Autopsy Findings

In all cases of high-voltage electrocution but in only about half (50%) the cases of low-voltage electrocution, electrical burns will appear on the body. In low-voltage electrocution, these may occur at the point of entry or the point of exit, at both, or at neither. If the current enters over a broad surface area that offers minimal resistance, there may be no electrical burn. The best example of this is an individual electrocuted in a bathtub. Absence of burns in low-voltage electrocutions, however, can occur with only a small area of contact. Electrocution can produce accelerated onset of rigor mortis caused by the muscle contractions and depletion of ATP. If this does occur, it may be eccentric, reflecting the passage of the current through the body.

Electrical burns tend to be on the palms of the hands and tips of the fingers (entry sites) and soles of the feet (exit sites) (Figure 16.1). In low-voltage electrocutions, they may appear as either an erythematous area of blistering or as an irregular chalky white lesion, often with raised borders and a central crater. There may be some yellowish or black discoloration of the burn sites caused by heat. Generally, the burns are small in size, from a few millimeters up to 1-1.5 cm. Microscopically, the epidermis shows a Swiss cheese appearance. If there is only brief contact with a live wire, there may be no burns. The person may collapse from ventricular fibrillation and fall away from the wire. When there is prolonged contact, there will be severe burns caused by the heat generated by the electrical current. One cannot differentiate antemortem from postmortem electrical burns. The burns indicate only that current has passed through the skin. Minute particles of metal from the conducting surface may be deposited in the burns, especially in high-voltage electrocutions. These can be located and identified by scanning electron microscopy.

In contrast to low-voltage burns, high-voltage burns may be extremely severe, with charring of the body. If the burns occur from contact or proximity to a high-voltage line, numerous individual and confluent areas of third-degree burns will present (Figure 16.2). The multiple small burns are caused by arcing of the current. If the contact with the high-voltage current is not direct, but through current running through an intermediary object such as a ladder or pole, the burns are large and irregular, chalky white in

Figure 16.1 (A and B) Electrical burns of hands representing points of entry.

(continued).

Figure 16.1 (A and B) Electrical burns of hands representing points of entry.

(continued).

color, often with raised borders and a central crater with yellowish or black discoloration of the burn sites caused by heat. If the individual is wearing shoes, and the exit site is a foot, there may be arcing exit burns. With very high voltage, there can be massive destruction of tissue with loss of extremities and rupture of organs.

In all cases of suspected electrocution, there should be an examination of the alleged source of the electrical current including electrical devices the individual was handling at the time of death. In low-voltage electrocutions, examination of the device rather than examination of the body will often provide the cause of death, because burns may not be present. Thus, one can make a diagnosis of electrocution without an electrical burn, based on the circumstances of the death, negative autopsy findings and the examination

Figure 16.1 (continued) (C and D) Electrical burns of feet representing exit sites

of the electrical device in use. In high-voltage electrocution, tissue from the victim may be adherent at the point of contact with the source of the current (e.g., a metal ladder).

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