Forensics and Fiction: Clever, Intriguing, and Downright Odd Questions from Crime Writers

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Forensics and Fiction

Clever, Intriguing, and Downright Odd Questions from Crime Writers

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By Lyle, D. P.

St. Martin's Minotaur

Copyright © 2007 Lyle, D. P.
All right reserved.
ISBN: 9780312365516

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What Are the Symptoms and Signs of Bleeding to Death? Q: What would be the symptoms and visible signs of being bled to death? The situation in my story is a man being bled to death by way of blood transfusion tubes. Marion Arnott Paisley, Scotland Author of Sleepwalkers A: Blood is a liquid filled with various cell types, one type being the red blood cells (RBCs). These contain hemoglobin, a molecule that carries oxygen (O2) from the lungs to the tissues and removes carbon dioxide (CO2) from the tissues and transports it to the lungs, where it is exhaled with each breath. Bleeding, depending upon how rapid it is, leads to two basic derangements. One is a drop in blood pressure (BP), resulting in shock, and the other is the development of anemia, which is a low level of RBCs in the blood.
The former is due to a rapid drop in the volume of the blood (think bleeding air from a tire—as you do, the pressure within the tire falls) and the latter is due to a loss of the blood cells that carry oxygen. In your scenario, if the blood is removed rapidly, the volume of blood in the victim’s body falls, which causes a drop in BP, and results inshock and, if not treated appropriately and quickly, death. This is what happens when someone exsanguinates (bleeds to death) after an auto accident, a gunshot wound (GSW), or a rapidly bleeding ulcer. Depending upon the size of the person, the body contains from 8 to 12 pints of blood. The rapid loss of 3 or 4 pints would lead to shock in most people. So, if the blood were removed from your victim rapidly, his BP would fall and he would begin to show signs of shock. These signs and symptoms include shortness of breath, weakness, dizziness, chills, thirst, and as it progresses, confusion, disorientation, sleepiness, coma, and death. This could happen over a few minutes or an hour or so, depending upon how rapidly the blood was removed. If the bleeding is slow (your villain removing a little blood each day) the person will become progressively anemic. In anemia the RBC count is low, so the ability of the blood to transport O2 to the body is reduced. Why? Less RBCs per ounce of blood means that each ounce of blood pumped by the heart carries less O2. This means the tissues receive less O2 and the symptoms of anemia reflect this reduction. They include shortness of breath (particularly with activity), fatigue, weakness, lethargy, headache, pallor (pale appearance), and chills. If your perpetrator bled your victim to death slowly, by removing blood little by little, these symptoms and signs would develop and progress as the anemia worsened. This could occur over many hours, days, or weeks. How Long Might My Character Survive in a Cave  with No Food or Water? Q: A character in my story is trapped in a cool, dark cave with no food or water for several days. The gist of the story shows the rescuers trying to find him intercut with scenes of what he goes through emotionally and physically.
He is in excellent physical shape, early twenties, but almost dies from the experience. How long would that take? Any gritty details? Tammy Guest Atlantis Project Deydreem Productions A: If your victim had a sufficient supply of good air, the major threats to his life would be dehydration and hypothermia (low body temperature). If he had enough warm clothing or materials to make clothing from, such as canvas or some other material, he would be able to avoid hypothermia for a longer period of time. If not, he would lose heat from his body fairly quickly. How quickly? That depends upon the actual temperature within the cave and whether the environment was damp or dry. Cold and wet would do him in more quickly. The symptoms of hypothermia would be shivering, fatigue, weakness, and aching in his muscles and joints. As it progressed he would become lethargic, confused, and disoriented. He might even hallucinate. He would ultimately slip into a coma and die if not rescued. The presence of dehydration would magnify these symptoms. Dehydration is sneaky and comes on at varying rates. If he is well hydrated at the beginning, has no significant medical problems, takes no dehydrating medications such as diuretics, does not consume alcohol, and doesn’t overexert himself (sweating and heavy breathing take water from the body very quickly), it could take a couple of days before he showed signs of dehydration. It would then take several more days before he got into trouble, and a week or more before he was in danger of dying. It is highly variable, so this gives you great leeway in how you construct your story. The symptoms of dehydration are similar to those of hypothermia. The general order of their appearance is: thirst, fatigue, weakness, shortness of breath, dizziness, disorientation, confusion, delusions, hallucinations, loss of consciousness, coma, and death.
In a hot desert this sequence could play out in twelve hours, more or less. In your scenario it could take three to eight or so days, depending upon the above variables. How Long Could a Child Survive in the Cold Waters Off the Coast of Maine? Q: I’m writing about a twelve-year-old boy of average build who jumps out of a boat off the coast of Maine. The average water temperature in that area is approximately 55 degrees Fahrenheit. How many minutes could he live before dying of hypothermia? A: Hypothermia onsets in the young and the old more quickly than it does in the average adult. Water temps in the mid 50s can definitely lead to hypothermia in a short period of time. The exact time is widely variable, depending upon such things as the victim’s size, weight, percent of body fat, type of clothing, last meal, alcohol or drugs in the system, general health, and the movement of the water, to name a few. Large, obese, well-clothed people last longer. A recent large meal or alcohol intake will hasten heat loss, as will moving water. Think wind chill, only in the water. A cold stream or a choppy sea would remove body heat faster than would a calm cove. You’ve no doubt heard of children drowning in frozen lakes and being pulled out forty-five minutes or more later and surviving without any problems. The reason is that the water is so cold (near freezing) that the metabolic processes in the body are slowed, and thus the body survives with no oxygen. This seems to occur only in children. But, your 55 degrees won’t work in that fashion. That’s just not low enough to “freeze” the body. So, how long can your victim survive? The range is wide and could be as little as five minutes and as long as an hour.
Average would be fifteen to thirty minutes in most circumstances. What Duration of Exposure to High Environmental Temperatures Would Prove Lethal for a Pregnant Woman? Q: In my story, a pregnant lady in her mid thirties, roughly five weeks prior to her due date, is left bound and gagged in a non-air-conditioned dump somewhere just outside of Las Vegas. Assuming she and her unborn baby are in perfect health and temperatures in Vegas are around 90 degrees Fahrenheit, how long could this woman go before she’s in danger of either dying or losing her baby? What might be the logical sequence of her deterioration over a ten-hour time span under these conditions? Gar Anthony Haywood (writing as Ray Shannon) Los Angeles, California Shamus- and Anthony-award-winning author of Man Eater and Firecracker garanthonyhaywood.com A: Exposure to this level of temperature, particularly in a very dry climate such as Las Vegas, would rapidly lead to dehydration, and then heat prostration and heatstroke. Collectively these three derangements are termed “heat injuries.” When the body is exposed to extremes of temperature, breathing and sweating increase in an attempt to lower the body’s core temperature. This leads to dehydration. As water loss from the body progresses, the body’s core temperature begins to rise and sweating increases. The blood pressure (BP) then begins to drop, the heart rate increases, and the body temperature can reach as high as 104 or 105 degrees. This is termed heat prostration. Further along in this process the severe dehydration and high body temperature causes damage to the brain, particularly the area we call the hypothalamus, which controls body temperature regulation. When this happens sweating ceases and the core temperature may soar to 106–108 or higher. This is called heatstroke, and is a true medical emergency. If the body temperature is not quickly lowered and the victim rehydrated, the brain will be permanently damaged and death will follow. The 90-degree heat, low humidity, and your unfortunate young lady’s inability to reach a water source would lead to rapid dehydration. She would experience thirst, shortness of breath, fatigue, headache, and dizziness.
As she developed heat prostration, each of these symptoms would be magnified, and she would experience confusion, disorientation, delusions, and visual or auditory hallucinations. That is, she would see and hear bizarre things. As she slipped into heatstroke, coma, seizures, and shock would follow, culminating in her death. All these changes would be more serious and would come on more rapidly in a pregnant woman, since her cardiovascular system would already be under stress from the pregnancy. By ten hours she would be severely dehydrated, and could even enter heat prostration or heatstroke, though the latter two would probably take eighteen to thirty-six hours to develop. This varies widely from person to person, so if after ten hours she were only dehydrated, that would be realistic. Or, if she developed one of the more severe forms of heat injury, or even if she died, this would also be possible and believable. You can have it any way you need for your story. When rescued, her treatment would be directed toward lowering the core temperature as quickly as possible. Moving her to a shaded, well-ventilated area and pouring water over her while fanning her with a towel could be life saving. If able to swallow, she would be given water to drink. She would then be transported to the hospital, where IV fluids and further cooling measures, such as a cooling blanket (a synthetic drape through which cold water is circulated) or an ice bath, would be instituted. She and her baby could survive unscathed, or one or both of them could suffer severe brain damage, or one or both of them could die. Any of these scenarios is possible. How Would a Heart Attack Be Treated During  a Commercial Plane Flight? Q: One of my characters is a sixty-five-year-old married man who has angina, for which he takes nitroglycerin. I want to give him a nonfatal heart attack during a commercial plane flight from Tampa to New York City. He’s treated on an emergency basis by the flight attendants or a physician passenger. When he gets to New York City he’s taken to a hospital and is told he needs a quadruple bypass. He refuses to get the bypass right away (for story reasons), and then has another attack, is taken back to the hospital, and is near death for a while. Finally he agrees to have the surgery. Will this sequence of events work? What actually happens on the plane and at the hospital?  M. Diane Vogt Tampa, Florida mdianevogt.com A: The scenario you lay out is not uncommon.
Men refuse the proper medical care all the time. They are often pigheaded when it comes to health. It’s that Superman thing. On the plane he would develop chest pain, shortness of breath, nausea, and diaphoresis (become sweaty). The flight attendants would ask if any M.D. was on the flight, and if so he would help with the man’s care. They would give him oxygen, lay him down in the rear of the plane, and divert the flight to the nearest major airport. So have this happen near New York if that’s where you want the story to occur. Otherwise he might end up in Atlanta, Washington D.C., or wherever the nearest major city is. Airlines have emergency kits and, using one, the M.D. could start an intravenous line (IV) and attach the onboard cardiac monitor. If the victim suffered a cardiac arrest, the doctor would immediately begin CPR, and hopefully the plane would be equipped with an AED (automatic external defibrillator). If so, this would be attached to the victim, using sticky disklike electrodes that would be placed on his chest. The AED has a computer that reads the cardiac rhythm. If he developed the deadly rhythms called “ventricular tachycardia” (V-Tach or VT) or “ventricular fibrillation” (V-Fib or VF), the AED would deliver an electric shock to hopefully snap the heart back into a normal rhythm. Once in the hospital he would be taken to the ICU where an electrocardiogram (EKG) and blood work would show that he had had a heart attack (myocardial infarction, or MI). He would go to the catheterization lab for a coronary angiogram, which would reveal multivessel coronary artery disease (CAD), and surgery would be recommended. After he refused and had another MI, he would be in an even more precarious situation, and might then agree to the surgery. Seen it a thousand times. Copyright © 2007 by D. P. Lyle, M.D. All rights reserved. 
 

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Excerpted from Forensics and Fiction by Lyle, D. P. Copyright © 2007 by Lyle, D. P.. Excerpted by permission.
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