Forensics Quiz (with a tribute to Sherlock season 3 episode 3)

Here's a link to a playlist of five 30 second videos that I thought of when I saw the quiz question. I highly suggest you watch it because: one, the cinematography is amazing. Two, Benedict Cumberbatch! And three, it relates to the quiz question! (mostly)

http://www.youtube.com/playlist?list=PLQRfrVEGU-GPKyGg2zAKxcm6Tqhz8DEKG&feature=edit_ok

Question:
A twenty-year old man was found supine on Thompson Creek Trail with a bullet wound. The entrance of the wound was on the left lateral side 1 cm above the 3rd rib. The exit would was 5 cm above the belly button in the umbilical region. While tracing the bullet path, you notice at the entrance the bullet travels in the frontal plane with a 45-degree downward angle.  Upon inspection of the right side of the rib cage by x-ray, you observe that the 8th rib is fractured. Fragments of the bullets are then traced to the final exit wound. What is the leading differential diagnosis (and why) and what are three plausible alternatives and how would you rule them out?

Answers

1. Blood loss: Now, obviously we have a slightly different case than Sherlock did. Sherlock's bullet acted like a cork, blocking blood from flowing out of the body for the most part. Our man was shot from the side and his bullet didn't stay in his body. He had two holes in his body, which meant twice the blood loss. And since we're assuming he didn't have a mind palace like Sherlock, he probably wouldn't have been able to figure out which way he needed to fall to reduce the amount of blood loss. Not that it would him much good since he had two wounds.

If the cause of death wasn't blood loss, then there must have been some magic going on. There is going to be blood loss, but it might not be the case if something else killed him first.

2. Lung puncture: The bullet had fractured the 8th rib on the right side of the rib cage. With most bullets, fractured ribs mean that sharp parts of the rib stick out and poke other organs. One of them could have been a lung.

This could be disproven by checking to see if a lung was punctured and whether or not there was frothy blood saliva in the man's mouth when discovered.

3. Spleen ruptured/destroyed: The bullet entered the left lateral side angled down forty-five degrees. There is a chance that the bullet passed through the spleen.

If the spleen wasn't hit, then it wasn't the cause of death.


Another cause of death after the initial bullet wound and numbness sensation is hypovolemic shock, which is caused by lack of oxygen flowing in the blood. Either way, no matter where you get shot, hypovolemic shock is going to happen, unless you die instantly.

So that's that. Hope you liked the Sherlock clips. Go watch the show! It's really good.