Mechanisms of Death

Stab and incised wounds are "low-velocity" injuries, and the consequences are usually limited to the direct effects of a discrete wound track. Wound tracks require exploration to determine the cause of death based on the location of the wound and associated bleeding, i.e., quantitation of blood in cavities. Mechanisms of death include:

• Shock owing to exsanguination.

• Air embolism (when neck structures are involved; see Subheading 12.1; Chapter 5, Subheading 14.8.; and refs. 11, 73, and 129).

• Asphyxia from aspirated blood (e.g., injury to lung, trachea or vertebral artery [Fig. 35; refs. 15,19]).

• Cardiac tamponade.

• Hemo- and/or pneumothorax.

• Brain and spinal cord injury (Fig. 14; refs. 9, 11, 31, 32, 90, 133, and 134).

• Delayed complications—marked hypotension during the immediate postoperative period; various postoperative complications including pulmonary embolism, pneumonia, wound sepsis (Fig. 17), rebleed, and cardiac ischemia (73); meningitis from skull wound (119).

Fig. 35. Stab wounds of neck. Trachea opened at autopsy. Lumen filled with blood.

Pathologists must be aware of the immediate and proximate causes of death in these cases (see Chapter 1, Heading 11).

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