CRI 174: Special Crime Investigation 1 with Legal Medicine

Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title: Drowning Materials:

Student Activity Sheets
Learning Targets: Ballpen
1. Describe Drowning
2. Identify the types of drowning References:
McLay W.D.S. (2009). Clinical
forensic medicine. 3rd edition.
Cambridge University Press, New
York.

A. LESSON PREVIEW/REVIEW
Introduction
Good day to all! On this topic, we are going to talk about death by asphyxia, but the discussion
will focus more on drowning. As a future investigator, it is very important to know if the aspect of
drowning was used in the commission of crime; this will serve as the investigative lead to determine the
exact cause of death and the mechanism that resulted in death.

B.MAIN LESSON

Asphyxia is applied to all forms of violent death due to interference with the process of respiration. It is
a condition in which the supply of O2 to the blood or tissues or both has been reduced below normal level.

Types of asphyxial death:

1. Anoxic death
Failure of arterial blood to be normally saturated with O2 due to:
a)Breathing in an atmosphere with insufficient O2- High altitude
b)External obstruction of the air passage – traumatic crush asphyxia
c)Paralysis of the respiratory center – poisoning, injury, anesthesia
d)Mechanical interference of the passage of air- drowning, asthma
e) Shunting of blood

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 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

2. Anemic anoxic death

Decrease capacity of the blood to carry O2 due to Hge, CO poisoning, Low Hgb

3. Stagnant anoxic death

Failure of circulation due to Heart failure, shock, arterial venous obstruction

4.Histotoxic anoxic death

Failure of the cellular oxidative process, cannot be utilized in the tissues. Cyanide

Phases of asphyxial death:

1.Dyspneic phase- Breathing is rapid and deep, PR inc., Rise of BP
- due to lack of O2 and retention of CO2

2. Convulsive phase- Cyanosis more pronounced, pupils dilated, unconscious

- Tardieu spots =petechiae /hges in the visceral organs
- due to stimulation of CNS by CO2

3. Apneic phase- Breathing is shallow, gasping

- Due to paralysis of respiratory center

Classification of Asphyxia:
1.Hanging
2.Strangulations: by ligature, manual strangulation, spl forms –palmar
3.Suffocation: choking
4.Asphyxia by drowning
5.Asphyxia by pressure on the chest
6.Asphyxia by irrespirable gasses

ASPHYXIA BY SUBMERSION OR DROWNING

It is a form of asphyxia where the nostrils and mouth have submerged in watery fluid.

Time required for death in drowning:

● Submersion for 1 ½ minutes is considered fatal.
● Average time required for death in drowning is 2 to 5 minutes.

Emergency treatment in Drowning

1. Schaefer’s method–Face down, prone position:operator exerts pressure in ribs
2. Sylvester’s method- Lying on his back, astride over body, swinging arms

Post-mortem findings:
1. External findings

a) Wet clothes, pale face, F.B. clinging on skin surface

b) “Cutis anserine” or “goose flesh” – skin is pale , contracted

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 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

c) Washerwoman’s hands and feet – skin of hands & feet:bleached

d) Postmortem lividity – marked in the head, neck and chest.
e) Presence of firmly-clenched hands with objects – Person was alive at first
f) Physical injuries for struggle
g) Suicidal drowning – Pieces of stone

2. Internal findings

A. RESPIRATORY SYSTEM

1. “Emphysema aquosum” – Lungs are distended overlapping the heart

➢ Due to irritation made by the inhaled water on the mucous membrane of
the air passage which stimulates the secretion of mucous.

2. “Edema aquosum”– Due: Entrance of water into air sacs, Lungs are doughy

3. “Champignon d’ocume” – whitish foam accumulates in the mouth/nostrils

➢ Due: abundance of mucous secretion
➢ One of the indications that death was due to drowning.

4. Tracheo-bronchial lumen – congested, filled with froth

5. Blood stained fluid found inside chest cavity.
6. Section lungs show fluid with bloody froth.

B. HEART
1. Both sides of the heart may be filled or emptied with blood.
2. Salt water drowning – Blood chloride content is greater than the left side.
Fresh water- Blood chloride is more on the right side. FRESH- RIGHT

C. STOMACH
Presence food in the stomach but absence of water.> Death is rapid or submersion made after death.
Impossible for water to get into the stomach if the body is submerged after death.

FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING

1.The presence of F.B. in the hands of the victim.
The clenching of the hands is a manifestation of cadaveric spasm in the effort of the victim to save himself from
drowning.

2. Increase in volume (emphysema aquosum)

edema of the lungs ( edema aquosum)

3. Presence of water in the stomach

4. Presence of froth, foam, F.B. in the air passage found in the medium where the victim was found.

5. Presence of water in the middle ear due to violent inspiration when the mouth is full of water.

This document is the property of PHINMA EDUCATION

 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Floating of the body in drowning:

-Within 24 H due to the decomposition which causes the accumulation of gas in the body, the body floats.
- Body is flexed because of the dominance of the flexor muscles
-“tete de negri” – bronze color of head and neck; face as the most dependent portion of the body.

Homicidal D. = struggle, motive, articles found near the place, phys. injuries
Suicidal D.= note, heavy objects, mentality, Hx of previous attempt
Accidental = Absence of violence in the body., exclusion of suicide, witnesses

Types of Drowning
1. Near drowning
The term “drowning” is most commonly used to describe a fatal incident, but not all drowning results in
death. In many instances, a victim is rescued and resuscitated and can survive the event.
To distinguish between fatal and non-fatal drowning, the term “near drowning” is used. This is when the
patient is rescued before the point of death.

2. Dry drowning
When a drowning person sinks and becomes more deeply unconscious, the stimulus to breathe is still
present. As they try to breathe, water enters the pharynx. This stimulates the reflex that closes the larynx and
epiglottis, thus diverting water to the stomach. With the airway sealed, the patient suffocates. Approximately
ten percent of drownings are dry drownings where water has not entered the lungs.

3. Freshwater drowning
When external respiration (exchange of gasses in the lungs) is interfered with by freshwater entering
the lungs, the body will absorb the water into the blood. This haemodilution distorts the pH value of the blood
[normal blood pH is 7.4 on a scale of 1 to 14, 1 being most acidic and 14 being most alkaline, 7 being neutral].

The body can cope with, and rectify, small changes in pH. But larger changes associated with significant
haemodilution may result in cardiac arrest, sometimes within two to four minutes of rescue.

4. Saltwater drowning
Saltwater has the opposite effect of fresh water, with water being drawn from the blood into the lungs.
As the viscosity of the blood increases, the circulation becomes sluggish, slowing the heart rate until the point
of cardiac arrest. Cardiac arrest may occur up to 12 minutes after rescue.

5. Secondary drowning
When a drowning victim is successfully rescued and resuscitated, they may appear to be fully
recovered. But their life could still be in danger.

If water has entered the body, rapid absorption from the stomach to the bloodstream will take place,
causing haemodilution and distortion of pH balance. This could kill the patient up to 72 hours after being
rescued.
If the patient drowned in salt water, residual water in the lungs could draw fluid from the bloodstream
causing pulmonary edema or ‘shocked lung syndrome’, which may occur many hours after the event.

This document is the property of PHINMA EDUCATION

 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

There are three main complications associated with drowning:

➢ Hypothermia. This must be considered in all cases of near drowning. The symptoms of hypothermia
can mimic cardiac arrest.
➢ Alcohol. Alcohol can speed the onset of hypothermia, slow reactions, and increase the risk of vomiting;
➢ Mammalian diving reflex. This is a physiological response particularly common in young babies that
occurs when a victim is plunged face-first into icy cold water. This little-understood reflex results in a
near-total shutdown of the respiratory, circulatory, and nervous systems to the point of ‘suspended
animation’ and apparent death.

However, victims have been known to make a complete recovery after up to 38 minutes submerged
and 16 subsequent hours of resuscitation.

1. The cause of death was drowning. Allegedly, the victim committed suicide by drowning herself.
After conducting a post-mortem investigation, contusions and body lesions were found on the body of
the victim. Based on these facts, did the victim really commit suicide? If not, what crime transpired?
Defend your answer.
Based on the presence of contusions and body lesions on the victim's body, it casts doubt on the theory that the
victim committed suicide by drowning herself, suggesting the possibility of foul play and indicating that the victim may
have been subjected to physical harm before or during the drowning incident, leading to suspicion of homicide rather
than suicide.

2.Based on the scenario above, what is the importance of keeping an open mind when creating a
plausible theory?

In the scenario above, it's important to keep an open mind when creating a plausible theory, as it allows for
considering all possible explanations and interpretations of the evidence, ultimately increasing the likelihood of
uncovering the truth behind the crime.

This document is the property of PHINMA EDUCATION

 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

1. What is the average time required for death in drowning for it to 2 to 5 minutes
be certain?
2. It is caused by prolonged exposure to very cold temperatures, a
condition that occurs when the body’s temperature drops below
95° F (35° C). Normal body temperature is 98.6° F (37° C). Hypothermia
3. It is a condition in which the human body is deprived of oxygen. Asphyxia
4. It is an immediate survival after asphyxia due to submersion. Near drowning
5. A type of drowning where water never reaches the lungs. Dry drowning

C. LESSON WRAP-UP

Summary
Drowning is defined as a form of suffocation due to the airways of the mouth and nose
becoming immersed in a liquid. If a victim doesn’t return to the surface to breathe, the body detects
excess carbon dioxide and decreased oxygen levels and enters a state of breathing emergency. This
is accompanied by panic and physical distress, and in most cases, the inhalation of water into the
lungs. The airways then close to prevent further fluid intake until the victim eventually loses
consciousness.
Most fatal incidents of drowning occur when a victim is alone. But the presence of a bystander,
particularly someone who is trained in drowning first aid, greatly increases a person’s chances of
survival.
Drowning can be categorized into five different types: near drowning, dry drowning, freshwater
drowning, saltwater drowning, and secondary drowning.

Frequently Asked Questions

1. What is the Classification of Asphyxia?

● Hanging
● Strangulations: by ligature, manual strangulation, spl forms –palmar

This document is the property of PHINMA EDUCATION

 CRI 174: Special Crime Investigation 1 with Legal Medicine
Module #11 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

● Suffocation: choking
● Asphyxia by drowning
● Asphyxia by pressure on the chest
● Asphyxia by irrespirable gasses

2. What is the distinction of homicidal, suicidal, and accidental drowning?

Homicidal– struggle, motive, articles found near the place, phys. injuries
Suicidal– note, heavy objects, mentality, Hx of previous attempt
Accidental– Absence of violence in the body., exclusion of suicide, witnesses

Answer Key
1. 2 to 5 minutes
2. Hypothermia
3. Asphyxia
4. Near drowning
5. Dry drowning

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