Death by Cold / Starvation

By:-

Prof. Dr Shahid Hanif

 DEATH DUE TO COLD/HYPOTHERMIA
Hypothermia occurs due to prolonged exposure
to cold i.e below 95 F.
According to Mr. Mills clinical picture varies
with the fall in body temperature.
95--90 F ---- Shivering, increase voluntary motor
activity cutaneous vasoconstriction.
89—75 F ---- Stoppage of shivering, decrease B.M.R,
decrease BP, disturbance of conciousness.
75 or Below --- Failure of temperature regulating
mechanism.
_Complete loss of consciousness.
_Irreversible fall of body temperature.
 CAUSES OF HYPOTHERMIA
EXOGENOUS FACTORS
--Environmental temperature
--Wind current
Related with surrounding environment.
ENDOGENOUS FACTORS
Related with physical condition of the person.
--PHYSICAL CONDITIONS
Extremes of age, malnutrition, fatigue prolonged immobility.
--DISEASES
Myxoedema, Hypopitutarism.
--DRUGS
Barbiturates, Largactil, Alcohol.
 CLINICAL FEATURES

- Body very cold (to touch), colour pink or bluish,

respiratory movements shallow and irregular HR
decreased.
-Blood stained vomiting and diarrhoea.
LATE COMPLICATIONS
Chest infections, Pneumonia.
TREATMENT
Hospitalization, gradual rewarming, O2 and supportive
treatment.
MLI
Mostly accidental, Possibility of homicide in infants and
very old debilitated people.
AUTOPSY FINDINGS (EXTERNAL)
(1) Skin colour pink (due to increased oxyHb, as O2 is not
utilized by the tissues).
(2) Cutaneous erythamatous patches on face, Gangrene
of fingers and Toes (Vasoconstriction).

INTERNAL FINDINGS (NON SPECIFIC)

_Congestion of internal organs.
_Pancrease_ Focal Hemorrhages.
_G.I _ Hemorrhages+Erosions
_Liver, spleen, kidneys show droplets of fat.
_Preservation of all the internal organs.
Deep Superficial Frostbite

Clear blebs extending distally are indicators for favorable outcome.

(Courtesy of James O'Malley, MD.)

Thawed Frostbite Typical appearance of frostbite soon after
rewarming. Deep frostbite was caused by wearing
mountaineering boots that were too tight in extreme cold at
high altitude. Note deceptively benign appearance of this
devastating injury. (Courtesy of James O'Malley, MD.)
Frostbite Blebs

Proximal blebs, both clear and hemorrhagic. (Courtesy of Scott W.

Zackowski, MD.)
Late Frostbite

Late appearance of frostbite with demarcation starting to occur. Early

surgery should be avoided in favor of autoamputation unless infection
supervenes. (Courtesy of James O'Malley, MD.)
 STARVATION
It is lack of intake of food and water leading to protein
deficiency, caloric deficiency and dehydration.
(A) starvation may result from:
1. Total deprivation of food ?
2. Partial deprivation of food ?
3. Use of unsuitable food ?
(B) Starvation may be
(1) Acute

Accidental
Deliberate withholding _ Hunger strike
 (2) Chronic
In refugee camps
Famine
Neglect

SURVIVAL PERIOD :
Total deprivation of food and fluid. 7_10 days
Deprivation of food only. 50_60 days
POSTMORTEM FINDINGS
External
Body emaciated, weight reduced
tremendously.
Skin dry shrivelled, pigmented, fat free.
Muscles dark reduced in size without fat. Foul
smell, dryness, cracking of lips, eyes sunken.
 Internal
Stomach intestine_ Collapsed, contracted, empty_
Mucous membrane thin, Ulcerated. Heart small,
Atrophied_(brown atrophy). Kidneys_ free from
surrounding fat, Reduction in weight and size of all the
organs except_ Gall bladder which is distended with
bile.
_Urinary bladder empty
_Bowel_ thin papery
MLI
SUICIDAL
Hunger strike very common but death due to this is very
rare_ Possible in Insanes and prisoners_ (force can be
used)
Homicidal:
Illegitimate children, very old debilitated people.
Accidental:
Most common, In Shipwrecks, Earthquake, famine
and diseases leading to stricture esophagus.
EFFECTS OF HIGH TEMPERATURE
Heat Stroke
-Acute onset due to exposure to very high
environmental temperature.
-Body temperature may rise to 106 F and above.
-Mortality is high, Death occurs within 24_48 hours.
Heat Hyperpyrexia
Onset comparatively delayed.
_Symptoms of _ Headache, Thirst, Nausea, Vomiting,
Pain and weakness of muscles, Dry skin, Fainting,
mental confusion. Death may be delayed for 3-4 days
or up to one week.
_In both the conditions temperature regulating centre
is knocked off.
_Shift the patient to cooler well ventilated place.
Cold sponging_ I/V fluid in plenty_
HEAT CRAMPS
Occur when sudden muscular activity in extremely hot
environment like playing game or running _ cramps of
the muscles occur_
HEAT EXHAUSTION
Gradual loss of salt and water because of prolonged
exposure to extremely hot humid environment. To
treat this condition cool environment, rehydration and
correction of electrolyte imbalance is required.
AUTOPSY FINDINGS (NON SPECIFIC)
All organs show Oedema, Congestion, Petechial
hemorrhages_
Flattening of gyri in the cerebrum_
Lungs_ frothy hemorrhagic fluid_
Heart_ epicardial and endocardial hemorrhages_