Accidents on entering the water -​ Hyperextension of spine (especially neck) → Entering water w. Feet first is safer than head first -​ Diving into shallow water → Common cause of injury -​ → Safety precautions -​ Physical/Mental fitness + Have a buddy + Training + Equipment check + Dive planning + Avoid alcohol (Small amount of alcohol can enhance narcosis) -​ → Fitness to dive -​ Respiratory conditions + ear surgery + Addiction + Uncontrolled diabetes + Mental instability + Obesity (sekkur) -​ → Assessment of respiratory fitness to dive -​ Spirometry → FEV1 + FVC + PEF -​ FEV1 + PEF need to be > 80%  -​ FEV1/FVC needs to be > 70% Decompression sickness What is it -​ byrjar oft ca 10 min eftir að manneskjan er komin upp úr or may be delayed after 3 days -​ → Injuries caused by rapid ↓ in pressure surrounding body → Such as during ascent from deep dives Mechanism -​ Saturation by inert gas (On-gassing) = Alveoli → Blood → Tissue (Begins during descend phase) -​ Governed by Henry‘s law → saturation determined by pressure + Time + Tissue perfusion + Absorption (fatty tissue) -​ Pressure: deeper a diver goes, the more pressure is exerted, and therefore, more nitrogen dissolves into the body. -​ Time: The longer a diver stays underwater at a certain depth, the more time nitrogen has to dissolve into the tissues. -​ Tissue perfusion: Tissues that receive more blood flow will absorb nitrogen faster. -​ Tissue absorption: Fatty tissues absorb nitrogen more readily than other tissues because nitrogen is more soluble in fat. -​ Air is inhaled into the alveoli (air sacs in the lungs), where gases (like nitrogen) dissolve into the blood. -​ From the blood, nitrogen moves into the tissues (especially in fatty tissues), because under increased pressure, more nitrogen dissolves into the body. -​ Desaturation by inter gas (Off-gassing) = Tissue → Blood → Alveoli (Begins during ascend phase) -​ Leads to supersaturation → Partial pressure of dissolved gas in blood + tissues becomes ↑ than in lungs -​ Supersaturation: As the pressure decreases, tissues become supersaturated with nitrogen. This means the pressure of nitrogen in the tissues is higher than in the lungs. In a slow ascent, nitrogen can escape slowly and safely through the lungs. In a rapid ascent, nitrogen comes out of solution too quickly, forming bubbles in the blood and tissues, which can lead to DCS. symptoms -​ Decompression syndrome type 1 -​ Fatigue + joint/muscle pain + skin rashes and „skin beds“ (joints and skin) -​ Type 2 -​ Clouded thinking + Numbness + Weakness + Paralysis + Rash + Poor balance (neurological, respiratory and cardiovascular) Treatment -​ Recompression therapy → to ↓ bubble size + Relieve symptoms (maður andar inn 100% pure oxygen) -​ pressure is increased to shrink nitrogen bubbles in the body and help them dissolve safely back into the blood. -​ The patient breathes 100% oxygen, which speeds up nitrogen elimination and promotes healing of damaged tissues. -​ The pressure is then gradually decreased to simulate a safe ascent, allowing nitrogen to leave the body without forming new bubbles. -​ This treatment is most effective when given soon after symptoms appear. Adjuvant therapy -​ Normobaric O2 adm + NSAID (to ↓ inflammation + thrombocyte aggregation) + Steroids (↓ inflammation) + Diazepam (Muscle relaxation + anxiety) Decompression line -​ Broad term for bubble related clinical symptoms → DCS + CAGE (+ PULMONARY BAROTRAUMA - diver fails to breathe properly = overinflation of lung = rupture of alveoli = air bubbles into bloodstream) -​ CAGE = Cerebral arterial gas embolism → Introduction of bubbles into arterial blood due to pulmonary barotrauma !!→ Altered mental status + hemiparesis + Motor/sensory deficits + Seizures + Loss of consciousness + Apnea + Shock -​ Symptoms of AGE usually develop rapidly (minutes)  -​ Decompression sickness = Bubble formation from dissolved inert gas Neurological decompression sickness -​ Type 2 DCS -​ → Cerebral DCS = Occlusion of cerebral vascular beds by gas microbubbles -​ Symptoms = Hemiplegia + Visual disturbances + Confusion + Speech disorder -​ → Spinal DCS = Occlusion of spinal cord by gas microbubbles -​ Symptoms = Weakness + Paralysis + Loss of sensation + Incontinence -​ → Cardiac DCS = Sometimes classified as 1 -​ Microbubbles in heart muscle Indirect effect of pressure diving -​ Occur due to changes in partial pressure of gasses in diver‘s breathing environment -​ → Nitrogen narcosis = Caused by ↑ pressure of nitrogen dissolved in blood stream during deep dives → Affects divers in >30m -​ Mechanism = Nitrogen dissolves in fatty membrane of nerve cells → ↓ Nerve signal transmission → CNS depression -​ Symptoms = Similar to effect of alcohol = Memory + confusion → Severe cases = Hallucination + ↓ motor skills + loss of consciousness -​ Treatment = No direct treatment → Ascend to shallower depths usually reverses the effect -​ Prevention = Divers can replace nitrogen w. Helium in their breathing mix → Allows divers to reach up to 700m wo narcosis High pressure nervous syndrome (HPNS) -​ Occurs at great depth → Associated w. Rapid or deep compression -​ Mechanism = CNS reacts negatively to ↑ pressure + rapid changes in pressure → Neurological + physiological symptoms -​ Symptoms = Dizziness + nausea/vomiting + fatigue + muscle twitching + Poor sleep + ↓ intellectual + psychomotor performance -​ Prevention = Add small amount of nitrogen to gas mixture (to stabilize nervous system) + Slow/gradual compression rate + takes breaks at various depths Oxygen toxicity -​ Caused by breathing O2 at ↑ pressures → Affecting CNS + other parts (especially lungs) -​ Types = CNS (Seizures) + Pulmonary (Respiratory distress) -​ Symptoms = Initially nausea → Visual disturbances (flashing lights + tunnel vision) + Tinnitus + Confusion + tingling + muscle twitching -​ Prevention = Monitor O2 levels + exposure time → Avoid prolonged exposure of high oxygen pressure