Info

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Record presence of lividity.

External examination

Blood, urine, and vitreous

Chest cavities

Heart and great vessels

Abdomen

Skull and brain

Neck

Soft tissue compartments at any location

Record presence of lividity.

Photograph all external wounds; measure all lacerations.

Photograph and measure all patterned abrasions and patterned contusions.

Record cuts from windshield glass.

Determine impact injuries in pedestrians. Collect scalp hair and blood (see below) from victims of hit and run accidents. Collect foreign material in wounds. Prepare roentgenograms if venous air embolism is supected. Collect sample for toxicologic study (p. 16) from all victims, including passengers. Create pleural window to detect pneumothorax. If blood is seen, examine internal mammary vessels (see under "Note"). Measure volume of blood.

Record evidence of cardiac contusion.

Laceration of heart or great vessels

(measure volume of blood).

Follow routine procedures for dissection of heart and great vessels (see Chapter 3).

In situ bubble test may reveal venous air embolism.

Record evidence of trauma and volume of blood in peritoneal cavity; estimated volume of blood in retroperitoneal soft tissues.

Autopsy assistant may saw the skull but pathologist should inspect brain in situ and remove it personally. For removal and specimen preparation of brain, see p. 65. Record brain weight.

Posterior neck dissection is indicated (p. 67) if there is no craniocerebral or cardio-vascular trauma, or if suffocation is suspected. Record evidence of trauma and estimate volume of blood.

Intense lividity and absence of lethal wounds may indicate that the crash occurred because the driver was dead from heart disease.

Small, medium, or large patternless abrasions and contusions.

Patterned injuries often can be matched to objects in or about the vehicle. Tempered glass injuries (see above under "Note").

Impact injuries in pedestrians may help to reconstruct the accident. Hair and blood of the victim may identify the vehicle involved in a hit and run accident. Venous air embolism.*

Evidence of alcohol or drug intoxication.

Pneumothorax, hemothorax, e.g., after laceration of internal mammary vessels.

Cardiac contusion after concussion of the heart.

Evidence of exsanguination.

Evidence of coronary occlusion or other major cardiovascular disease that may have been the cause of the accident. Air embolism.*

Laceration of solid organs; rupture of hollow viscera or vessels, other evidence of trauma and hemorrhage into the abdominal cavity or soft tissues.

Cerebral lacerations at the pontomedullary junction. Cerebral edema.

Trauma to the craniocervical articulation.

Achalasia, Esophageal

Synonyms and Related Terms: Cardiospasm; diffuse esophageal spasm; primary symptomatic achalasia; secondary achalasia. Possible Associated Conditions: Chagas disease;* gastric malignancies; irradiation; lymphoma.*

Organs and Tissues Procedures Possible or Expected Findings

Larynx, trachea, bronchi, and lungs

Airway obstruction;* aspiration bronchopneumonia.

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