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1 2016

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3 i pdf PDF html pl A TEX 2ε

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5 iii Postmortem changes abrasions bruise laceration stab wound incised wound chop wound cause of death

6 iv hanging (ligature strangulation manual strangulation drowning Munchausen s syndrome by proxy Whiplash shaken baby syndrome

7 v unexplained sudden death

8

9 A. i ii a) b) c) B. i ii 2. A. B. DNA i ii 3.

10 forensic medicine forensic pathology forensic toxicology medico-legal forensic sciences 2. forensic pathology 3. forensic toxicology 4. forensic genetics 1985 Jeffreys DNA 1987 Mullis PCR DNA 5. forensic odontology, forensic dentistory DNA 6. forensic anthropology physical anthropology DNA 7. legal medicine forensic medicine medical jurisprudence (medico-legal aspects of medical practice)

11 1.2 3 Department of Legal Medicine 8. forensic entomology life cycle succession URI: 9. forensic Sciences American Academy of Forensic Sciences AAFS: forensic sciences Forensic science is the application of scientific principles and technological practices to the purposes of justice in the study and resolution of criminal, civil and regulatory issues. AAFS 11 Criminalistics, Digital & Multimedia Sciences, Engineering Sciences, General, Jurisprudence, Odontology, Pathology & Biology, Physical Anthropology, Psychiatry & Behabioral Sciences, Questioned Documents, Toxicology Included among the Academy s members are physicians, attorneys, dentists, toxicologists, physical anthropologists, document examiners, psychiatrists, physicists, engineers, criminalists, educators, digital evidence experts, and others.

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13 5 2 Postmortem changes decomposition livor mortis, livdity, postmortem hypostasis hypostasis 1. dependent areas 2. A. Hb: reddish purple, B. HbCO: cherry red to pinkish C. HbO 2 : bright red D. HbCN: E. HbS:,

14 6 2 Postmortem changes 3. A fixed, maximum coloreation B. dependent area dependent areas C p. 54 p internal livor mortis: autopsy imaging (AI) 6. p. 54 Tardieu s spots * rigor mortis postmortem stiffening of the body ATP *1 Tardieu postmortem petechiae Tardieu s spots

15 decomposition ex. drowning cadaveric spasm : body temperature 1. A. B. C. D. E. 2. rectal temperature S reverse sigmoid curve PC

16 8 2 Postmortem changes cloudiness of the cornea autolysis putrefaction cf: Casper s law: 1 1/2, 1/8 1. discoloration : 1 2 HbS 2. marbling : hemoglobin 3. swellingvesicle formation 4. A. insect activity life cycle succession forensic entomology B. C. : 5. skeletonization scavenger

17 mummification A. B. 3 C. 2. adipocele Clostridium perfringens

18

19 injury (wound)

20 blunt force injury A. abrasion B. bruise, contusion C. laceration 2. sharp force injury A. incised wound B. stab wound C. cut(chop) wound 3. gunshot wound: 3.3 impact, crush pressure scrape blunt force injuries 3.4 abrasions scrapecrush 1. scrape (brush) abrasion: graze (sliding) abrasion 2. impact (pressure) abrasion: patterned abrasion 3. A

21 3.5 bruise 13 B. 1 3 C D. 2 vital reaction p bruise patterned injury 2 tramline bruise laceration crush shear lacerattion variation (stretch striae)

22 tissue bridging A. B. C. 6. Decollement traumatique, avulsion, direct fracture 2. indirect fracture, 3. 4.

23 child abuse commotio cordis 3. cardiac tamponade 4. LAD 5. steering wheel injurydashboard injury p CPR p p CPR 1. 2.

24 craniocerebral injuries impact injuriesacceleration/deceleration injuries 1. A. B. i bursting fracture diastasis a) bending fracture patterned fracture b) depressed fracture c) penetrated fracture: p.25 ii skull base fracture a) transverse hinge fracture motor cyclist s fracture) b) longitudinal fracture c) ring fracture (fall) (impact to the chin) [ ] black eye raccoon sign, ) ➀ ➁ orbital top ➂ gravitational seepage C. epidural hematoma lucid interval 100ml

25 D. traumatic subarachnoid hemorrhage i ii E. contusion i coup contusion ii contrecoup contusion iii iv v F. traumatic intracerebral hemorrhage 2. acceleration/deceleration injuries A. acute subdural hematoma,sdh i bridging vein ii iii epidural hematoma iv v vi p.77

26 18 3 B. traumatic axonal injury, TAI diffuse axonal injury, DAI 6 12 retraction ball 2/3 SDH DAI DAI

27 19 4 sharp force injuries 4.1 stab wound 1. A. B. C. D. E. 2. A. B. i Langer ii iii

28 20 4 iv guard mark v p. 14 C. incised stab wound D. E. (entrance) (exit) i ii 3. A. i guard mark ii 4.1 iii B. C. xcm ycm zmm xcm xcm ycm zmm D.

29 4.1 stab wound E. F. G. 4. A. : B. : C. D. E. 5. A. B. C. defence wound

30 incised wound 1. A. B. C. D A. B. 1 hesitation mark C. 4.3 chop wound

31 4.3 chop wound A. B. C. D. E

32

33 25 5 gunshot wound, GSW 5.1 small arms handgun 1. A. swing-out B. break-top C. solid-frame single action double action single action type double action type 2. semiautomatics A. blow-back: B. recoil: firing 3. single-shot derringers inch mm

34 rifle barrel length 16 single-shot pump-action bolt-action autoloading ( ) lever-action rifling rifle mark Manufacturer twist number Colt left hand twist 6 S & W right hand twist 5 * right hand twist shotgun smooth-bore choke (spread) single-shot lever-action over-and-under pump-action double-barrel autoloading bolt-action gage 10, 12, 16, 20, 28,.410) 1lb gage = bore 10gage = 0.775in 12gage = 0.729in submachine guns. 2. machine guns. crew-operated ammunition ➀ ➁ powder propellant) ➂ ➃ bullet projectile) smokeless powder lead bulletmetal-jacketed

35 bullet full metal jacket partial metal jacketed ➀ ➁ ➂ ➃ ➄ shot) birdshot pellets shotgun slug E(J) = mv2 m (kg) v 2 E S 20J/cm2 S 3.5J/cm m/s 1000m/s m/s 5.2 temporary cavity entrance GSWexit GSW wound track perforating GSWpenetrating GSWgunshot wound shotgun wound SGW contact woundsintermediate-range woundsdistant GSW near-contact wounds

36 28 5 contact wounds 1. hard contact 2. loose contact 3. angled contact 4. incomplete contact muzzle print near contact wounds intermediate-range wounds powder tattooing 10cm powder grain

37 Special 4-in barrel powder tattoing powder grain frake powder: 45 60cm 180cm ball powder: cm 600cm distant wounds entrance woundexit wound 1. (marginal abrasion, abrasion ring) A. excentric B. C. D. re-entry GSW 2. bullet wipe) 3. inward beveling outward beveling 1. 2.,, shored exit

38 (graze wound) superficial perforatiing wound inward beveling outward beveling (keyhole-shaped defect) 2. intermediate target internal recochet X X shotgun wound ( ) scalloping 1m petal mark

39 m satellite pellet holes 2m 3m 5.2.6

40

41 cause of death /3

42 34 6 crush syndrome ml 80ml X

43 vital reaction

44

45 km/h 50km/h 1.

46 38 7 A. B. C. 2. steering wheel injury 3. A. B. 3 seat belt abrasion 2 300km whiplash injury

47 motorcyclists fracture fuel tank injury

48 Messerer km/h 70km/h 100km/h

49

50

51 A. B

52 (presumptive identification) 2. (positive identification) DNA X

53 A. B. C. D. E. ) F. G cf

54 Todd 1920 Suchey Brooks 1992 phase 1: ossific nodules phase 2: (ventral rampart) phase 3: phase 4: phase 5: phase 6:

55 Phase A. 20 B. 30 C

56 cf % 80 90%

57 cf. Casper s law p ABO contamination DNA PCR DNA STR

58

59 51 10 hypoxia anoxia (mechanical asphyxia chemical asphyxia (poisoning) suffocating gas 10.1 strangulation suffocation SIDS p. 89 p

60 52 10 carotid artery vertebral artery jugular vein trachea * 5kg* 30kg 2kg 15kg vertebral (internal) venous plexus , , positional asphyxia O 2 CO 2 suffocating gus 8% 6%

61 hypoxia anoxia, hypercapnia 1. A. B. 1 C. 2. A. B. C. anoxia, hypercapnia D A. hypercapnia B. C A. B. 1

62 visceral congestion hypoxia petechiae anoxia postmortem fluidity of blood anoxia plasminogen activator plasminogen plasmin fibrin

63 10.4 hanging hanging ligature sexual asphyxia, autoerotic asphyxia complete suspension 2. imcomplete suspension

64 56 10 ligature mark furrow V mirror image Tardieu spot p

65 10.5 (ligature strangulation (ligature strangulation A. B. C. 2 5.

66 fingernail mark anterior neck dissection 3. 4.

67 10.6 manual strangulation manual strangulation

68

69 drowning hypoxemia 2. p

70 , emphysema aquosum, hemorrhagic pulmonary edema contamination

71 11.1 drowning goose flesh, cutis anserina 4. washerwoman s hands m

72 m 50kg kg 15 10m kg 26.4kg m 6 70kg 40kg no panic syndrome PaO 2 PaCO 2 CO 2 PaCO 2 PaO 2 dry drowning

73 / %

74 pugilistic attitude 1 2 p. 67

75 epidural thermal hematoma X DNA Burn and scalding thermal injuries (burn) (scald) p eschar

76 Wallace 9 3 1/3 Schmarts burn index 15 Burn index = 3 (%) (%) 1 hypovolemic shock Curling s ulcer (heat cramp) (heat exhaustion) heat stroke Na

77 p p

78 cherry red lividity paradoxical undressing hide-and-die syndrome (Wischnewski

79 chilbrain frost bite 1 3

80 dry type starvation dry type starvation V 200V 400V

81 ,000-6,000V 20, ,000power transmission system 2. A. B. C. 24V 400V 3000V 10 V 35cm 1. 50Hz ) 60Hz Hz 2. 50,000 Hz perception current 60Hz 1mA 5mA 45µA let-go current 60Hz 10 15mA 50 75mA 60Hz 50-80mA 100mA 1 2A Ωcm KΩ/cm Ω/cm 2 4.

82 , electric mark 1. Q(cal)=0.24I 2 RT I: (A), R: (Ω), T: paterned injury 4.

83 metallization electric burn, Joule burn arborescent burn (Lightning)

84

85 battered child syndrome 20 Caffey (1946) 6 Shilverman (1963) history Kempe (1963) battered child syndrome history neglect impulse or angry homicide

86 battered child syndrome child abuse child abuse child abuse p X

87 medical (nutritional) negrect 2. physical negrect 3. safety negrect A. lack of supervision B. failure to protect 4. educational negrect 5. emotional negrect accident-prone child

88 Munchausen s syndrome by proxy 1977 Meadow Munchausen 13.8 Whiplash shaken baby syndrome 1972 Caffey

89 13.8 Whiplash shaken baby syndrome 81

90

91 83 14 neonaticide perinatal abuse WHO terminal bronchioli alveoli

92 (caput succedaneum 5. (hydrostatic lung test) 17 CPR (2 7 ) 2 ) suffocation physical sign 2. strangulation 3.

93 lack of care 14.5 DNA DNA

94

95 87 15 sudden (unexpected) death WHO CPAOA Cardiovascular disease A. Coronary atherosclerosis 50% and/or

96 % B. Coronary artery spasm C. Hypertensive cardiovascular disease coronary atherosclerosis D. Cardiomyopathy E. Myocarditis F. Valvular diseases G. Arrhythmogenic disorders conduction system disorders H. Aortic dissection 2. Intracranial lesions A. Subarachnoid hemorrhage berry aneurysms, AVM B. Intracranial hemorrhage hypertensive disease C. Epilepsy D. Primary brain tumors astrocytoma 3. Respiratory system diseases A. Pulmonary thromboembolism cf. economy class syndrome B. Asthma C. Pneumonia D. Pneumothorax 4. Gastrointestinal tracts A. Gastrointestinal hemorrhage B. Liver cirrhosis

97 15.3 unexplained sudden death 89 C. Acute pancreatitis 5. Urogenital tract Rupture of a tubal pregnancy 15.3 unexplained sudden death SMDS cf. Idiopathic vf Sudden infant death syndrome(sids) NICHD 1989 The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, examination of the death scene, and a review of the clinical history. Cases failing to meet the standards of this definition, including those without a postmortem investigation, should not be diagnosed as SIDS.Cases that are autopsied and carefully investigated, but which remain underesolved may be designated as undetermined, unexplained, or the like. Seatle, WA 1969 The sudden death of an infant or young child which is unexpected by history, and in which a thorough postmortem examination fails to demonstrate and adequate cause of death ,

98 90 15 arousal response 1 SIDS SIDS explained death judgement call gray zone

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22●24頁●6-16▲救急外来▲.ppt No. 98 No. 62 No. 92 No. 60 No. 61 No. 99 GQM No.172 A B GRMRM RM 4B 5 No.337 No.357 No.359 No.112 No.200 151226 25 No. 31 1461 30mg/dl 0.15mg/l mg/dl 20-50 51-100 101-200 201-300 301-400 401-450- 10 No.201

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