Forensic Pathology Case Studies


CASE 8: Vehicular accident with blunt trauma


Clinical History:

A 19-year-old man was involved in a high-speed chase. He was driving a stolen vehicle and was pursued by highway patrol officers. After 5 miles, he lost control of his vehicle, striking another vehicle nearly head-on. Paramedics arrived on the scene and had to extricate him from the vehicle. He had no blood pressure and a barely palpable pulse. He died at the scene despite resuscitative measures. The driver of the car he struck (who was wearing a seat belt and whose auto had an airbag) was taken to UUMC and was in stable condition with only minor contusions.

Image 8.1:

The accident scene is depicted here. The deceased driver's auto is represented by the dark blue car. The dark blue car is at fault.

Image 8.2:

The actual auto from which he was extricated is shown here. Note the extensive damage to the driver's side.

Image 8.3:

At autopsy, the chest is opened to reveal hemorrhage. This is extensive blunt force trauma with hemorrhage.

Image 8.4:

This is the aorta. Note the transverse laceration.

Image 8.5:

Postmortem toxicology results are shown here. The ethanol is well over the legal limit and at a high enough level to cause impairment of driving ability.

Questions:

  1. What is the name of the process shown in image 8.3?

    2. This is hemopericardium, which can produce a cardiac tamponade.

  2. If more than one person were in the car in a fatal collision, how can the medical examiner determine which one was the driver?

    3. The pattern of injuries might suggest which person was the driver (e.g., steering wheel injury).

  3. What public policy measures can affect death rates from vehicular accidents?

    4. Seat belt laws that are enforced. The number of vehicular accident deaths in some places is higher because of the difference in the seat belt laws (and for motorcycle and bicycle helmets). Is it worth it? If you support stronger public health laws, that is definitely an example of what some would consider justifiable but paternalistic uses of the law (though others would argue that it too paternalistic and not justifiable).