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A comprehensive guide for clinicians on differentiating between rigor mortis and cadaveric spasm, two conditions that can present with similar symptoms. It highlights key differentiating factors, including timing of onset, history of preceding events, and distribution of stiffness. The document also emphasizes the importance of considering the history of events and the presence of hypostasis in determining the cause of death. It concludes with a reminder that any doubt over the presence of rigidity should prompt the clinician to act in the patient's best interests.
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Also known as livor mortis, post-mortem staining or lividity. This is he pooling of blood in congested vessels in the dependent part of the body in the position in which it lies after death. This is due to the effects of gravity and can start to become visible after 30 minutes (Komang Ralebitso-Senior, 2018). To confirm hypostasis, it is important to identify pallor in the upper facing aspects of the body. initially, hypostatic staining may appear as small round patches looking rather like bruises, but later these coalesce to merge as the familiar pattern. Above the hypostatic engorgement there is obvious pallor of the skin. The presence of hypostasis is diagnostic of death - the appearance is not present in a live patient. In extremely cold conditions, hypostasis may be bright red in colour, and in carbon monoxide poisoning it is characteristically 'cherry red' in appearance. Rigor mortis occurs first in the small muscles of the face, next in the arms, then in the legs; these changes taking 30 mins to 3 hrs. Children will show a more rapid onset of rigor. The recognition of rigor mortis can be made difficult where, rarely, death has occurred from tetanus or strychnine poisoning.In some, rigidity never develops (infants, cachectic individuals, and the aged), while in others it may become apparent more rapidly (in the conditions in which muscle glycogen is depleted): exertion (which includes struggling), strychnine poisoning, local heat (e.g. from a fire, hot room or direct sunlight). Rigor should not be confused with cadaveric spasm (sometimes referred to as instant rigor mortis), which develops immediately after death without preceding flaccidity following intense physical and/or emotional activity. Examples include death by drowning or a fall from a height. In contrast with true rigor mortis, only one group of muscles is affected and not the whole body. Rigor mortis will develop subsequently. Where tissue damage indicates that the patient has been dead for days or longer. When a child is stillborn and died more than a day before birth as indicated by the skin loosening and slipping off when touched.
When can Cadaveric Spam Occur? As previously stated, it can be seen in deaths that have occurred after experiencing significant physical or emotional stress and is therefore common in traumatic deaths (Mesri, et al., 2017). Some other examples of when it can occur: •Exercise or vigorous activity •Electrocution •Convulsions •Hyperthermia / High fever before death / infection •Intoxication with stimulants (amphetamines, cocaine,aspirin, strychnine) •Cerebral hemorrhage •Drowning ‘Drowning is a well recognised context in which cadaveric spasm may be encountered ("the drowning man clutching at straws")’ (Lawler, 1992). Rigor Mortis versus Cadaveric Spasm Unlike cadaveric spasm, rigor mortis affects involuntary muscles, as well as voluntary muscles (Mesri, et al., 2017). (Kaushal, 2014)
‘Rigor mortis occurs first in the small muscles of the face, next in the arms, then in the legs’ (JRCALC, 2017). Considerations for Clinicians Muscle stiffness or rigidity following cardiac arrest is not in isolation an absolute indication that rigor mortis is present, as cadaveric spasm can present similarly, as already stated. Hypostasis The clinician should also look for hypostasis (also known as livor mortis, post-mortem staining or lividity), as this is a diagnostic of death (JRCALC, 2017). Hypostasis is the pooling of blood in congested vessels in the dependent part of the body in the position in which it lies after death. This is due to the effects of gravity and can start to become visible after 30 minutes (Komang Ralebitso-Senior, 2018). To confirm hypostasis, it is important to identify pallor in the upper facing aspects of the body, where blood has been drained from (JRCALC, 2017). History of Events The clinician should consider the cause and circumstances preceding cardiac arrest and attempt to create an estimated timeline of events. This should be used concurrently with the physical signs present. Concluding Comments Remember that rigor mortis is a process that occurs over a period of hours, and early signs will usually only occur initially in the small muscles of the face. Hypostasis is a more discernable sign unequivocally associated with death, when contrasted with the pallor in the upper part of the body.
