In this lesson

A 75 year old man is found dead on the porch of his home. Observe the scene and think about why he collapsed and what additional testing may be needed by the medical examiner. 

Man lying face down on the steps of a wooden front porch of a house with blue siding and door. An prescription bottle is near his right hand.

  • Several dozen people in the United States every year die due to insect envenomation i.e. stings from bees, wasps, hornets, and fire ants. While most people have limited reactions (pain, raised bump, itchiness) to an insect sting, some deaths occur from hypersensitivity reactions or anaphylaxis. A hypersensitivity reaction is an allergic reaction to repeat exposure(s) of the sting. Some reactivity can occur immediately, but some reactions can be delayed by hours as the immune response builds. Anaphylaxis is a severe immune reaction in response to an exposure, resulting in swelling of the airways, shock, or even a heart arrhythmia within minutes of an exposure. Envenomation from numerous stings or bites can induce shock, hemolysis (breakdown of red blood cells), and rhabdomyolysis (break down of muscle fibers), leading to rapid multiorgan failure or cardiac arrest.

  • The lawnmower and the bags of presumed lawn clipping or other yard material suggest that the decedent may have been working outdoors for an extended period. This should make the investigator think about what conditions could have caused or contributed to the decedent’s death.

  • If this inhaler is prescribed to the decedent, why is it here? Does the decedent need it for asthma, allergen exposure, or exercise? Why did he drop it? Or is it a red herring

  • The prescription bottle belongs to the decedent and it is for nitroglycerin tablets. Some individuals with heart disease take nitroglycerin during episodes of angina (chest pain related to decreased blood flow to the heart muscle). Carrying this medication may indicate the decedent has more severe heart disease than outward appearance could indicate.

  • The decedent has access to water while doing the yardwork, but his electrolyte, urea nitrogen, and creatinine levels could provide more information regarding dehydration.

    1. Is the decedent hot or very dry (i.e. not sweating) to the touch?

    2. A liver temperature may not be an accurate reflection of the decedent’s body temperature at death. His time of death is uncertain, and prolonged exposure to a hot environment could raise the body temperature

    3. Are there signs of injury?

    4. Are there signs of insect stings, stingers, and dead or alive insects on the body?

    5. The decedent may have died due to natural disease. If there are no signs of trauma, envenomation, or if environmental contributors have been ruled out, this decedent may not need an autopsy if there is enough medical history to indicate the most likely natural cause of death. However, an autopsy can rule in or out a more exact cause, such as an asthma attack, a heart attack, or pulmonary embolism, or it can demonstrate the unknown severity of underlying disease.