Forensic science, medicine, and pathology
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Forensic Sci Med Pathol · Jun 2013
Case ReportsCircumstantial and toxicological features of deaths from self-administered intravenous anesthetic/narcotic agents.
For a better understanding of circumstantial and toxicological findings of fatalities resulting from self-administration of intravenous anesthetic/narcotic agents, medico-legal autopsy files of the State Institute of Legal and Social Medicine Berlin from 1998 to 2011 were reviewed retrospectively. Of a total of 15,300 autopsies, 9 cases of such deaths were identified, and all were health care professionals. Medical supplies for injection were found still on, or near, the body at the scene. ⋯ Benzodiazepines were detected in 4 cases. All of them were used together with propofol or opioids, and contributed to death by inhibiting respiration. It is essential to consider means of administration as well as additive or synergistic effects of combined agents when interpreting toxicological results in such cases.
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"Bloodless aortic dissection" is a rare cause of sudden death due to an aortic dissection without intimal tears and with no blood present within the dissected aortic wall. The first case was described in 1993. ⋯ The presented case involves a rapidly fatal aortic dissection in a 64 year old man without any intimal tears and no blood in the dissected aortic wall, although the dissection involved the entire aorta. Death was considered due to myocardial ischemia since the dissection had reached the aortic root and the origins of the coronary arteries.
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Emergency medicine measures often have to be carried out under suboptimal conditions in emergency situations and require invasive patient treatment. In the case of a fatal outcome these measures have to be evaluated at autopsy, regarding indications, correct implementation and possible complications. ⋯ In the following review we provide an overview of established, new and alternative techniques for emergency airway management, administration of drugs and management of hemorrhagic shock. The aim is to facilitate the understanding and autopsy evaluation of current emergency medicine techniques.
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Forensic Sci Med Pathol · Mar 2013
Case ReportsIncidental occult gunshot wound detected by postmortem computed tomography.
The body of a 59 year old woman underwent postmortem computed tomography (PMCT) examination prior to forensic autopsy, using a 256 slice multidetector row computed tomography scanner. A large left tension pneumothorax detected on the PMCT was considered to be a likely cause of death and this was confirmed at autopsy. In addition there was an unsuspected PMCT finding of a probable gunshot injury traversing the right orbit, facial bones and frontal sinus. ⋯ PMCT in this case was not only diagnostic of cause of death, but also revealed retained projectile fragments of an old gunshot wound to the face. Without prior imaging such findings would have been undetected at autopsy. This case further underscores the contribution of routine PMCT examination to forensic autopsy practice.