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Hazem Ali
ELECTROCUTION
Hazem Ali
SOURCE
Low-Voltage Lines (Domestic): varies from country to country
USA: 110 120 V, 60 Hz cycles per second (AC)
Egypt, Europe: 220 240 V, 50 Hz (AC)

High-Voltage Lines
1ry distribution power lines: up to 20,000 V
High tension power lines (towers): up to 100,000 V

Industrial:
Very high voltage: up to 400,000 V

Natural:
Lightning
SOURCE
Direct current (DC):
Flows constantly in the same direction
Less commonly used (some industries)

Alternating current (AC):

reverses its direction at regular intervals
Commonly used in household devices

Why AC is more dangerous than DC?

More commonly used (more accidents)
More risk for muscle spasm hold-on and cardiac arrhythmia
The danger to the body exists when the rate lies between 40 and 150 Hz
cycles per second
An increase/decrease in rate above/below this range decreases the danger.
E.g. at 1720 cps the heart is 20 times less likely to fibrillate than at 150 cps
PHYSICS

(I) amount of current flow

(V) electromotive force
(R) resistance to the conduction of electricity
PHYSICS
Amperage (Current):
The actual amount of electricity flow (number of electrons
per unit time)

Current is the most important factor in electrocution:

A current of high voltage with low amperage can be less dangerous
than one with moderate voltage but high amperage

Factors affecting amperage:

Voltage (direct relation)
Resistance of the tissue (inverse relation)
Time for which the current is flowing (affects degree of tissue damage)
PHYSICS
Amperage (Current):
Current of 1 mA tingling sensations
Current of 5 mA muscle tremors
Current of 8-20 mA muscular spasm hold-on
Current around 40 mA loss of consciousness
Current of 75-100 mA ventricular fibrillation
Current above 1 ,000 mA (1 A) cardiac arrest
In this case, the heart should start beating normally after the circuit is broken
(provided no irreversible damages occurred to the heart)
Current above 4 A is used to arrests ventricular fibrillation defibrillator
PHYSICS
Voltage (Tension):
The Force required to produce 1 ampere of intensity when
passed through a conductor having the resistance of 1 ohm

Most fatalities follow shocks from currents of 220250 V,

which is the usual range of household supply
Low voltage (below 50 V) usually non-fatal

Voltage below 500 V muscular spasm and hold-on effect

Voltage above 500 V severe muscular contractions that
throw the victim away
PHYSICS
Duration of Contact:
The longer the contact, the greater will be the damage

Low-amperage current needs longer time (i.e. minutes) to be

lethal
By respiratory muscle spasm

High-amperage current needs shorter time (i.e. seconds) to be

lethal
By ventricular fibrillation
PHYSICS
Resistance of tissues:
The major barrier to the electric current is the skin

The blood vessels in the dermis serves as a favorable medium for the
passage of current
filled with electrolyte rich fluid

Factors affecting resistance of skin:

Thickness of the keratin-covered epidermis:
palms and soles are more resistant than thin skin
Dryness of skin:
dry hands/feet can offer up to 1 million ohms of resistance
Wet skin (from sweating or external moisture) offers 1000 ohms or less
Area of contact
PHYSICS
Area of Contact of the Body:
The smaller area of contact between the skin and the electric
supply will exert more resistance than the larger area
Tip of dry finger > palm of wet hand > wet body in a bath

Passage of a current through a localized area of contact also

generate sufficient heat to burn the skin
This is why electrocution in a bathtub may occur without any external mark

The current passage through vital organs (e.g. heart, brain) is

more dangerous
Small current through the chest can be fatal; large current through extremity
alone may have limited effect
CAUSE OF DEATH
The current tends to run from the point of contact to the point of grounding,
following the shortest path, not necessarily the path of least resistance
Common entry site: hand
Common exit site: foot, other hand

1ry causes of death:

Ventricular fibrillation (most common)
Spasm of the respiratory muscles
Paralysis of the brainstem centers

2ry causes of death:

Head/Body injuries from falling from height
Complications of severe burns (high-voltage lines)
CAUSE OF DEATH
Ventricular fibrillation:
When the current passes through the thorax, from hand to hand or from hand to
leg routes
Cardiac arrest Pallor (No cyanosis)

Spasm of the respiratory muscles :

When the current passing through the thorax may lead to tetanic contraction of
the muscles of respiration
Respiratory arrest Cyanosis (congestive hypoxia)

Paralysis of the brainstem centers :

when the current passes through the head (rarely when unprotected head touch
the source)
The current can damage brainstem and leads to paralysis of cardiac and/or
respiratory centers
JUST BEFORE DEATH
It is very common for the individual receiving a fatal electric
shock to not lose consciousness immediately, but to yell
out or state that he just burned himself prior to collapse.

This is because the brain has approximately 1015 sec of

oxygen reserve, irrespective of the heart.
Thus, an individual can remain conscious for 1015 s after cessation of the
heart as a pumping organ
MANNER OF DEATH
Most common accidental

Rarely suicide

Extremely rare homicide

Some states in America judicial electric chair

SCENE INVESTIGATION
Scene investigation is the key to the diagnosis of electrocution

First step, be sure that electricity is turned off

Victim status:
Clothed/naked
Simple cloths/protective gloves or shoes
Dry/wet skin
Points of contact with the source/ground.

Clothes of the victim should also be described and preserved

properly
SCENE INVESTIGATION
Pay attention to all electrical devices, tools, machines
(especially older or poorly maintained ones)
Look for circuit defects
Look for retained skin/hair of victim

Pay attention in all work-related deaths

Electrocution is a usual suspect

Pay attention in all watery environment-related deaths

(bathtubs, swimming pools)
Even if no suspicious lesions grossly
AUTOPSY
In cases of cardiac arrest:
Pallor (no cyanosis)

In case of respiratory arrest:

Cyanosis
Visceral congestion
Petechial hemorrhages

In case of violent muscle contraction:

Accelerated onset of rigor mortis
Long bone fractures
If the individuals are grasping something, they will continue to do so.
AUTOPSY
Entry marks:
(1) Collapsed blisters:
Mechanism:
When firm contact to conductor
Generated heat splits the skin layers blister
On cooling collapse

Gross:
Usually hands, fingers
Small (few mm 1 or 2 cm)
Firm, Round oval areas
If the contact is with the long axis of the wire linear groove
Zones:
Central depression crater
Surrounded by raised edges of blanched skin
Due to arteriolar spasm by effect of electricity
Outermost intact skin may be mildly hyperemic
AUTOPSY
Entry marks:
(2) Spark nodule:
Mechanism:
When loose contact to conductor
the current spark jumps the gap between the source and the skin
melting of keratin
On cooling nodule of condensed keratin

Gross:
Usually hands, fingers
Small (few mm 1 or 2 cm)
Hard, brownish nodule
Surrounded by areola of blanched skin (due to arteriolar spasm)
AUTOPSY

contact blister and adjacent spark burn

In many electrical burns these two types are combined as a result of:
Movement of the hand or body against the conductor
Irregularity of the shape of the conductor.
AUTOPSY
The strong flexion of rigor mortis may bring the fingers down
to the palms and obscure electrical marks

So it is essential in all autopsies (when electrocution is a

possibility) to examine the flexor surface of the fingers by
forcible breaking of the rigor and even cut flexor
tendons at the wrist to release the rigor clenching of the
fingers
AUTOPSY
Exit Marks:
Usually feet

Variable in appearance but usually have some of the

features of entry marks

More tissue disruption, even skin laceration

Burns and perforations of the clothing or shoes may be

seen
AUTOPSY
So, is electric mark helpful and diagnostic? - NO
Can varies in size and shape
depending on many factors especially area of contact

Can be absent
If area of contact is large (as in deaths occurring in the bathtub)
If area of contact in hidden place (as in deaths of children holding wire in their
mouths)

Can't be differentiated from thermal burn

Can give similar gross and microscopic features
Scanning E/M can be helpful in these cases

Cant differentiate ante-mortem from post-mortem injuries

Gives the same picture (unless outside zone hyperemia)
AUTOPSY
High-voltage current
Exposure:
Direct contact
Current arcing over several centimeters without real contact

Effects:
Multiple individual and confluent burns and charring
High-voltage currents can produce extremely high temperature (up to 4000 C)
Bone fractures
Even loss of extremities or organ rupture can be seen

Crocodile skin effect:

Multiple, discrete, punched-out burns
Due to dancing of current sparks over the body
AUTOPSY
Multiple individual and confluent burn areas
Crocodile skin
HISTOPATHOLOGY
Skin:
Epidermis:
Coagulative necrosis of epidermis and corium

Separated epidermal layers from each other or from the

corium blisters

Show variable sized micro-spaces in the corium and

epidermis honeycomb appearance

Epidermis cells are flattened, elongated, with their nuclei

become horizontally stretched, streamed (especially
basal cells)
HISTOPATHOLOGY
Skin:
Dermis:
Homogenization (denaturation)
Cells of the skin appendages may show similar damage as
epidermis cells
Subcutaneous fat:
Fat cells in severe cases may appear to be cooked and display a
homogenous, golden color

ALL the previous features can be shown in thermal injuries

(non-specific)
Electron microscope and Chemical analysis can help solving these
 HISTOPATHOLOGY
Bubbly coagulation necrosis of the
epidermis

Blister formation
 HISTOPATHOLOGY

Coagulative necrosis of the epidermis, with a glassy purple/pink appearance (asterisk)

Large vacuoles (arrowhead)
The nuclei become wavy and stretched out (arrow)
 HISTOPATHOLOGY

Separation of the epidermis from the dermis ()

Microblisters, best seen in the thick stratum corneum ()

Represent channels made by escaping steam.

Dermal collagen is denatured, producing homogenous, pronounced hematoxylin staining ()

Compare it with the dermal collagen on the right side of the photo.
HISTOPATHOLOGY
Microblisters at epidermis (arrow)
Streaming of nuclei
HISTOPATHOLOGY

Microblisters in the stratum corneum

Charring of the surface (arrow).
Metal fragments from the point of skin contact
may be seen
HISTOPATHOLOGY
Heart:
Damage to Conductive system: (fatal arrhythmia)
No Pathology (common)
Waviness and fragmentation

Damage to Vascular system:

Rupture Hemorrhage
Spasm Acute infarction
Wall damage Micro-thrombi

Damage to Myocardium:
Contraction bands
Necrosis (+/- cellular reaction depending on survival time)
Hemorrhage

Again, ALL these features are non-specific

HISTOPATHOLOGY
Skeletal Muscle:
Similar to cardiac muscle damage (hemorrhage, necrosis)

Lung:
Congestion, petechial hemorrhage
Bone marrow emboli (in cases of long bone fractures)

Kidney:
Myoglobinuria from rhabdomyolysis

Brain:
Congestion, petechial hemorrhage
Axonal fragmentations
Shrinkage of neural tissue with widening of perivascular spaces

Again, ALL these features are non-specific

 LIGHTNING
Hazem Ali
PHYSICS
Benjamin Franklin (17061790) discovered that lightning flashes
were electrical discharges and not gaseous explosions

In lightning, the discharge may be:

From cloud to cloud
From cloud to the earth (through tallest object in contact with earth)

95% of lightning discharges are negative (only 5% are positive)

Lightning chooses the path of least resistance (not the shortest)

PHYSICS
The lightning characterized by:
Direct current
with 20,000 amperes
And a million volts
Over an average period of 30 microseconds

Lightning hits the victim by:

Direct hit (strike)
Indirect hit:
Side-flash: lightning hits intermediate non-metal object (e.g. tree)
arc to the victim (nearby one)
Conduction: lightning hits intermediate metal object (e.g. water pipe)
flows through it to the grounded victim (bathtub)
CAUSE OF DEATH
Damaging mechanisms:
Direct effect (strike itself)
Burns (due to generation of huge amount of heat)
Blast effect (due to rapidly expanding air by heat)
Compression effect (due to return waves of air)

Causes of death:
Brain injury: paralysis of respiratory and/or cardiac centers
Heart injury: arrest
Electro-thermal injuries: burns and its complications
Blast injuries: lacerations, fractures, and organs rupture
SCENE INVESTIGATION
Tearing, bursting or ripping of clothing or shoes
Sometimes gives a false impression of criminal assault / rape

Damage to the ground, houses, trees or animals

Metallic objects in the area may get melted, fused

Iron objects become magnetized

History of thunderstorm could help solving the difficult cases

AUTOPSY
Singing of the body hair

Surface Contact burns:

Due to molten or heated up metallic objects worn or carried by the victim
Some melted metal may be implanted into the skin

Linear burns:
Due to current passage through area of the skin offers lesser resistance
i.e. moist creases and folds of the skin

Arborescent Fern-like burns:

Unknown mechanism
Seen in 1/3 of cases
Patterned fern-like area of transient erythema over shoulders and flanks
Starts after 1 hours and Fades within 24 hours if the victim survives
AUTOPSY

Arborescent or filigree burns

AUTOPSY
Blast effect:
Severe lacerations, fractures, organs rupture

Ruptured tympanic membranes (with blood flow from external ear)

Can be misinterpreted as head trauma
 THANK YOU
Hazem Ali