Cause of Death?

[medicgirl05]

I recently had a call and felt a little stumped.

Call came out for unconscious patient at a local hotel. We arrived and found the patient DOA in the bathroom. No medical history, no meds in the room, and no family present. Patient hadn't been seen or talked to in almost a week so also an unknown down time. So we found him on the floor between the tub and toilet. It looked as though he had been sitting on the toilet(though there was nothing in it) and fallen off to hit his head on the bathtub faucet. There was about an inch of blood/water in the tub presumably from a small lac to his head. The wierd part is that his face was BLACK and swollen. His legs weren't black, just purple tinged at places. My partner thought maybe he was electrocuted but I didn't see any evidence of that. My only idea is that maybe he had a PE, but would that cause him to be black? I've seen people who had recent PE's and were cyanotic from the neck up, but never black. Any idea?

[Medicman14]

I recently had a call and felt a little stumped.

Call came out for unconscious patient at a local hotel. We arrived and found the patient DOA in the bathroom. No medical history, no meds in the room, and no family present. Patient hadn't been seen or talked to in almost a week so also an unknown down time. So we found him on the floor between the tub and toilet. It looked as though he had been sitting on the toilet(though there was nothing in it) and fallen off to hit his head on the bathtub faucet. There was about an inch of blood/water in the tub presumably from a small lac to his head. The wierd part is that his face was BLACK and swollen. His legs weren't black, just purple tinged at places. My partner thought maybe he was electrocuted but I didn't see any evidence of that. My only idea is that maybe he had a PE, but would that cause him to be black? I've seen people who had recent PE's and were cyanotic from the neck up, but never black. Any idea?

Dependant Levidity?

Guy fell over and blood settled to gravity, turning the skin darker with time.

Just a guess, offered for discussion...

Sent from my ASUS Transformer Pad TF300T using Tapatalk 2

[Arctickat]

Medicman is likely on the right track. The face and scalp are the most vascular areas of the integumentary system. If I understand your description of his position properly it sounds like his head was likely lower than or about the same level as the rest of his body. Livor Mortis is caused by gravity pulling the blood to the lower areas of the body because it is no longer being circulated. When the blood pools in the head it'll make it a very dark colour.

My suspicion is that the cause of death is from a vasovagal response while bearing down on the toilet, or bubonic plague.

What I'm wondering is why they called you? If the guy had been dead for a week I doubt there was much we could do. Fortunately, we don't even get calls like that here.

[paramedicmike]

In a lot of places with which I've been affiliated it's an automatic dispatch. Report of a dead guy? Send EMS!

With regards to the cause of death, who knows? The guy's been dead for likely up to a week. The black face and head could be from pooling blood or post alien abduction.

Will you have access to autopsy results? That'll be the definitive answer.

[medicgirl05]

The man's head was level with the edge of the bathtub. The rest of him was lower. Usually the blood settles in the lower part of the body, that's why I'm confused.

As for the autopsy results, it's hit or miss wether they will give me that information. I plan on calling in a week or so, but sometimes they say it is irrelevant for me.

The call came in from the manager of the hotel and I'm thinking she called 911 not knowing what to do. We were the first to arrive on scene. It happens pretty regularly that we are called to a very obvious DOA. I think it is just that the public doesn't know what to do, and the dispatchers don't either.

[Arctickat]

Was the neck flexed? This would restrict the ability of the blood to leave the head. Mike stated what I was thinking and forgot to type. The only conclusive answer you'll get is from a pathologist.

[DFIB]

Were there any signs of foul play? Ligature marks around the neck? Was there any evidence of anyone else being in the room?

Did you get a chance to look at his sclera? Anything that looks like petichiae? Hifema?

Did there seem to be any evidence of choking? Any blood in ear canal? Did the blackness look anything like a Battle sign pattern or raccoon eyes?

Could a cerebral hemorrhage cause this sign?

Sorry I only gave more questions and no answers but I just don't know what to think.

[DwayneEMTP]

(oops. Posting at the same time as DFIB. Redundancies are accidental.)

But having a conclusive answer wouldn't make for much of a conversation...

My first thought was pooling too, but it doesn't sound likely here based on the position of the body. I wonder if the position of the neck, as mentioned above, maybe could have restricted vascular return but still allowed the arteries to pump the head full of blood? I find the fact that it's black, despite there still being purple areas on other parts of the body really interesting....

It sounds like what I've seen with hanging...I wonder if just an anatomical positioning fluke could have created the same result?

[DFIB]

(oops. Posting at the same time as DFIB. Redundancies are accidental.)

You are so smart!

[scratrat]

I have had the same case. Head was black and the rest of the body was purplish.

My theroy:

1. His head was in the bathtub and the neck was over the edge of tub closing the carotids.

2. This caused a certain amount of blood to remain "trapped" in the head instead of draining to the bottom.

3. Since it couldn't drain, it remained and, well, clotted, hence the black appearance.