1 00:00:00,360 --> 00:00:04,360 Speaker 1: Today's episode includes information about the death of individuals. If 2 00:00:04,400 --> 00:00:06,720 Speaker 1: this sort of thing upsets you, this is not the 3 00:00:06,800 --> 00:00:10,360 Speaker 1: episode for you. May I suggest you watch a movie, 4 00:00:10,720 --> 00:00:16,200 Speaker 1: maybe something like White Christmas, Welcome to Mayhem the More 5 00:00:17,360 --> 00:00:27,400 Speaker 1: with their host Doctor Kinder crowns today's episode, the weather 6 00:00:27,480 --> 00:00:32,440 Speaker 1: outside is frightful. Last week, winter storm Fern swept across 7 00:00:32,479 --> 00:00:36,720 Speaker 1: the Midwest, south, and northeast. It affected thirty four states 8 00:00:36,760 --> 00:00:39,440 Speaker 1: and two hundred and twenty million people, including where I 9 00:00:39,600 --> 00:00:43,800 Speaker 1: live in North Texas. These winter storms bring freezing temperatures, 10 00:00:43,880 --> 00:00:48,479 Speaker 1: high winds, sleet, ice and snow, and with that burst pipes, 11 00:00:48,760 --> 00:00:52,280 Speaker 1: icy roads, and power outages. People are trapped in their 12 00:00:52,280 --> 00:00:55,240 Speaker 1: homes without power or heat, and of course the homeless, 13 00:00:55,560 --> 00:00:58,000 Speaker 1: if they can't find shelter, have to find a way 14 00:00:58,040 --> 00:01:02,040 Speaker 1: to survive. Every year wherever I've worked, we will get 15 00:01:02,040 --> 00:01:04,679 Speaker 1: a number of people dying from exposure to the cold, 16 00:01:04,959 --> 00:01:08,399 Speaker 1: also known as hypothermia. And of course there were more 17 00:01:08,440 --> 00:01:11,759 Speaker 1: cases of hypothermia when I've worked up north, but there's 18 00:01:11,800 --> 00:01:15,600 Speaker 1: still a few every year here in Texas, particularly during 19 00:01:15,640 --> 00:01:19,160 Speaker 1: these types of winter storms, because Texas is just not 20 00:01:19,240 --> 00:01:24,000 Speaker 1: as well prepared for arctic temperatures. I thought on today's episode, 21 00:01:24,240 --> 00:01:26,720 Speaker 1: I would discuss a few of the cases I've had 22 00:01:27,200 --> 00:01:31,880 Speaker 1: and my experiences when Snowzilla comes to town. So let's 23 00:01:31,880 --> 00:01:35,960 Speaker 1: get started. A normal body temperature in people is ninety 24 00:01:35,959 --> 00:01:40,480 Speaker 1: eight degrees fahrenheit or thirty seven degrees celsius. Hypothermia occurs 25 00:01:40,480 --> 00:01:43,520 Speaker 1: when the body temperature goes below this, and this is 26 00:01:43,560 --> 00:01:46,320 Speaker 1: because the loss of heat from the body exceeds the 27 00:01:46,360 --> 00:01:49,720 Speaker 1: heat production by the body. The most common cause of 28 00:01:49,800 --> 00:01:54,360 Speaker 1: hypothermia is, of course, exposure to low environmental temperatures, but 29 00:01:54,400 --> 00:02:00,840 Speaker 1: there are other causes, including hypothyroidism, hypoglycemia, strokes, sepsis, in 30 00:02:00,880 --> 00:02:03,920 Speaker 1: a number of other things. But these cases are for 31 00:02:04,000 --> 00:02:06,680 Speaker 1: another show, and today we're only going to focus on 32 00:02:06,800 --> 00:02:10,920 Speaker 1: cases caused by cold weather. The cases of hypothermia that 33 00:02:10,960 --> 00:02:14,200 Speaker 1: come into a medical examiner's office range from, of course, 34 00:02:14,240 --> 00:02:18,520 Speaker 1: the unsheltered, homeless people, elderly people in homes without power, 35 00:02:18,800 --> 00:02:21,600 Speaker 1: the demented or mentally ill that wander away from their 36 00:02:21,600 --> 00:02:25,239 Speaker 1: care facility in the dead of winter, alcoholics that pass 37 00:02:25,280 --> 00:02:28,040 Speaker 1: out on a snowy night and go to sleep outside 38 00:02:28,600 --> 00:02:32,240 Speaker 1: or fall and sustain injuries in which they can't get 39 00:02:32,280 --> 00:02:36,080 Speaker 1: themselves out of the cold environment. Hypothermia occurs, of course, 40 00:02:36,160 --> 00:02:40,000 Speaker 1: on land, which is also known as dry hypothermia, and 41 00:02:40,360 --> 00:02:43,959 Speaker 1: in water, which is known as wet or immersion hypothermia. 42 00:02:44,840 --> 00:02:47,440 Speaker 1: In my career, the majority of the hypothermic cases I 43 00:02:47,440 --> 00:02:50,000 Speaker 1: have dealt with have been on land, with a few 44 00:02:50,120 --> 00:02:54,480 Speaker 1: coming from the frigid water. People dying of immersion hypothermia 45 00:02:54,760 --> 00:02:59,480 Speaker 1: generally die quickly or suffer from acute hypothermia because of 46 00:02:59,520 --> 00:03:02,400 Speaker 1: the intent its cold stress caused by falling into the 47 00:03:02,400 --> 00:03:05,520 Speaker 1: freezing water. One of the cases I had of immersion 48 00:03:05,600 --> 00:03:08,680 Speaker 1: hypothermia was an individual trying to fix the gears on 49 00:03:08,720 --> 00:03:11,799 Speaker 1: a bascule bridge during winter. If you don't know what 50 00:03:11,800 --> 00:03:14,400 Speaker 1: this type of bridge is, it's one that lifts up 51 00:03:14,400 --> 00:03:17,639 Speaker 1: and lets river traffic through. He and a coworker were 52 00:03:17,680 --> 00:03:20,560 Speaker 1: working on the stuck mechanism, and at some point both 53 00:03:20,560 --> 00:03:23,919 Speaker 1: of them slipped and were caught by their harnesses. Other 54 00:03:24,000 --> 00:03:27,680 Speaker 1: coworkers called for help. As time passed, one of the 55 00:03:27,760 --> 00:03:32,520 Speaker 1: workers became frustrated dangling high above the river and slipped 56 00:03:32,520 --> 00:03:35,000 Speaker 1: out of his safety harness and fell into the river. 57 00:03:35,760 --> 00:03:38,400 Speaker 1: He thought he could just fall into the river and 58 00:03:38,480 --> 00:03:41,440 Speaker 1: swim to the shore and be okay, but he didn't 59 00:03:41,480 --> 00:03:44,360 Speaker 1: account for the fact that the water was near freezing 60 00:03:44,960 --> 00:03:47,960 Speaker 1: and he was an insulated gear. When he hit the water, 61 00:03:48,040 --> 00:03:50,280 Speaker 1: he was seen struggling for a brief period of time 62 00:03:50,400 --> 00:03:54,160 Speaker 1: and then slowly stopped moving, slipping under the water, all 63 00:03:54,200 --> 00:03:57,680 Speaker 1: while his coworker watched in horror. The co worker was 64 00:03:57,720 --> 00:04:01,040 Speaker 1: subsequently rescued by the way. A little later on, when 65 00:04:01,040 --> 00:04:04,240 Speaker 1: this individual came into the medical examiner's office for autopsy, 66 00:04:04,800 --> 00:04:06,960 Speaker 1: the first thing I had to do was remove all 67 00:04:07,040 --> 00:04:09,560 Speaker 1: his gear, and once I got it off his body, 68 00:04:09,600 --> 00:04:12,160 Speaker 1: I decided to weigh it, and it weighed over one 69 00:04:12,200 --> 00:04:15,240 Speaker 1: hundred and twenty pounds due to all the water that 70 00:04:15,280 --> 00:04:18,320 Speaker 1: had seeped into the clothing. With that and the fact 71 00:04:18,360 --> 00:04:20,960 Speaker 1: that he was in freezing cold water, he didn't have 72 00:04:21,040 --> 00:04:25,080 Speaker 1: a chance. He died from drowning, but I also contributed 73 00:04:25,360 --> 00:04:29,159 Speaker 1: hypothermia to the cause of death. Cold water conducts heat 74 00:04:29,279 --> 00:04:32,560 Speaker 1: twenty to twenty five times faster than dry air, so 75 00:04:32,680 --> 00:04:34,919 Speaker 1: you will die quicker in cold water than you would 76 00:04:34,960 --> 00:04:38,520 Speaker 1: on land. Factors that can affect your survival time can 77 00:04:38,560 --> 00:04:42,080 Speaker 1: be dependent on your nutritional status, type of clothing you're wearing, 78 00:04:42,240 --> 00:04:45,240 Speaker 1: and of course the temperature of the water. If you 79 00:04:45,320 --> 00:04:49,440 Speaker 1: fell into thirty two degrees fahrenheit water or zero degrees celsius, 80 00:04:49,760 --> 00:04:53,440 Speaker 1: which is almost freezing. You will probably lose consciousness in 81 00:04:53,520 --> 00:04:56,760 Speaker 1: less than fifteen minutes, with a survival time range of 82 00:04:56,800 --> 00:04:59,720 Speaker 1: fifteen to forty five minutes. Those who die at the 83 00:04:59,760 --> 00:05:02,920 Speaker 1: shore or time interval. It is often because of the 84 00:05:02,920 --> 00:05:06,280 Speaker 1: production of irregular heart beats or arrhythmius caused by the 85 00:05:06,279 --> 00:05:10,720 Speaker 1: bodies sudden baso constriction of the blood vessels, and reflex 86 00:05:10,760 --> 00:05:14,400 Speaker 1: stimulation of the heart due to hitting that sudden cold water, 87 00:05:14,800 --> 00:05:17,320 Speaker 1: which is a little different than dry hypothermia, where the 88 00:05:17,360 --> 00:05:23,480 Speaker 1: cold temperatures slowly cool you down. Clinically, hypothermia starts when 89 00:05:23,520 --> 00:05:27,400 Speaker 1: the body temperature drops below ninety five degrees fahrenheite or 90 00:05:27,440 --> 00:05:31,599 Speaker 1: thirty five degrees celsius from ninety five to ninety degrees 91 00:05:31,600 --> 00:05:34,839 Speaker 1: fahrenheit or thirty five to thirty two degrees celsius. You 92 00:05:34,920 --> 00:05:38,440 Speaker 1: start shivering, which is the body's involuntary contraction of muscles 93 00:05:38,440 --> 00:05:42,200 Speaker 1: to help produce heat. You get impaired judgment, slight loss 94 00:05:42,200 --> 00:05:45,840 Speaker 1: of coordination, and internally, the heart rate goes up in 95 00:05:45,880 --> 00:05:49,200 Speaker 1: an attempt to increase pumping of warm blood throughout the body. 96 00:05:49,880 --> 00:05:52,680 Speaker 1: The vessels vasa constrict to shunt blood away from the 97 00:05:52,720 --> 00:05:56,280 Speaker 1: skin and towards the core, reducing heat loss. Alcohol can 98 00:05:56,279 --> 00:05:58,800 Speaker 1: affect this part of the process by causing the vessels 99 00:05:58,800 --> 00:06:02,560 Speaker 1: not to constrict but to dilate, which makes alcoholics lose 100 00:06:02,600 --> 00:06:06,559 Speaker 1: heat faster. There is increased mucous production during this time, 101 00:06:06,640 --> 00:06:09,520 Speaker 1: which causes a very runny nose. This is because the 102 00:06:09,560 --> 00:06:13,279 Speaker 1: nose works to warm and humidify cold, dry air before 103 00:06:13,279 --> 00:06:17,560 Speaker 1: it reaches the lungs. This, along with the condensation formed 104 00:06:17,560 --> 00:06:21,719 Speaker 1: inside nasal passages, causes the nasal glands to produce excess 105 00:06:21,839 --> 00:06:26,280 Speaker 1: mucus to protect the lining. At the moderate level of hypothermia, 106 00:06:26,320 --> 00:06:30,200 Speaker 1: the body temperatures between ninety and ninety two degrees fahrenheit 107 00:06:30,360 --> 00:06:34,040 Speaker 1: or thirty two and twenty eight degrees celsius. At this point, 108 00:06:34,200 --> 00:06:39,159 Speaker 1: the brain's temperature regulation begins to fail. Shivering ceases because 109 00:06:39,160 --> 00:06:42,520 Speaker 1: the body has run out of energy reserves and muscles 110 00:06:42,560 --> 00:06:46,320 Speaker 1: are too cold to contract. The body shunts blood only 111 00:06:46,360 --> 00:06:50,120 Speaker 1: to the core, abandoning the extremities, and this causes the 112 00:06:50,200 --> 00:06:54,680 Speaker 1: kidneys to filter more fluid, resulting in excess urination. There 113 00:06:54,720 --> 00:07:00,280 Speaker 1: is confusion hallucinations in delirium along with slurred speech, and 114 00:07:00,320 --> 00:07:03,919 Speaker 1: you also have paradoxical undressing, which I will explain later. 115 00:07:04,440 --> 00:07:07,840 Speaker 1: Your heart rate slows, your blood pressure drops, and your 116 00:07:07,880 --> 00:07:12,040 Speaker 1: heart begins to beat irregularly, and breathing slows. At the 117 00:07:12,120 --> 00:07:15,720 Speaker 1: severe level, the body temperature is between eighty two and 118 00:07:15,760 --> 00:07:19,160 Speaker 1: seventy five degrees fahrenheit or twenty eight and twenty four 119 00:07:19,200 --> 00:07:23,160 Speaker 1: degrees celsius. You're unconscious at this point, but with a 120 00:07:23,240 --> 00:07:28,480 Speaker 1: pulse you're essentially in a coma. No reflexes, fixed dilated pupils. 121 00:07:28,560 --> 00:07:33,040 Speaker 1: The heart's electrical signals are disrupted, causing slow, irregular heart beats. 122 00:07:33,440 --> 00:07:35,720 Speaker 1: The heart is no longer pumping blood enough to meet 123 00:07:35,720 --> 00:07:39,520 Speaker 1: the body's demands. The lungs fill with fluid, and breathing 124 00:07:39,560 --> 00:07:43,960 Speaker 1: becomes slow, labored, with gasping breasts. At less than seventy 125 00:07:43,960 --> 00:07:48,119 Speaker 1: five degrees fahrenheit or twenty four degrees celsius, you appear dead, 126 00:07:48,400 --> 00:07:52,320 Speaker 1: pulseless with no breathing. At this point, you can be saved, 127 00:07:52,560 --> 00:07:56,320 Speaker 1: but it's unlikely, and after this you of course die. 128 00:07:56,960 --> 00:08:02,920 Speaker 1: Wo There was one case I had of an elderly 129 00:08:03,000 --> 00:08:06,000 Speaker 1: woman whose electricity and gas were shut off due to 130 00:08:06,040 --> 00:08:08,800 Speaker 1: non payment of bills. During the coldest few days of 131 00:08:08,840 --> 00:08:11,760 Speaker 1: the year. The temperature in the house had plummeted and 132 00:08:11,800 --> 00:08:14,960 Speaker 1: her house was poorly insulated. She had areas of the 133 00:08:14,960 --> 00:08:17,760 Speaker 1: house where there were gaps letting in cold air. She 134 00:08:17,840 --> 00:08:21,679 Speaker 1: attempted to plug these with plastic grocery sacks, and also 135 00:08:21,800 --> 00:08:24,640 Speaker 1: she had been putting plastic grocery sacks in between the 136 00:08:24,720 --> 00:08:28,360 Speaker 1: walls to act as insulation because the house had no 137 00:08:28,520 --> 00:08:32,240 Speaker 1: real insulation. No one had seen her for over a week, 138 00:08:32,400 --> 00:08:35,360 Speaker 1: and eventually a well being check was performed by police. 139 00:08:35,760 --> 00:08:39,200 Speaker 1: When police entered her home, her attempt at insulating with 140 00:08:39,320 --> 00:08:43,040 Speaker 1: grocery sacks had failed. The inside of the house was freezing. 141 00:08:43,880 --> 00:08:47,520 Speaker 1: The house was also in disarray, but not like a 142 00:08:47,679 --> 00:08:51,000 Speaker 1: order home. There was instead a night stand tipped over, 143 00:08:51,480 --> 00:08:55,040 Speaker 1: books and clothes piled on a couch and strewn about 144 00:08:55,040 --> 00:08:59,480 Speaker 1: the house. They found her body naked and burrowed underneath 145 00:08:59,480 --> 00:09:03,320 Speaker 1: her couch, with multiple items of clothing laying on top 146 00:09:03,360 --> 00:09:06,839 Speaker 1: of her. There was initial concern of foul play because 147 00:09:06,840 --> 00:09:10,160 Speaker 1: of how she was found, but what had happened was 148 00:09:10,360 --> 00:09:13,720 Speaker 1: she was exhibiting the findings that occur in hypothermia cases, 149 00:09:14,240 --> 00:09:19,200 Speaker 1: and these are paradoxical undressing, hide and die behavior, which 150 00:09:19,240 --> 00:09:24,080 Speaker 1: is also known as terminal burrowing. Paradoxical undressing and hide 151 00:09:24,160 --> 00:09:27,839 Speaker 1: and die behavior are not present in every case of hypothermia, 152 00:09:28,240 --> 00:09:32,959 Speaker 1: but occur in fairly large percentages. Paradoxical undressing occurs when 153 00:09:32,960 --> 00:09:37,240 Speaker 1: the individual is suffering from extreme confusion and disorientation coupled 154 00:09:37,280 --> 00:09:41,080 Speaker 1: with the muscles of the blood vessels becoming exhausted, which 155 00:09:41,160 --> 00:09:46,960 Speaker 1: causes the vasoconstriction to fail, resulting in widespread vasodilation. This 156 00:09:47,120 --> 00:09:49,880 Speaker 1: causes a surge of warm blood from the core to 157 00:09:49,920 --> 00:09:53,959 Speaker 1: be circulated everywhere, resulting in a hot flash. The confused 158 00:09:53,960 --> 00:09:57,400 Speaker 1: brain thinks the person is burning up and solves this 159 00:09:57,559 --> 00:10:01,560 Speaker 1: problem by removing all the clothing, making the individual naked, 160 00:10:01,920 --> 00:10:04,880 Speaker 1: and this is often associated with the hide in die 161 00:10:05,000 --> 00:10:09,319 Speaker 1: syndrome or terminal burrowing. With this behavior, people have been 162 00:10:09,360 --> 00:10:14,400 Speaker 1: found burrowed into cabinets, pantries, under shelves with pulled down furniture, books, 163 00:10:14,400 --> 00:10:16,760 Speaker 1: and clothes on top of them. The reason for this 164 00:10:16,880 --> 00:10:20,160 Speaker 1: behavior is a primal response by the brain stem that 165 00:10:20,280 --> 00:10:24,600 Speaker 1: causes the individual to seek small, confined spaces for protection, 166 00:10:25,200 --> 00:10:29,000 Speaker 1: similar to hibernating animals. When this decedent was brought into 167 00:10:29,040 --> 00:10:33,040 Speaker 1: the medical examiner's office, she showed the typical autopsy findings 168 00:10:33,040 --> 00:10:36,440 Speaker 1: of hypothermia and nothing else, so her cause of death 169 00:10:36,520 --> 00:10:40,120 Speaker 1: was hypothermia. Again, but before we go into the autopsy findings, 170 00:10:40,200 --> 00:10:43,679 Speaker 1: I want to discuss another complication of hypothermia, and that 171 00:10:43,840 --> 00:10:47,400 Speaker 1: is the frozen body. And my example of this was 172 00:10:47,440 --> 00:10:49,800 Speaker 1: a case of a young man in his twenties. He 173 00:10:49,920 --> 00:10:53,199 Speaker 1: was found dead by railroad workers in an open topped 174 00:10:53,440 --> 00:10:57,920 Speaker 1: railroad car at the Union Pacific Railroad yard in Chicago. 175 00:10:58,600 --> 00:11:00,920 Speaker 1: It was early February and two thousand and four and 176 00:11:01,000 --> 00:11:03,959 Speaker 1: the temperature had been as low as six degrees fahrenheit 177 00:11:04,400 --> 00:11:09,079 Speaker 1: with associated snow, ice and freezing fog. When the deceitent 178 00:11:09,200 --> 00:11:11,680 Speaker 1: was found in the railroad car. He was dressed for 179 00:11:11,720 --> 00:11:17,120 Speaker 1: winter thermal beanie insulated jacket, two shirts in thick pants 180 00:11:17,480 --> 00:11:20,560 Speaker 1: as well as boots. He also had with him a 181 00:11:20,600 --> 00:11:23,920 Speaker 1: red mountain bike. It was believed he might have been 182 00:11:23,960 --> 00:11:27,160 Speaker 1: trying to get somewhere by jumping on the train and 183 00:11:27,200 --> 00:11:30,840 Speaker 1: then getting off later to go biking. He had no identification, 184 00:11:31,160 --> 00:11:34,240 Speaker 1: so who knows where he had come from. They tried 185 00:11:34,320 --> 00:11:39,040 Speaker 1: fingerprinting him, but no prints matched anything where he came from. 186 00:11:39,160 --> 00:11:42,679 Speaker 1: Who knows who he was? Who knows? I don't think 187 00:11:42,679 --> 00:11:46,200 Speaker 1: he was actually ever identified and in a few days, 188 00:11:46,280 --> 00:11:49,360 Speaker 1: that case will be nearly twenty two years old. At 189 00:11:49,360 --> 00:11:51,959 Speaker 1: the scene, there was no signs of foul play. Law 190 00:11:52,040 --> 00:11:54,480 Speaker 1: enforcement felt it looked like he had just laid down 191 00:11:54,480 --> 00:11:57,800 Speaker 1: and went to sleep after getting on the train. On 192 00:11:57,840 --> 00:12:00,520 Speaker 1: the day I performed his autopsy, I got the body 193 00:12:00,520 --> 00:12:02,440 Speaker 1: out of the cooler, and when I opened the body 194 00:12:02,440 --> 00:12:06,000 Speaker 1: bag to evaluate him, I found he was frozen hard. 195 00:12:06,520 --> 00:12:08,760 Speaker 1: The thing about it is the average adult body is 196 00:12:08,800 --> 00:12:11,200 Speaker 1: made up of about sixty percent water, and when a 197 00:12:11,240 --> 00:12:14,400 Speaker 1: body is left in freezing conditions, it will freeze as 198 00:12:14,480 --> 00:12:17,760 Speaker 1: solid as a rock. You can't even cut into their 199 00:12:17,800 --> 00:12:20,760 Speaker 1: skin with a scalpel blade because it is so hard. 200 00:12:21,360 --> 00:12:23,920 Speaker 1: So what do we do in this situation, Well, it's 201 00:12:23,960 --> 00:12:26,559 Speaker 1: like taking a frozen turkey out. You let them thaw. 202 00:12:27,400 --> 00:12:29,880 Speaker 1: This can be done at room temperature, which takes a 203 00:12:29,920 --> 00:12:33,320 Speaker 1: long period of time. But in Chicago, what we did 204 00:12:33,440 --> 00:12:35,960 Speaker 1: was we put them under warming lights or heat lights, 205 00:12:36,440 --> 00:12:39,640 Speaker 1: or is the autopsy text like to call them fry lights. 206 00:12:39,800 --> 00:12:42,520 Speaker 1: You don't want to warm the body too fast because 207 00:12:42,559 --> 00:12:45,680 Speaker 1: it can create artifacts, So you place the body under 208 00:12:45,720 --> 00:12:48,640 Speaker 1: these lights and every day you go check to see 209 00:12:48,679 --> 00:12:51,280 Speaker 1: if they had thought enough to be autopsied. You would 210 00:12:51,280 --> 00:12:54,080 Speaker 1: do this by poking them in the abdomen. What's your finger? 211 00:12:54,640 --> 00:12:57,600 Speaker 1: I know, real scientific, right, And when you poke the 212 00:12:57,640 --> 00:13:01,200 Speaker 1: abdomen if it feels like poking plato. They were warm 213 00:13:01,320 --> 00:13:04,240 Speaker 1: enough to autopsy, and that's what I did with this case. 214 00:13:04,920 --> 00:13:07,800 Speaker 1: Once he was thought out enough, we did the autopsy. 215 00:13:08,200 --> 00:13:11,440 Speaker 1: And cutting into these thought bodies is always difficult. The 216 00:13:11,559 --> 00:13:15,199 Speaker 1: skin and muscle can still be somewhat frozen and less pliable, 217 00:13:15,600 --> 00:13:18,800 Speaker 1: which makes it more difficult to separate. The organs can 218 00:13:18,840 --> 00:13:21,760 Speaker 1: still be stiff and frozen and hard to cut through, 219 00:13:22,080 --> 00:13:25,000 Speaker 1: and the blood and other bodily fluids are semi solid 220 00:13:25,040 --> 00:13:28,280 Speaker 1: to ice crystals. Everything is cold and it makes your 221 00:13:28,320 --> 00:13:32,240 Speaker 1: hands hurt. I typically have warm water running to combat this, 222 00:13:32,880 --> 00:13:35,439 Speaker 1: but not too hot. One time I had the water 223 00:13:35,520 --> 00:13:37,960 Speaker 1: too hot and cooked all the organs that I had 224 00:13:38,000 --> 00:13:40,480 Speaker 1: out in a pan, making them all a kind of 225 00:13:40,559 --> 00:13:44,480 Speaker 1: dull gray color. Plus it gave off an auto odor 226 00:13:44,920 --> 00:13:49,320 Speaker 1: best described as hot dog vomit with a twist of iron. 227 00:13:50,080 --> 00:13:54,120 Speaker 1: I only did that once in this particular case. He 228 00:13:54,200 --> 00:13:57,920 Speaker 1: had again the typical findings associated with hypothermia and no 229 00:13:58,040 --> 00:14:01,360 Speaker 1: other signs of injury or medical condition, so as cause 230 00:14:01,400 --> 00:14:05,840 Speaker 1: of death was made hypothermia manner of death accident. Determining 231 00:14:05,880 --> 00:14:09,839 Speaker 1: the cause of death of hypothermia autopsy can be difficult 232 00:14:10,040 --> 00:14:13,160 Speaker 1: because there are no definitive findings a point only to 233 00:14:13,280 --> 00:14:16,720 Speaker 1: a diagnosis of hypothermia. All of the findings can be 234 00:14:16,760 --> 00:14:19,720 Speaker 1: found in other conditions. But when you get a combination 235 00:14:19,840 --> 00:14:22,760 Speaker 1: of these findings along with the scene findings and especially 236 00:14:22,800 --> 00:14:27,360 Speaker 1: a body temperature, you can determine hypothermia quite easily. And 237 00:14:27,440 --> 00:14:30,080 Speaker 1: there are a triad of findings that are usually found 238 00:14:30,520 --> 00:14:34,440 Speaker 1: that traditionally point to a diagnosis of hypothermia, and these 239 00:14:34,480 --> 00:14:39,560 Speaker 1: are Wishnooski's ulcers, frost airthema, and hemorrhage in the muscles, 240 00:14:39,760 --> 00:14:44,680 Speaker 1: particularly the iliosoas muscle. Let's go through the findings of 241 00:14:44,720 --> 00:14:47,760 Speaker 1: the triad as well as other findings. The one most 242 00:14:47,760 --> 00:14:52,400 Speaker 1: people agree is associated with hypothermia is called Woshnowski's ulcers 243 00:14:52,600 --> 00:14:56,000 Speaker 1: or spots. These spots were found by a Russian doctor 244 00:14:56,080 --> 00:14:59,280 Speaker 1: by the name of S. M. Wushnouski, who in eighteen 245 00:14:59,360 --> 00:15:03,640 Speaker 1: ninety five describe these dark brown or black gastric mecosal 246 00:15:03,720 --> 00:15:07,840 Speaker 1: lesions in association with cold exposure. They have been described 247 00:15:07,840 --> 00:15:10,800 Speaker 1: as altars, but are really more hemorrhagic areas than the 248 00:15:10,800 --> 00:15:14,920 Speaker 1: gastric mecosa that vary in size from about a millimeter 249 00:15:15,040 --> 00:15:18,800 Speaker 1: to two centimeters in diameter, and sometimes you can have 250 00:15:18,880 --> 00:15:22,320 Speaker 1: a few of them to hundreds, making the mecosa surface 251 00:15:22,320 --> 00:15:25,520 Speaker 1: of the stomach look like a leopard's pelt. They vary 252 00:15:25,560 --> 00:15:29,560 Speaker 1: in presence in hypothermia cases. In the literature, it's said 253 00:15:29,600 --> 00:15:31,720 Speaker 1: that it occurs in about forty to one hundred percent 254 00:15:31,760 --> 00:15:35,680 Speaker 1: of cases. They're not ulcerations and they're not erosions, but 255 00:15:35,760 --> 00:15:39,600 Speaker 1: they're believed to be possibly hemorrhages of the gastric glands 256 00:15:39,640 --> 00:15:42,320 Speaker 1: in the lining of the stomach, but this is also 257 00:15:42,400 --> 00:15:46,320 Speaker 1: not one hundred percent certain. Wishnuski's spots can also be 258 00:15:46,400 --> 00:15:51,920 Speaker 1: seen in numerous other conditions, including diabetic chutoacidosis, fatal burns, 259 00:15:51,960 --> 00:15:56,840 Speaker 1: and methanol and ethylene glycol poisoning, so they aren't specific 260 00:15:56,880 --> 00:16:01,600 Speaker 1: to hypothermia. The next finding is frost to arithema, which 261 00:16:01,680 --> 00:16:05,920 Speaker 1: was first described by a German naturalist named Wilhelm Keferstein. 262 00:16:06,400 --> 00:16:10,120 Speaker 1: Frost arethema are reddish to purple to violet or brownish 263 00:16:10,160 --> 00:16:14,000 Speaker 1: areas of skin discoloration that are found located over extensive 264 00:16:14,040 --> 00:16:18,320 Speaker 1: surfaces of large joints, usually like the elbows or knees. 265 00:16:19,160 --> 00:16:21,840 Speaker 1: Typically we see them most in the knees, so it 266 00:16:21,880 --> 00:16:26,280 Speaker 1: can be called the red knees of hypothermia. Lividity can 267 00:16:26,360 --> 00:16:29,040 Speaker 1: also be bright red or pink in coloration, but this 268 00:16:29,160 --> 00:16:32,840 Speaker 1: isn't specific to hypothermia. Other conditions that you may see 269 00:16:32,880 --> 00:16:38,120 Speaker 1: this in is carbon monoxide toxicity in exposure to cyanide. Also, 270 00:16:38,160 --> 00:16:40,280 Speaker 1: if a body's been left in the cooler too long, 271 00:16:40,360 --> 00:16:43,760 Speaker 1: they'll take this pink coloration on, so again it's not 272 00:16:43,880 --> 00:16:48,440 Speaker 1: very specific for hypothermia. The pancreas can be hemorrhagic, which 273 00:16:48,520 --> 00:16:52,040 Speaker 1: was traditionally thought to be part of cold exposure, but 274 00:16:52,160 --> 00:16:54,600 Speaker 1: in recent literature this has been ruled out as a 275 00:16:54,640 --> 00:16:58,880 Speaker 1: diagnostic criteria because it occurs in other conditions, and some 276 00:16:58,960 --> 00:17:03,240 Speaker 1: believe the person may have had hemorrhagic pancreatitis and just 277 00:17:03,360 --> 00:17:06,160 Speaker 1: happen to be in a cold environment, so it's difficult 278 00:17:06,160 --> 00:17:09,600 Speaker 1: to say. The last part of the triad is hemorrhage 279 00:17:09,720 --> 00:17:14,040 Speaker 1: or bleeding in the skeletal muscle, particularly the iliosoas muscle, 280 00:17:14,359 --> 00:17:18,000 Speaker 1: which is located in your lower back. It's postulated that 281 00:17:18,040 --> 00:17:24,120 Speaker 1: these hemorrhages are associated with intense shivering. Associated with hypothermia. Microscopically, 282 00:17:24,480 --> 00:17:27,000 Speaker 1: there can be a number of specific findings as well, 283 00:17:27,320 --> 00:17:30,840 Speaker 1: depletion of the liver's glycogen, fatty degeneration of the renal 284 00:17:30,960 --> 00:17:35,800 Speaker 1: tubular epithelium, various areas of hemorrhage and necrosis of the pancreas, 285 00:17:36,240 --> 00:17:40,000 Speaker 1: as well as hypoxic and fatty changes of the cardiac myocytes. 286 00:17:40,480 --> 00:17:44,520 Speaker 1: There's also reports of postmaron biochemistry where there's been findings 287 00:17:44,520 --> 00:17:49,080 Speaker 1: of alterations in the blood ketones, corhizol, free fatty acids, 288 00:17:49,480 --> 00:17:52,840 Speaker 1: as well as urine catecholamines, but I have never actually 289 00:17:52,920 --> 00:17:57,080 Speaker 1: run those tests, so I won't comment on those further. Ultimately, 290 00:17:57,119 --> 00:17:59,760 Speaker 1: there are several findings that can be found and in 291 00:17:59,760 --> 00:18:02,480 Speaker 1: the setting of an individual found in a cold environment 292 00:18:02,600 --> 00:18:08,040 Speaker 1: with paradoxical undressing, cold body temperature, findings of Kushnouski's ulcers, 293 00:18:08,080 --> 00:18:11,080 Speaker 1: red knees, as well as hemorrhages and musculature all can 294 00:18:11,119 --> 00:18:16,120 Speaker 1: point to hypothermia. Inclosing, hypothermia is a complex cause of death, 295 00:18:16,520 --> 00:18:20,960 Speaker 1: determined with clinical investigative findings and a combination of autopsy 296 00:18:21,000 --> 00:18:25,280 Speaker 1: and laboratory findings. All these combined can give you the 297 00:18:25,320 --> 00:18:29,400 Speaker 1: final answer. And I just want to say winter weather 298 00:18:29,480 --> 00:18:32,240 Speaker 1: can be fun, or remember to take a break and 299 00:18:32,320 --> 00:18:37,439 Speaker 1: warm up, and that brings us to the end of 300 00:18:37,440 --> 00:18:41,160 Speaker 1: the episode. I hope you learned something and I hope 301 00:18:41,160 --> 00:18:44,120 Speaker 1: you were entertained until the next time.