The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Sep 1998
Case ReportsInadvertent intrathecal administration of potassium chloride during routine spinal anesthesia: case report.
During routine spinal anesthesia, an ampule of potassium chloride, instead of bupivacaine, was mistakenly opened and inadvertently administered intrathecally to a patient, resulting in pain, cramps, and death within 2.5 hours of injection. We discuss the medicolegal implications of such an error and possible preventive measures pertaining to this case.
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Am J Forensic Med Pathol · Sep 1998
ReviewReexamination of custody restraint position and positional asphyxia.
The use of the hogtie restraint (also known as hobble or prone maximal restraint) by law enforcement and prehospital personnel has come under scrutiny because of reports of sudden deaths in persons placed in this restraint position. Some contend that this body position restricts chest and abdominal movement to the point that individuals are at risk for hypoventilatory respiratory compromise and "positional" asphyxiation. ⋯ We also review the current research findings from human physiology studies that have investigated the effects of the hogtie position on respiratory and pulmonary function. We conclude that the hogtie restraint position by itself does not cause respiratory compromise to the point of asphyxiation and that other factors are responsible for the sudden deaths of individuals placed in this position.
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Twenty autopsy reports, comprising 1 fall, 1 cutting, 1 burn, 1 drowning, 1 strangulation, 3 gunshot wound, and 13 traffic fatalities, were scored by the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The codes were adequate for wounds of skin and long bones, and for most wounds of viscera. The autopsy descriptions were more detailed than the coding criteria for craniocerebral, cervicovertebral and muscular trauma, and less detailed for thoracoabdominal visceral, and long bone trauma. ⋯ AIS scores were low and did not seem to reflect the lethal outcome when the lethal mechanism was purely physiologic and without a striking morphologic derangement, as in instances of cerebral or cardiac concussion, compression of the neck, occlusive airway hemorrhage, and visceral herniation into an adjacent body cavity. The scores were similarly low when therapy was delayed or adverse. Low AIS and ISS scores in a fatality from blunt or penetrating trauma may be useful retrospective clues to the presence of purely physiologic death mechanisms or therapeutic problems.
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Medical examiners have a unique database about trauma victims, many, if not most, of whom died at the scene or in transit to a hospital and who, thus, never had their injuries documented by trauma surgeons and so never entered into a local or regional trauma registry. These trauma registries have assisted in assessing the magnitude of traumatic injuries in the community and in evaluating the community's emergency medical systems. Without information about those who are dead at the scene or who die in transit, these trauma registries are incomplete and the evaluations based on them inaccurate. ⋯ For some cases the expert system "requested" and received clarifying information, all of which was present in the medical records. This research demonstrates the feasibility of gathering accurate and consistent information on the estimated 50% of trauma deaths who do not reach a hospital and who are not included in acute care registries. Without data on such patients, our evaluation of trauma systems is incomplete and resources directed at prevention and treatment may be misapplied.
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Am J Forensic Med Pathol · Sep 1998
Problems in the interpretation of hemorrhage into neck musculature in cases of drowning.
To investigate the possible causes of unexplained hemorrhage into the neck musculature in deaths due to drowning, all cases of drowning between the years 1985 and 1995 examined by members of the Department of Forensic Pathology, University of Sheffield were reviewed. Cases were selected in which hemorrhage was found within the neck musculature but in which no apparent explanation for the hemorrhage, such as compression of the neck or trauma, was present. Eight cases were identified from a total of 99 deaths from drowning. ⋯ The Prinsloo and Gordon artifact may be an operative factor in at least some cases. Hemorrhage may result from violent neck movements during the process of drowning. Apparent "bruising" of the neck musculature does not always indicate compression of or trauma to the neck.