Forensic Medicine

— Dr. Risheek Gupta

Types of injuries 00:01:20

Abrasion Most superficial - epidermal injury Incised Lacerated

Bruise Blood vessel injury - limited to skin wound wound Irregular
Contusion Bleeding into & round organs w/ collection I
margins
Regular w/ local
Laceration Blunt weapon margins bruising
Incision Sharp/Edged weapon(max. dimension - Length) Clean
Stab Sharp object w/ deep wound(max. dimension - Depth) wound Tissue
Chop Axe inflicted wound bridges

Abrasion(MC) Pressure/Imprint Battle sign 6 penny bruise Tram track bruise

Graze/Gravel rash/ abrasion Ectopic bruise of NAI/Child abuse MLC : Lathi charge
Brush burn MCF# Retinal h’ges
SDH
Epithelial heaping
Multiple # of differing ages
Metaphyseal corner/Bucket handle #
ARTIFICAL BRUISE: Pruritic & Vesicular
Non evolving, vital reaction x Bhilawanol/Semicarpol(Bhilawa/Marking nut)
Injuries 00:11:22

Age of abrasion — 1 week Age of contusion Livor mortis vs contusion:

RRRBBB
Raw-Red-Reddish Brown-Brown-Black Dependent: Livor mortis
Well defined:Livor mortis
Direction: Heaping of epithelium Blanch:Livor mortis
Vital reaction Extravasation: Contusion
Enzymatic rxn OxyHb DeoxyHb Bilirubin
Negative and positive zone Colour change: Contusion
& Biliverdin
Injured area
Multiple bruises different age: NAI
No colour change:Subconjunctival hemorrhage
Stab : Fish tail
Laceration : Swallow tail
Antemortem vs Postmortem clot:
Firm, dark red- Antemortem
Incision Death d/t Striae of Zahn - Antemortem
Circulatory Coralline platelet thrombus-AM
collapse & Chicken fat clot- Post-mortem
neurogenic shock
resulting from
evisceration of
Harakiri = Seppuku
gut
Jigai Suicide by cutting IJV
 Injuries 00:16:25

Incised looking Defence cuts Hesitation cuts Filigree burn/ Crocodile burn - Electrical
laceration Homicidal Suicidal Arborising pattern/ injury(High voltage)
Lichenberg flower Flash burn as well
Against bony d/t Lightening
Crush injury may
prominences also occur d/t Electrical injury
VS Electrical burns - More dangerous: AC
Lacerated looking Rhabdomyolysis - Most important factor for death: Amperage
Incision @ soft tissue - MCC of death: Arrhythmia
Rx w/ aggressive
axilla & scrotum Rigor mortis- Early onset
hydration
Joule burn - low voltage injury
Dry skin is a barrier to current
Thermal injuries 00:21:55

EDH with honeycomb

appearance
VS Bilateral, diffuse
Heat Hematoma

Heat stiffening/ Heat Fracture Skull fracture

Pugilistic attitude/ Heat rupture Outward elevation Inward depression
Boxer’s attitude
No bleeding
Paradoxical undressing;
D/t heat mediated Intact nerves and VS Laceration
vessels “Hide & die”
protein coagulation Stomach ulcers
Wishnewsky ulcer: Hypothermia
Curling ulcer: Burns
Cushing ulcer: Head injury
Cameron ulcer: Sliding hernia - Hiatal

Moist Δ(Sacld;
Heat cramps d/t Electrolyte loss Dry Δ >65 C) Chemical burn
&

Heat exhaustion d/t Electrolyte loss + Dehydration Charring Blisters+ Ulcers+

Heat stroke Core tempr. rises >40.5 C + Heat stressor Singeing Splashing+ Distinct
Classical: Sweating x + CNS dysfunction Blackening Line of colouration +
Exertional: Sweating may be seen redness+
RTA and Blast Injuries 00:28:45

Whiplash injury Tertiary blast/Secondary injuries : Head/Spine injuries, Fractures

Hyperext & Hyperflex

Pattern bruise

Sparrow foot marks

Post. hip dislocation

PCL #
Patella #
Secondary blast injury : Primary blast injury :
Aortic tears: Ladder rung Marshall’s Δ - ACL TM(MC)> Lung > Colon
Transverse tears Abrasion + Contusion + d/t blast waves
Days within which death attributed to RTA 30 days Laceration
No fractures
d/t shrapnels, missiles etc.
 Skull fractures 00:32:58

VS suture :
X serrations Chance of
X cortex brain
injury

Linear/Fissure Depressed/ Ping pong/Pond # Comminuted # Ring # Motorcyclist/

(MC) Signature # Children Hinge #

Lucid interval: EDH

Valid evidence, will and criminally liable
 Ballistics 00:36:33

Rifle Shotgun
Calvin Goddard: Father of Ballistics

Terminal
Rifling
Gyroscopic
I
Choking Dispersion
ability
-
Proximal/Internal Intermediate/External
PELLET Gauge
BULLET
Wound

1 pound lead = 454 gms

Primary marking: Class - manufacture Secondary marking: Individual gun characteristics
Bullet fingerprinting: Both - 2 > 1
Dermal nitrate test GSR GSR collected using paraffin wax SEM-DEXA
Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy Best - GSR
Kennedy phenomenon Iatrogenic manipulation of Wound
Rayalasima phenomenon Stab - bullet
 BLACK
GC - lubricant/
KCS
bullet wipe
AC - abrasion KNO3 Sulphur
Charcoal
T Dermis - Barium nitrate SMOKELESS
B
B x wipe off Lead peroxide
Entry wound - inverted Lead styphnate single-base powder-nitrocellulose
Antimony Sulfide double base powder-NC + nitro-glycerine
Exit wound : Everted / x BBT / x GC / AC triple-base powder- NC + NG +
Tetracene
nitroguanidine

SEMI-SMOKELESS
80% black + 20% smokeless
 Cruciate Cherry red BBT X BB X BBT
GC T GC
BBT/GC/AC
AC GC
AC
Inside - AC
- Close Near/Intermediate Distant
Contact
Shotgun Contact Close 1-2m 2-4m Distant
<1m (near) (intermediate) (>4m)
Complete
Rathole app. Partial dispersion
dispersion

&
Types of Bullets: 00:52:15

Yawing bullet
Tandem/Piggy
back bullet

Tumbling bullet
Dum dum Frangible Ricochet bullet(same Puppe’s rule : Sequence of
bullet bullet side entry & exit fracture - new fracture can’t
wound) cross previous fracture lines
A f/b B f/b C
-

Keyhole:Tangentially
Gutter fracture: Outer table
Kronlein shot: Brain evisceration
Asphyxial deaths 00:55:38

Fresh Water vs Salt Water Drowning Dry Drowning: Laryngospasm

Haemodilution Haemo-concentration
• Na Cl Near Drowning: Death d/t Other complication -
• Na Cl
sepsis, hypothermia
• RBC lysis : K • Mg Sr
• Myocardial anoxia Immersion syndrome:
• MCC death :
Cold - vasovagal shock - Cardiac vagal inhibtion
Arrhythmia • Gettler test : Cl in
• Gettler test : Cl in heart chamber
heart chamber
Signs of AM drowning(vs PM drowning)

Cadaveric spasm Diatom test : BM & Paltauff’s Frothing++ Washerwoman hands

No relaxation viscera; Silica shell pleural Non specific sign
VS Rigor mortis Acid/alkali haemorrhage
resistant
Suffocation:
Heimlich - adults
Café coronary
Death in drunk obese
individuals d/t
choking on food -
Back thrust appears as cardiac
Chest thrust
arrest initially
Smothering Gagging

Choking
<2yr
Masque ecchymoses

Burking Traumatic asphyxia Positional asphyxia Overlaying

Jack knife
Strangulation:

Throttling Mugging Bansdola Garrotting/Spanish

windlass

Cyanosis

ASPHYXIAL
DEATH

Congestion Tardeau
spots
 Features Hanging Strangulation
Direction Oblique Transverse
Continuity Non- continuous Continuous
Level in the neck Above thyroid At or below thyroid
Hanging
Base Pale, hard, parchment-like Soft and reddish

Hyoid fracture Abduction # Adduction #

Surest Sign of Antemortem Hanging: Dribbling of saliva

Simon bleeds
Epidural vessel #

La facie sympathique
 Human identification 01:10:56

Teeth: Temporary teeth Permanent teeth 12-14 Mixed dentition:6-11yrs

Best method: FDI method I M1 C M2 M1- CI- LI-PM1-PM2-C-M2- M3 Total: 24
Carabelli’s cusp- Caucasian 6 12 18 24 months 6 7 8 9 10 11 17-25 Permanent : (age-5)x4
Gustafson criteria >25 yrs Total : 20 Years
Most reliable-Root transparency

Dactylography-Galton system Fingerprints

Start @ 14 weeks
Development in fetus by 24 weeks
Quelet rule:Different in Identical twins
Rugoscopy: Palatal impressions

Whorl Superimposition: Skull identification w/ picture

Arch Loop(MC)
Indian skull : Mesatocephalic Change Disease
Complete loss Burns, Celiac disease
DNA samples-Blood, muscle, teeth (Not nails)
Permanent impairment RT, Electrical injury,
Ashley rule: sternum >149 mm, sternum <149 mm Leprosy,
Change in distance Acromegaly, Rickets
Durhan (Product test), Curren, Brawner rule: Insanity
Ridge alteration Scleroderma, Eczema,
Krogman’s accuracy max- Pelvis(sex determination) Acanthosis nigricans
 Female Pelvis Male Pelvis
Shape of the Wider Narrower
pelvis
Pelvic inlet, outlet Larger Smaller
Coccyx Moveable and more curved Immovable and less curved
anteriorly anteriorly
Public arch Wider V shaped
Subpubic Angle Greater than 90o Less than 90o
Pelvic brim Large and round Small and heart-shaped
Sciatic notch Wider Narrower
Obturator foramen Small and triangular-shaped Large and oval-shaped

Sacroiliac joint Short, wider and curved Long, narrow and straight
surface
Pelvic acetabulum Small and faced anteriorly Large and faced laterally

All large and wide in

females except: Corpobasal index:
Obturator foramen Breadth of S1/ Breadth of base of sacrum *100
Sacro-iliac joint surface
Acetabular notch
Feature Male Female
Architecture Rugged Smooth
Plate Large, broader and U shaped Smaller and parabola
Occipital condyle Large Small
Supra orbital ridges Prominent Less prominent
Digastric groove More deep Less deep
Mastoid process Large and blunt Small and pointed
Zygomatic arch More prominent Less prominent
Occipital protuberance Well marked Less marked
Frontal eminence Small Large
Parietal eminence Small Large
Orbits Square with smooth margin Rounded with sharp margin

All large and wide in males except:

-F/P eminence
-Nasal aperture
-Female forehead, orbit, chin round
Angle of mandible >120( )
 BONE AGE ESTIMATION 01:21:51

T
T C H
S TP
L

CRITOE
Capitulum - 2 yr
LMO
Lat. epicondyle - 14 yr
Radial head - 4 yr 2 mon:Capitulum Lambdoid suture: 45yrs
Int. epicondyle - 6 yr Med. epicondyle - 15 yr
Olecranon - 16 yr 3 mon: Hamate
Trochlea - 8 yr
Olecranon - 10 yr 3yr:Triquetrum
Ext. epicondyle - 12 yr 4yr: Lunate
5-6yr: S-T-T
ESHA Ki Wrist 9-12yr: Pisiform
S-T-T :
Elbow Shoulder/Hip/ Wrist Scaphoid,
16 yr Ankle/Knee 19 yr Trapezoid,
18 yr Trapezium
Thanatology 01:27:55
Algor mortis : PM cooling - 15 min
12 hr Sigmoid Eye changes:
Decomposition - linear Minutes: Keworkian sign
Rigor mortis :
Begins 3-6hrs:Tache noir
onset - 1 hr
after>18 hrs 6hrs: Corneal opacification
0.7C/hr
12 hr 12 hr Best indicator TSD- Vitreous K
d/d : Cobra bite Tache noir

PM lividity/Livor mortis : Marbling

onset - 30 mins • 36-48 hours
• Sulfmeth-Hb

PM caloricity: Rigor mortis Face f/b neck f/b thorax f/b PM lividity:
Heat stroke First- Heart UL f/b Abdomen f/b LL Cherry red- CO
Pontine hemorrhage First external- Eyelid Brick red- Cyanide
Sepsis Nysten’s rule Proximal—Distal, craniocaudal Chocolate- Nitrite
Tetanus/strychnine Rule of 12
Cholera Not in fetus <7mon
NOT BURNS Late rigor mortis: Asphyxia, Hemorrhage, Pneumonia
 3-12 months
Dry & hot climate
No odour
Excellent organ preservation

Putrefaction Adipocere Mummification

No organ preservation Fat saponification - lipase
Foul smell Humid/near water body
3 days -3 months Fruity smell
Putrefaction delay: Putrefaction: Casper’s dictum AWE Time to decompose
Strychnine, metallic Larynx/trachea-> Prostate,
poison, Carbolic acid nongravid uterus, bone, teeth Air(1) : Water(2) : Earth(8)
Decomposition begins in the RIF
Autopsy 01:38:14

Order in autopsy: Organs preserved in Poisoning cases:

1) Poisoning Cranial cavity 1st - odour Blood NaF + K-oxalate
2) Newborn Diaphragm(Live birth - low) Urine Tol. blue > Thymol
3) Asphyxia Neck last Entire stomach
4)Pneumothorax Pleura 1st Proximal 30cm SI Ideal : Rectified spirit
500g liver MC : Saturated salt solution
Virchow- Head f/b Thorax f/b Abdomen Half of each kidney
Letulle- En masse
Ghon- En block
Rokitansky- in situ - HIV-AIDS/COVID
Submentum to pubic B/L Acromian to Bimastoid to Submentum to
symphysis(Spare the subxiphoid to pubic Suprasternal notch umbilicus to B/L
umbilicus) symphysis to pubic symphysis Mid-inguinal points
Incisions:
I – MC
Y- Breast preservation Embalming fluid:
Modified Y- Neck Preservative: Formalin
Inverted Y- Infants I Germicide: Phenol
X- Cutodial Buffer: Sodium borate
Umbilicus spared Anticoagulant: Sod. Citrate
NOT ETHANOL
I-shaped Y-shaped Mod. Y-shaped Inverted Y- X-shaped
shaped
Sexual perversions 01:42:38

Exhibitionism Exposing ones’s genitals to an unsuspecting person or Freud’s stages of

performing sexual acts that can be watched by others psychosexual
development :
• oral(1yr)
Frotteurism Touch or rubbing against a non-consenting person
• anal(1-3yr)
• phallic(3-6yr)
Voyeuristic disorder Observe an unsuspecting person who is naked, • latent(puberty)
354C undressing or engaging in sexual activates • genital(puberty)
354D- Stalking
Sexual masochism Wanting to be humiliated, beaten, bound or otherwise
disorder made to suffer for sexual pleasure
Sexual sadism disorder In which pain or humiliation of a person is sexually
pleasing
Transvestic fetishism Arousal from clothing associated with members of the
Eonism opposite sex
VS Gender dysphoria - feeling trapped in
=>
Oedipus complex one’s own body d/t incongruity b/w
Son attracted to mother assigned gender & personal gender
Electra complex identity
Daughter attracted to father
TORTURE 01:46:35

Falanga/
Wet submarine Hog tying
Telefono Bastinado Parrot perch
El planton Saw horse

Declarations
Tokyo,Istanbul,Hamburg Torture
Hongkong Elderly abuse
Venice Terminal illness
Oslo Abortion
Helsinki and Nuremberg code Human experimentation
Ottawa Child care
Sydney Brain death
Geneva Hippocratic oath
Malta Role of doctor in hunger strike
Stains for fluids 01:49:52

BLOOD SEMEN Choline - Brown rhomboid

Luminol stain-UV light 1) Florence stain
CONFIRMATORY TEST 2) Barberio test
1) MICROCRYSTAL TEST 3) Brentamine / Walker test
TEICHMANN: Haemin 4) MUP test Acid PO4ase
Brown rhombic 5) ICT-Semenogenelin, LDH
TAKAYAMA: Haemochromogen CONFIRMATORY TEST: MICROSCOPY Saliva
Pink feathery
Best BSP - Barberio-Spermine- Crystal violet: Sweat
2) MICROSCOPY
3) ABSORPTION SPECTROSCOPY Picric acid(yellow needle)
Edelman’s agent:
Christmas tree Faecal
stain

Teichmann Takayama test

test
Medical law-Court proceedings 01:52:22

Evidence: Direct- Eyewitness/CCTV HIERARCHY OF COURTS Max punishment/fine

Indirect- Supreme court Life imprisonment
Circumstantial: Valid
High court Life imprisonment
Hearsay: Invalid
Sessions court Life imprisonment
Assistant sessions court 10 years
CJM 7 years
JM - 1st class 3 years/10k fine
JM - 2nd class 1 year/5k fine
JM : Judicial magistrate
Sexual Assault case: Duties of doctor Min age for consent: General Physical exam- 12 years
1) Inform police PV/PR/ Surgery/ transplant- 18 years
2) Consent for examination-Age: 12 years Implied- OPD - GPE
3) Psychological counselling Expressed- Verbal/ written
4) Written refusal Open/ blanket- donate “sample”
5) Provide diagnosis and treatment BEST: Written; informed consent
Time limit: Therapeutic privilege: Psychiatric patients
Tol. blue - victim injuries
Vaginal swab- 96 hrs Extended consent: Life threatening - x India
Semen sample- 72 hrs Therapeutic waiver: Patient says - x consent
Accused : Lugol’s iodine
Criminal negligence: Drunk doctor on duty
Duty-Dereliction-Direct causation-Damage Foreign body left inside
Res ipsa loquitor: facts speak for themselves Wrong side surgery
Medical maloccurence: Hysterectomy - ureter # - known complication
Dichotomy: Fee splitting
Professional misconduct: Ethics not followed - State medical council
Novus actus intervenes : Intervening act - x liable
Double jeopardy=Res judicata Same case can’t be tried in 2 different courts of law
Contributory negligence: Partly patient’s fault
Res indicate Civil negligence - case w/in 2 years
Leading questions: Cross-examination
OPD/ IPD records maintained for: 3 yr MLC records: 10 yr
Time to provide records: 3 days
Post humous child After death of biological parents

POCSO 2012 PCPNDT 2002: Prohibit sex selection

Penetrative sexual assault, Sexual assault, Sexual harassment, and prenatal diagnostic tests
Pornography Medical board: Paediatrician, OBGYN,
Aggravated: Mentally ill/Custody/Trusted authority Radiologist
Loco parentis Principal/Teachers Form F X detect/informed
 Hymenal tear: Glaister-Kleen rods
Posterolateral (4-7) Penile penetration
Anterior: Digital/Foreign body penetration
Intact despite intercourse: Child - deep seated
(MC)
HAASE’s rule
During the first five months of pregnancy:
Square root of the length = age of the fetus in months
MORRISON’s rule
After first five months of pregnancy:
Length divided by 5 = age of the fetus in months

Superfetation VS Superfecundation:
Twins 1 month apart Same cycle but different
>
Live born
Livevsborn
Live Still
born born Still
Stillborn
born Different cycle acts of coitus
Foder’s test: 60gms 30gms
Lochia Rubra - Serosa - Alba ~ 24 days
Plocquet’s test:(Lung:Baby)
I 1:35 1:70 0-4d 8d 12d
— Gelatinous
Wredin test: Vagitus uterinus/vaginalis - Cry before birth
membrane
Breslau’s second life test: Air in stomach + —
Intrauterine death signs:
Hydrostatic test Float Sink Earliest- FHR loss
Robert sign- Air in great vessels
False positive: PPV/Decomposition
Spalding sign Overlapping skull
False negative: Collapse/Pneumonia Ball sign Hyperflexion bones
 TOXICOLOGY: CORROSIVES 02:17:55

↑
Corrosive Poisoning: Stomach mucosa
Black/ Blotting paper- H2SO4(Oil of Vitriol)
-Acid:Coagulative necrosis(except HF) Yellow- HNO3- Xanthoproteic rxn.
-Alkali: Liquefactive necrosis Leather /Grey- Carbolic/Phenolic acid
Red velvet- Arsenic
Hypocalcemia: seen esp. w/ HF, PEG & Oxalic acid - Yellowish brown Phosphorus
UGIE: w/in 24 hrs i.v Ca gluconate(Rx) Slate gray Mercury

Oochronosis

Miosis
Magenstrasse(lesser curvature) Ewald’s tube
d/t PCT necrosis Universal antidote: Gastric lavage:
ATM Time: <1hr
H2SO4/Sulfuric acid Boiled lobster Phenolic/Carbolic acid
Blackening of skin, appearance Carboluria(green urine) • Activated charcoal(2) Position:Lt. lat. Decubitus
cartilage etc. + Chalky Boric acid d/t pyrocatechol & • Tannic acid(1) CI: Convulsants
White teeth hydroquinone • MgO(1) Corrosives
Strongest acid Delays putrefaction Comatose
Kerosene
Zargar’s Endoscopic classification of Corrosive
Injury to Esophagus & Stomach
 ASPHYXIANTS AND CARDIAC POISONS 02:24:59

ASPHYXIANTS
COLD
Carbon monoxide:250x affinity than O2
Anoxia- Anemic anoxia
>5% COHb :
Pulse oximetry: Normal
Symptomatic Lt./Down
Cutaneous blisters
CYANIDE: Bitter almond smell
Anoxia-Histotoxic anoxia(Complex IV - )
Lee Jones test Cherry red lividity
CAR DONA
Spanish fly
Trazodone
Canthardin, Priapism

Indian red scorpion –

Mesobuthus Aconite
Digitalis purpura White/Pink Yellow Oleander Nicotine
Autonomic storm Hippus/Hypotension
Foxglove Oleander Cerebra thevatia Homicidal
Nerium
DOC- Prazosin Root : most poisonous
Meetha zeher/Monk’s
hood
 SNAKES 02:30:32

=>

Common/Indian King Common krait -

Banded krait Viper Sea snake
Cobra cobra
Vasculotoxin Myotoxic
Elapideae - Neurotoxin - Haemolysis/DIC Rhabdomyolysis
descending paralysis WBCT > 10min
1st visible sign - ptosis X clot

Cobra - 3rd Krait - 4th Specific antidote: Polyvalent ASV: effective against
supralabial largest infralabial largest
Cobra, Krait, Russel’s viper & Saw scaled viper
CARRY NO RIGHT Given within 4 hrs 10 vials X test dose given
No torniquet/incision/cautery/sucking/coffee/alcohol
R-Reassure
I-Immobilize
G-Go to H-Hospital T-Tell symptoms Neostigmine + Atropine: Cobra > Krait
OTHER POISONS 02:36:24

must
Phossy jaw
White/Yellow(toxic)
Red - non toxic
Antidote : CuSO4

Phosphorus
Cannabis Cocaine Datura - thorn apple Hunan hands
Protoplasmic poison
Hyoscine/Atropine Capsicum Luminiscent vomit, feces
C/F - Hyperthermia; seeds(round) Smoking stool syndrome
mydriasis; Yellow fatty liver
secretions Diwali poison
Organophosphates (Dyflos/Malathion) = Early mushroom poisoning
Kerosene odour Irreversible - AChEi Itai itai disease: Cd - bone pain
Carbamates: Carbaryl/ Propxur - reversible CuSO4/Na amytal : Blue
Secretions/Miosis/HR Cholinergic
Antidote : Atropine(OP — + oximes)
Toxidrome
Garlic Odour: ALP
Aluminium
Late mushroom: Arsenic Phosphorus Phosphide
Hallucinogen - atropine C/I
Abrus precatorius Croton Ricinus Semicarpus/ Strychnine Nigella seeds
Abrin Jamalgota a.k.a Castor Marking nut GABA/Glycine - Kalaunji
Gunchi/Ratti (except castor oil - Bhilawanol Post synaptic
non toxic) Artificial
bruise

Krait - pre-synaptic
Cobra - post synaptic

Monday morning : Strychnine

1) fever + chills: Zn — d/d: Malaria Wenzell test,
2) Chest tightness Byssinosis Sonnenchein test
3) sickness (headache): Nitrates VS Wetzell test : CO
Japanese detergent suicide / Sewer gas / Bluish green lividity: H2S
 METALLIC / NON-METALLIC POISONS 02:47:31

- Aldrich-Mees lines
Thallium
-
Lead Acrodynia(Pink disease)

·
Arsenic
Burtonian lines Lead lines
Ideal homicidal poison
B - Behaviour changes
Plumbism=Saturnism Mercury
A - Alopecia + Madarosis A Anaemia(ALA dehydratase & Ferrochelatase x) Minamata disease
N - Neuropathy & Nail changes B Basophilic stippling(5’ Pyrimidine nucleotidase x) -Mad Hatter’s = Glass
Burtonian lines
C Colic/Constipation/Cabot

I
D - Dermatitis
Rain
>
- drop pigmentation C ring blower shakes =
D Drop(wrist; finger; foot) Danbury tremors
D
Urine E Encephalopathy -Erethism
E
BoneCan be detected in exhumed bodies F Facial pallor -Gingivostomatitis
F
Marsh, Reinsch, Gutziet G saturnine Gout
G
Tactile Hallucination CEA
• Cocaine(Magnan bugs)
• Ergot alkaloids Black foot/limb
• Arsenic disease(CEA)
ANTIDOTES: 02:52:22

PCM N-acetyl cysteine - glutathione replenishment CHELATORS: C/I : Cd, Fe Hemodialysis:

BAL/ Dimercaprol-HAL(Hg/As/Pb) Barbiturate
BZD Flumazenil DMSA/Succimer-HAL(Hg/As/Pb) Lithium
B blocker Glucagon D-penicillamine- Copper Alcohol
EDTA- Lead Salicylates
Cyanide Lille’s kit - PAPPA-A + Vit.B12 Desferioxamine- Iron Theophylline
Meth Hb Methylene blue Level >500ug/dl in children PP binding
Prussian blue-Thallium Vd
Fe toxicity:
GI bleed-> asymptomatic -> Liver failure-> pyloric stenosis

Forced alkaline diuresis Forced acidic diuresis

NaHCO3 NH4Cl
Lille’s kit
Weakly acidic drugs(-ate) Weakly basic(-ine)
Mtx/Salicylate Strychnine/Atropine/
Morphine

TCAs are weak bases(Imipr-AMINE, Desipr-AMINE) but managed

by forced alkalinisation as NaHCO3 stabilises myocardium &
protects from Na channel blocking properties of TCAs
ALCOHOL 02:57:22

Windmark formula

i
ALCOHOL WITHDRAWAL:
Earliest:Tremors(~6hrs)
Alcoholic hallucinosis: ~ 24-48 hrs
Delirium tremens: Altered sensorium - >48 hrs
TOC: BZD - Chlordiazepoxide
BZD safe in liver failure:Lorazepam, Oxazepam, Temazepam
Anti-craving: Naltrexone > Acamprosate LEGAL LIMIT: 30mg%
CRITICAL LEVEL: 150mg%
Ataxia/incoordination
McEwen sign >250mg% - alternate constriction &
dilatation
Morbid jealousy
Munich-Beer heart DCM, A.Fib.
Mellanby effect
Marchiafava Bignami Corpus callosum changes
(Global confusion/
Wernicke’s encephalopathy GOA Ophthalmoplegia/ HEROIN
Ataxia)
Korsakoff psychosis Confabulations Toxicity DOC: Naloxone
Antero/Retro-grade amnesia Withdrawal DOC: Methadone
Carbohydrate deficit transferrin > GGT
Motivational interviewing can be tried Acute Drug Intoxication
A

in substance abuse cases Class Clinical features

Hallucinogen • Dissociation Ketamine(phencyclidine derivative) Amnesia
Phencyclidine(Angel dust) • Nystagmus (horizontal or vatical) Violent behaviour
Hallucinogen • Euphoria
LSD(Acid, Paper) • Tachycardia/hypertension
Synaesthesia
• Bad trip, flashback

E
·

Stimulant • Seizures
Chest pain
Cocaine(White lady, Snow, • Tachycardia/hypertension
Bruxism
• Mydriasis
Blow, Coke, Crack) • Magnan bugs Nasal septal perforation
• Black teeth Intracranial haemorrhage
Stimulant • Violent behavior
Amphetamine/MDMA • Paranoid hallucinatory syndrome Mydriasis
• Choreiform movements
(Ecstasy, Crystal meth, Ice)
Cannabis(Weed; Grass; Joint; Reefer) Psychoactive • Increased appetite Hash oil : Most potent

·
Bhang / Majoon • Amotivational syndrome
Ganja Dried leaves • RUN AMOK Homicide f/b suicide
Charas/Hashish
Flower top(female) • Smell of burnt rope
Dried resin from stem • Conjunctival injection

·
Opioid • Depressed mental status S/c : skin popping
Heroin(Diacetyl morphine; Depressant • Miosis I.v. : Mainlining
• Respiratory depression
Brown sugar; dope; smack) • Constipation Chasing the dragon(heating
Speedball= cocaine + heroin • Marquis test in an aluminium foil f/b
Hot Shot= Heroin + Strychnine • COLD TURKEY puff inhalation)
Micky Finn= Chloral hydrate Withdrawal(Lacrimation, micturition, diarrhoea, mydriasis, yawning)
TOXICOLOGY MASTER-CHART 03:08:20

MIOSIS MYDRIASIS

CHOLINERGIC DEPRESSANT PONTINE ANTI- STIMULANT OPIOD

• secretions • secretion HEMORRHAGE CHOLINERGIC Cocaine WITHDRAWAL
• HR • HR • secretions • HR • secretion
CARBOLIC ACID
OPs; Carbamates; • RR • Hyperthermia • RR • Diarrhoea
Early mushroom • GCs Green urine/Carboluria
Datura • BP • Lacrimation
poisoning Opioids Oochronosis
• Yawning

PUPIL:
Cholinergic: Miosis - active
Anticholinergic:Mydriasis - passive
Sympathetic:Mydriasis - active
Anti-sympathetic:Miosis - passive
BNS 03:12:10

82- BNS 20 - Child <7 yrs not liable

83- BNS 21 - Child b/w 7-12 yrs; liability based on maturity
84- BNS 22 - McNaughten’s rule
85- BNS 23 - Involuntary drunkenness is not liable
McNaughten’s rule : A person who, at the time of
86- BNS 24 - Voluntary drunkenness is liable commission of an offence was of unsound mind,
is exempt if they didn’t know the nature of the act
or its consequences

87- BNS 25 - Consent valid for >18 yrs age

89- BNS 257- Consent not valid for <12 yrs age
90- BNS 28 - Consent of a child <12 yrs/insane/intoxicated/under threat - invalid
92- BNS 30 - Emergency Doctrine; in life saving situations, if no one available to consent,
consent is not needed a.k.a Implied consent
191- BNS 227 - (D) Perjury ; BNS 228 - Fabrication of evidence
193- BNS 229 - (P) Perjury & fabrication of evidence
228A- BNS 72 - (P) for disclosure of identities of Rape victims

299- BNS 100 - (D) Culpable homicide

300- BNS 101 - (D) Murder or Culpable homicide amounting to murder
302- BNS 103 - (P) for murder
304- BNS 105 - (P) for culpable homicide
 BNS 106 - (P)death of patient d/t rash/ i. Emasculation.
304A- ii. Permanent privation of the sight of either eye.
negligent act
iii. Permanent privation of the sight of either ear.
304B- BNS 80 - (P) Dowry death iv. Privation of any member or joint.
v. Destruction or permanent impairing of any
312:BNS 88 - Criminal abortion w/ consent of mother member or joint
vi. Permanent disfiguration of the head or face
313: BNS 89 - Criminal abortion w/o consent of mother vii. Fracture or dislocation of a bone or tooth
viii. Any hurt which endangers life or which causes
314:BNS 90 - Criminal abortion leads to death of mother the sufferer to be during the space of twenty
days in severe bodily pain or unable to follow
his ordinary pursuits
319- BNS 114 - (D) Hurt
*Update in point VIII : 15 days of severe bodily pain
320- BNS 116 - (D) Grievous hurt or inability to follow ordinary pursuits

375- BNS 63 - (D) Rape

376 - BNS 64 - (P) of Rape
 CrPC- IEA 03:20:18

Bharatiya Nagarik Suraksha Sanhita Police inquest:

Minimum rank
CrPC: Citation: Act No 46 of 2023 Sub-inspector-Sexual offences
174- BNSS 194 - Police Inquest Head constable-Others
Magistrate inquest:
176- BNSS 196 - Magistrate Inquest Custodial death/ rape/ disappearance:
Judicial Magistrate
Dowry death: Judicial/Executive
Bharatiya. Sakshya Adhiniyam
Exhumation: Magistrate
IEA-Bill No. 123 of 2023
32- BSA 26 - Dying declaration
45- BSA39 - Expert witness opinion
154-BSA 157 - Hostile witness
Leading question allowed

Common witness : First hand knowledge rule applies