Cause of Death?

[nypamedic43]

I was going to ask if you had inspected his chest. But I am guessing that you didnt...which is no big deal. I have seen this same thing...the face/head was black and the neck and chest, from the nipple line up was red and mottled. When I talked to the doc about it and explained it to him, he told me that sometimes, not all the time, that kind of coloring can come from the left ventricle blowing out. Considering how long this person had been down before being found, it could also be part of the decomp process with the way he was fell over.

[Jacki]

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.

[medicgirl05]

Jacki-your statement was addressed in the fifth post as quoted below.

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.

Please read all replies before posting.

Welcome to the city.

[Curiosity]

Traumatic asphyxia.

The sudden compression of the heart and mediastinum transmits this force to the capillaries of the head and neck. Pt presents with swelling and cyanosis to the head and neck. The skin below the will remain pink.

Could your patient have lost consciousness with his chest against the tub?

[Hooch.NREMT]

Based on what you described, although I would have to ask a little more… They guy could have had a VasoVagal episode and knock the noggin on the sink… Regarding the head being black…. thats where i have to ask a little more… what was his exact position, was the a particularly putrid smell? was the bathroom clean or dirty visually? Was is "black" or was it a deep purplish brown…? The dependent lividity is a fitting explanation, but ill throw a little spin on on it to be thinking outside the box… If it was truly a "black" in color, had a putrid smell, and the skin looked…. well…. swollen, and looking rather fluid filled… It could be that the tissue went necrotic from bacteria entering where the poor fella knocked his noggin…. but thats just taking it outside the box a bit…..

[Richard B the EMT]

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

Seems standard operating procedure. FDNY EMS does that, calling it "officially" "Presumption Of Death", under the authority of the Medical Director of the service.