mcod & pma new
DESCRIPTION
forensikTRANSCRIPT
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MCOD & PMATjiang Sari Lestari
DEPARTEMEN KEDOKTERAN FORENSIK & MEDIKOLEGALFAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
2015
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MCOD & PMA• Dead victim:– Multiple cause of death– Proximus mortis approach
• Living victim:– Multiple cause of damage/disease– Proximus morbus approach
EVIDENCE-BASED
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DEAD VICTIM
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Multiple Cause of DeathCurrent finding
I-a
I-b
I-c
I-d
II
Death
Direct cause of death
Antecedent cause
Antecedent cause
Underlying cause of death
Co-morbid factors
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Case #1Current finding
I-a
I-b
I-c
I-d
II
Kematian
Kegagalan sirkulasi
Perdarahan masif pada rongga dada
Luka robek pada paru kanan
Luka tembak masuk pada dada kanan
-
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Case #2Current finding
I-a
I-b
I-c
I-d
II
Kematian
Kegagalan sirkulasi
Disseminated Intravascular Coagulation
Septikemia
Hospital-acquired pneumonia
Gagal jantung kongestif
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Case #3Current finding
I-a
I-b
I-c
I-d
II
Kematian
Kegagalan pernapasan
Gangguan pertukaran udara di paru
Rusaknya jaringan paru
Tuberkulosis paru
-
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Case #4Current finding
I-a
I-b
I-c
I-d
II
Kematian
Kegagalan pernapasan
Penekanan pusat pernapasan di batang otak
Perdarahan subarachnoid
Trauma tumpul pada kepala
Intoksikasi alkohol
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Case #5Current finding
I-a
I-b
I-c
I-d
II
Kematian
Kegagalan sistem saraf pusat
Kerusakan jaringan otak
-
Luka tembak masuk pada kepala
-
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Proximus Mortis Approach
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LIVING VICTIM
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Multiple Cause of Damage/DiseaseCurrent finding
A-1
A-2
A-3
…
A-n
B
Damage/disease
Direct cause of damage/disease
Antecedent cause
…Infinite antecedent cause…
...
Underlying cause of damage/disease
Co-morbid factors
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Case #6Current finding
A-1
A-2
B
Satu luka tusuk pada perut kiri bawah
Kerusakan jaringan kulit, lemak, otot
Trauma benda tajam bermata satu
-
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Case #7Current finding
A-1
A-2
A-3
B
Satu buah memar pada pipi kanan
Perdarahan di bawah jaringan kulit
Kerusakan pembuluh darah di bawah kulit
Trauma benda tumpul
Hemofilia
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Case #8Current finding
A-1
A-2
A-3
B
Satu buah jaringan keloid pada punggung tangan kanan
Luka iris pada punggung tangan kanan
Kerusakan jaringan kulit dan lemak
Trauma benda tajam
Susceptibility to keloid
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Case #9Current finding
A-1
A-2
B
Diabetes melllitus tipe 2
Gangguan pembentukan insulin dan resistensi insulin
Kerusakan pada sel-sel beta pankreas dan obesitas
-
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Case #10Current finding
A-1
A-2
A-3
A-4
A-5
B
Penyakit jantung koroner
Penyumbatan arteri koroner oleh aterotrombus
Terlepasnya plak aterosklerotik dari dinding pembuluh darah jantung
Pembentukan unstable plaque pada dinding pembuluh darah jantung
Penumpukan kristal kolesterol dan foam cells pada dinding pembuluh darah jantung
Dislipidemia kronik
Hipertensi esensial grade II on treatment
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Proximus Morbus Approach
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PROXIMUS MORTIS/MORBUS
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Trauma tumpul
pada abdomen
Ruptur limpa
Perdarahan masif
rongga perut
Kegagalan sirkulasi Kematian
Trauma tumpul
pada abdomen
Ruptur limpa
Perdarahan masif
rongga perut
Kematian
Trauma tumpul
pada abdomen
Ruptur limpa Kematian
Trauma tumpul
pada abdomen
Kematian
I-d I-c I-b I-a Death
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Ia
IbIc
Id
Kegagalan sirkulasi
Perdarahan masif
Robekan pembuluh
darah besar
Lakalantas
Sirosis hepatis
Hepatitis B Alkoholisme
DIC
Sepsis
Abortus provocatus criminalis
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TERIMA KASIHLast update 21/10/2015