Death Circumstances, Injury Interpretation, and Follow-Up Investigation
Three separate questions
Distinguish cause (the disease or injury that initiated the fatal sequence), mechanism (the physiologic derangement, such as arrhythmia or exsanguination), and manner (natural, accident, suicide, homicide, undetermined). Manner reflects intent and circumstance, not injury severity; a self-inflicted wound and a homicidal wound may look identical.
Pattern recognition
Blunt trauma produces abrasions, contusions, and lacerations with tissue bridging. Sharp-force wounds are incised or stab; note that a stab wound's depth may exceed the blade length because of tissue compression. Firearm wounds require distinguishing entrance from exit: abrasion collars, soot, stippling, and muzzle imprints indicate range and direction, while exits are often irregular, everted, and may be shored. Asphyxial deaths may show petechiae, ligature furrows, and neck structure injury, but petechiae alone are nonspecific. Recognize blunt pediatric injury patterns, drowning, thermal and electrical injury, and the postmortem changes - algor mortis, livor, rigor, decomposition - that inform time-since-death estimates within wide margins.
Follow-up
Manner is often withheld pending toxicology, medical and psychiatric records, prescription monitoring data, witness interviews, and re-enactment. Document what is missing and why.
Traps
Do not call every gunshot to the head a suicide, do not equate homicide with cause of death, and do not write cardiac arrest as a cause. Confounders such as fever, ambient heat, and clothing alter postmortem findings.
Rule of thumb
Ask whether the findings could reasonably be explained another way before committing to a manner.