John W. Eisele

Correlation of Circumstances with Pathological Findings in Asphyxial Deaths by Hanging: A Prospective Study of 61 Cases from Seattle, WA

Correlation of the circumstances of death with the pathologic findings in this prospective study of deaths by hanging affords insight pertaining to certain of the pathophysiologic mechanisms involved in fatalities of this type. The presence of conjunctival and facial/periorbital petechial hemorrhages correlates with increasing levels of body support below the point of ligature suspension. Hyoid bone and/or thyroid cartilage fractures (found in 26% of cases) are most frequently identified in those persons found completely suspended and in victims in the older age ranges. No hyoid bone/thyroid cartilage fractures, internal soft tissue injury, or petechiae were present in 13 (21%) of the study cases.

Death from law enforcement neck holds.

ABSTRACTWe report two deaths which resulted from the use of neck holds by law enforcement officers. The mechanisms of death are discussed in addition to an assessment of the use of neck holds by law enforcement personnel. The hazards of neck holds are emphasized and we review those conditions where

Weight force during prone restraint and respiratory function

Prone maximal restraint position (PMRP, also known as hogtie or hobble) is often used by law enforcement and prehospital personnel on violent combative individuals in the field setting. Weight force is often applied to the restrained individuals back and torso during the restraint process. We sought to determine the effect of 25 and 50 lbs weight force on respiratory function in human subject volunteers placed in the PMRP. We performed a randomized, cross-over, controlled trial on 10 subjects placed in 4 positions for 5 minutes each: sitting, PRMP, PRMP with 25 lbs weight force (PMRP+25), and PRMP with 50 lbs weight force placed on the back (PMRP+50). We measure pulse oximetry, end-tidal CO2 levels, and forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). FVC and FEV1 were significantly lower in all restraint positions compared with sitting but not significantly different between restraint positions with and without weight force. Moreover, mean oxygen saturation levels were above 95% and mean end-tidal CO2 levels were below 45 mm Hg for all positions. We conclude that PMRP with and without 25 and 50 lbs of weight force resulted in a restrictive pulmonary function pattern but no evidence of hypoxia or hypoventilation.

Postmortem Methemoglobin Concentrations and Their Significance

Small concentrations of methemoglobin are present in the blood of normal individuals. Increased concentrations of methemoglobin can be formed by the action of certain chemicals or drugs, or in individuals with specific genetic defects. There is little information available concerning the validity of postmortem methemoglobin concentration as an indicator of antemortem methemoglobinemia. We measured blood concentrations of methemoglobin in 49 autopsy specimens. We conclude that postmortem methemoglobin concentrations are not valid indicators of antemortem methemoglobinemia.

Teenage suicide in King County, Washington. II. Comparison with adult suicides

&NA; The 25 teenage suicides that occurred in King County, Washington, during 1983 and 1984 were compared with the 158 adult suicides that occurred during 1984. The comparison included the following features: sex, race, declaration of intent, motive, method, isolation, alcohol or drug intoxication at the time of death, prior suicide threats and attempts, counseling history and diagnosis, and family history of suicide. For the teens, we also queried school or employment status, anxiety‐producing experiences, symptoms of depression, marital history of the parents, and number and order of siblings.

A procedure for the investigation of anesthetic/surgical deaths.

A procedure for the investigation of surgical/anesthetic deaths is presented which allows for clearly defined jurisdictional assessment and correlates the autopsy and toxicological findings with the pathophysiology of the anesthetic/surgical event. This procedure facilitates an accurate certification of the cause of death in patients who die during surgery and anesthesia.

Hemolysis and Hyperkalemia Complicate Malignant Hyperpyrexia During Anesthetic Death

A healthy, 15-year-old male received a thiopental, nitrous oxide, oxygen, enflurane anesthetic for appendectomy. Cardiac arrest, following succinylcholine administration, was associated with marked hyperkalemia (potassium levels 8.7 to 11.6 meq), hemolysis (hematocrit fall from 41.7 to 26.6%, plasma hemoglobin 27 mg/dL), and creatine phosphokinase (CPK) elevation (8900 units). Vigorous resuscitative therapy including dantrolene was unsuccessful. The diagnosis of malignant hyperthermia was made by the marked CPK elevation on blood samples drawn during resuscitation and analyzed by the Medical Examiners Office.

Boot top fractures in pedestrians. A forensic masquerade.

Fractures of the legs are characteristic injuries in automobile-pedestrian collisions. Typically these occur at the level of the bumper; measurement of the height of these fractures may be used to reconstruct the events surrounding the collision. We report two cases in which the lower leg fractures did not correspond to the bumper, but rather to the top of the boots worn by the pedestrians. In both cases the decedents were wearing boots with lugged soles which provided fixation of the foot and support for the foot and ankle. The mechanism of these injuries is analogous to boot top fractures which occur in skiing accidents.

Teenage suicide in King County, Washington. I. Rates of suicide for 26 years

&NA; The population‐adjusted rate of teenage suicide in King County, Washington, was reviewed for the 26 years from 1959 to 1984. For the entire period, the rate did not change significantly. An abrupt change did occur during the middle of this period, but, for reasons discussed in the text, this may well represent a change in procedures and philosophy of death certification rather than a real change in rate. Reasons for the apparent discrepancy with national statistics are discussed.