Journal of forensic and legal medicine
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A case of total elbow dislocation with significant swelling and loss of distal pulses during police arrest is described. To date, this specific injury in relation to police arrest has not been described in the literature. Whilst attempting to remove the detainee from a public transport vehicle, the patient and the officers involved fell to the ground with his arm slightly flexed. ⋯ Whilst there, it was noted that his left elbow was swelling dramatically and he complained of pain. The detainee and officers attended the emergency room and he was found to have a total dislocation of the left elbow and vascular compromise of the limb. The elbow was promptly reduced with sedation and a post reduction angiogram demonstrated injury to the tissues surrounding the brachial artery.
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The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. ⋯ Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes.
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Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. ⋯ C0-C1 dislocations were strongly related to fall height, with an OR of 8.3 for ≥3 m falls versus ground level. The findings of increased odds of skull base and lower cervical spine fracture in falls from a height are consistent with prior observations that the risk of such injuries is related to the degree of victim inversion at impact. The finding that C0-C1 dislocations are most common in falls from more than 3 m is unique, an indication that the injuries likely result from high energy shear forces rather than pure tension, as previously thought.
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Randomized Controlled Trial
The effect of the prone maximal restraint position with and without weight force on cardiac output and other hemodynamic measures.
The prone maximal restraint (PMR) position has been used by law enforcement and emergency care personnel to restrain acutely combative or agitated individual. The position places the subject prone with wrists handcuffed behind the back and secured to the ankles. Prior work has indicated a reduction in inferior vena cava (IVC) diameter associated with this position when weight force is applied to the back. It is therefore possible that this position can negatively impact hemodynamic stability. ⋯ PMR with and without weight force did not result in any changes in CO or other evidence of cardiovascular or hemodynamic compromise.
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Case Reports
Lack of impairment due to confirmed codeine use prior to a motor vehicle accident: role of pharmacogenomics.
We examined forensic serum toxicology and pharmacogenomics data from a woman on codeine shortly before she caused a motor vehicle accident. ⋯ Based on her genotype and phenotype and reports by the arresting officer, we suggest that the subject in question was not intoxicated by opiates at the time of her motor vehicle accident and may have been falsely incarcerated.