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Exposure Exposu
To cold re to
Heat
General Local
effects effects General Local
effects effects
Definitions
Thermal Death
Internal Heat
Enviromental Heat
Heat Load ( gain)
Heat Loss
1 C = 33.8 F
Heat loss and Heat gain
Heat is gained:
by conduction from warm air surrounding the body
by the body’s metabolic activity ( liver & muscles)
Heat is lost:
Thermoreceptors
Hypothalamus
nerves Muscles of
Sweat skin arteriole
glands walls relax
Muscles increase Skin arteries dilate
reduce secretion More blood to the
activity skin.
More radiation &
conduction of heat
Thermoreceptors
Hypothalamus nerves
Muscles of
nerves Sweat skin arteriole
glands walls
Muscles decrease constrict Skin arteries
constrict
shivering secretion Less blood to the
skin.
Less radiation &
conduction of heat
Systemic hyperthermia
Endogenous \ Febrile hyperthermia
Exogenous\ non-febrile hypothermia
Heat Cramps
Heat Exhaustion ( Heat prostration)
Heat Syncope ( Heat collapse)
Malignant hyperthermia
Heat Stroke
● Fourth level
● Fifth level
Complication:
If lives short time after acute insult :
Pneumonia
Tub. Necrosis of kidney
adrenal Hmg
hepatic necrosis
myocardial fiber necrosis &
subendocardia HMG
If the diagnosis of heat stroke has not
been made prior to death, the
diagnosis is often circumstantial based
on history, exclusion of other causes of
death
Autopsy finding:
not specific
Heat acclimatization
● Fourth level
● Fifth level
Hypothermia
December
Disabled
Live alone
Either :
1- General
2-Localized
Dry or in water
Considered
Externalhypothermia when temp
parts of body : enviromental
less 35C
Dependent
Internal part : constant temp. ( core
Temp.)
Case
- Heat production :
metabolism , muscular activity
- Heat loss :
increasing blood flow through skin or
sweating
Brown fat play role in chemical
thermogenesis by increase rate of
metabolism
Autopsy :
The tap water temp was 16 C
● Fourth level
● Fifth level
extremities may be cyanosed or they
may be white
Sometimes the feet are blue to the
ankles, above which is pale.
Oedema may be seen
blistering of the skin
Signs of pre-existing disease
Lesions with hypothermia
ACUTE GASTRIC
EROSIONS(Wischnevsky’s Gastric
lesion):
The stomach mucosa have numerous
shallow ulcers, the floor of each
containing a dark brown plug of altered
blood
the stomach contents sometimes
contain dark acid-affected blood.
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Second level
● Third level
● Fourth level
● Fifth level
PULMONARY OEDEMA: common but
not specific
PENVASCULAR HAEMORRHAGES:
in the brain, especially in the walls of
the third ventricle, they are not
particularly specific
Microinfarcts are common in many
organs in hypothermia.
Case
In December 2002 , man called a police , reporting he found his disabled
GirlFriend lying dead on the living room Floor.
toxicology : -ve
Histology : Wischnevsky’s spots
Diagnosis Made as Fatal
THE 'HIDE-AND-DIE'
SYNDROME
Also called terminal burrowing
behavior
In some cases of hypothermic death in
that it is associated with the victim
undressing and hiding away from sight
The signs of hypothermia are usually
present
problem then arises as to whether the
victim became hypothermic first,
which led to mental confusion that
Paradoxical undressing
● Fourth level
● Fifth level
Case # 2
Hyperacetonemia : occur
in hypothermia