George R. Nichols

AIRBAG MODULE COVER INJURIES

Serious and fatal injuries can be sustained when anatomic structures are in close proximity to an airbag module cover at the moment of airbag deployment. Three cases of injuries in vehicle operators associated with airbag module covers are reviewed and discussed. Injuries ranged from the traumatic avulsion of a thumb to the development of a subdural hematoma with associated cerebral edema and respiratory arrest. Motor vehicle operators should be aware that although airbags can significantly reduce the severity of injuries sustained in frontal collisions the module cover has the potential to inflict serious, even fatal injuries.

Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning

Fetal death due to acute carbon monoxide poisoning is rarely reported in the medical literature. Of the eight cases found in literature review, only one documented the fetal carboxyhemoglobin concentration. This paper reports a fetal death due to accidental nonlethal maternal carbon monoxide intoxication in which both maternal and fetal carboxyhemoglobin concentrations were obtained. The corrected carboxyhemoglobin concentration was 61% at the time of death in utero, while the maternal carboxyhemoglobin was measured at 7% after one hour of supplemental oxygen. The authors review the mechanisms of fetal death and emphasize the different carbon monoxide kinetics in the fetal circulation.

Unnatural Deaths in Nursing Home Patients

Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. Herein, we report a series of unnatural deaths in nursing home residents, including two homicides and seven accidental deaths. In four of the deaths, there was an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents. Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patients demise. The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.

Development and Implementation of the First Clinical Forensic Medicine Training Program

To address the un-met forensic needs of victims who are survivors of violent crimes and trauma, the first residency-based clinical forensic medicine training program and fellowship has been established. The Kentucky Medical Examiners Office and the Department of Emergency Medicine at the University of Louisville are currently training physicians to provide clinical forensic evaluations. The clinical forensic physicians evaluate adult and pediatric victims of blunt and penetrating trauma, sexual and physical abuse and collect evidentiary material when indicated. The development of a clinical forensic medicine training program and fellowship at the resident physician level is internationally unique.

Case report nonfracture associated fatal fat embolism in a case of child abuse

Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.

In the shadow of the baron: Sudden death due to Munchausen Syndrome

The authors describe a woman who died suddenly in an emergency department restroom after self-injection of corn starch in an attempt to gain admission to the hospital. At autopsy, multiple pulmonary vascular corn starch granulomata were identified, as well as pulmonary arteries filled with brewers yeast. Retrospective evaluation of the patients medical history showed multiple signs of Munchausen Syndrome. The authors suggest that the case illustrates the importance of scene investigation and review of the medical history by emergency department personnel and the forensic pathologist.

The use of black and white infrared photography for recording blunt force injury

Infrared (IR) wavelengths penetrate skin and can selectively image volumes of subsurface blood. Twenty‐eight blunt force injuries on nine decedents were photographed with color and IR film to compare the ability of each to image the injury. Of the 28 injuries, 10 were clinically interpreted as contusions, 4 as abrasions, 10 as abraded contusions, and 4 as erythematous discolorations, nos. Twenty‐four of these injuries were incised to determine the presence and extent of subsurface bleeding. It was found that contusion had been clinically missed in five cases, three because they were hidden by abrasion and two because they appeared only as a mild cutaneous erythema. All five cases were detected by IR and verified by incision. Melanin pigmentation contributed to masking of contusion in one case and postmortem lividity confounded interpretation of contusion in one case. In all 14 injuries featuring abrasion as a component, IR de‐emphasized or eliminated the visibility of abrasion. A single false negative was reported in which a visible contusion, verified by incision, was not seen with IR. In comparing injury patterns, color and IR renditions were dissimilar in a number of cases reflecting the difference between the manner in which light and IR photography imaged the depth and volume of blood within an injury. In summary, IR imaging of wounds can discover hidden bruises, verify clinical diagnosis of bruises, and augment interpretation of wound patterns. Clin. Anat. 2013.

Repeat Visitors to a Pediatric Forensic Medicine Program

Since the inception in 1990 of a Clinical Forensic Medicine Program at the Louisville Office of the Kentucky Medical Examiner Program, six children have undergone repeat evaluations for physical injuries. Herein, we examine the overall number of cases from January 1991 through December 1994, and the circumstances and outcomes of the six children undergoing reevaluation. Despite the implementation of an organized Forensic Medicine Program, some children in our area suffer repeated episodes of recognized abuse and death.

Dirty diving. Sudden death of a SCUBA diver in a water treatment facility.

We report a case of a sudden death in a SCUBA diver working at a water treatment facility. The victim, an employee of the facility with a specialty in electronics, was a sport diver not qualified in commercial diving. While attempting to clean sludge from a blocked drain 25 ft under water, the diver was suddenly pinned against the drain valve when the sludge plug was broken up. We review the mechanics of the incident and the actual cause of death, asphyxia, as opposed to drowning. We believe this to be the first reported case of traumatic (pressure) asphyxia in a SCUBA diver.

Fatal hemorrhage from minor trauma following massive salicylate ingestion

The anticoagulant property of aspirin has long been appreciated. Recently, the physiologic mechanism has been identified and documented extensively. Despite the long-lasting inhibition of platelet function and clinically significant postoperative hemorrhage following aspirin use, few serious complications or fatalities are reported in the current literature. We report a case in which fatal hemorrhage resulted from minor trauma following massive salicylate ingestion. A review of the cyclo-oxygenase mechanism is presented.