Sullivangaines1641

Deaths related to hostage situations occur in many forms, as these situations can easily escalate as a result of many confounding variables. When approaching such cases, forensic pathologists and death investigators should be mindful of the many details that should be well-documented at the scene and during autopsy to ensure that the correct conclusions and death certification are determined. This case report highlights a death in a hostage situation and the importance of correlating scene information and autopsy findings. An elderly female hostage was ambulating with a walker away from her ex-husband's home, after police negotiations successfully convinced her ex-husband to release her. The ex-husband then appeared at the door, brandishing a weapon, at which time a police officer shot at the man. Instead of striking the man, the rifle's projectile struck the woman in the chest. Subsequent investigation revealed that, although the police officer had a "clear shot" via the rifle sights, the muzzle end of the rifle was obstructed by the back corner of an automobile, behind which the officer was positioned during the hostage situation standoff. The case highlights a rarely discussed safety rule related to firearms recognition that the line of sight via a weapon's sights (or scope) is not identical to the barrel/bore axis. © 2019 The Authors.In 1987, a case report was published in the German journal Archiv für Kriminologie describing an apparently novel method of suicide in which the decedent produced a lethal amount of carbon monoxide by mixing formic acid and sulfuric acid. This method of chemical suicide remained obscure until 2003, when Dr. Philip Nitschke, a vocal supporter of assisted suicide, began promoting a homemade carbon monoxide generator which utilized this same chemical reaction. SB203580 datasheet In 2006, he coauthored The Peaceful Pill Handbook, which provided further details about how the device worked. Pro-voluntary euthanasia organizations and online forums continue to provide information about this method, promoting it as painless and efficient. There have been nine case reports of suicides and attempted suicides using this chemical reaction, with five reported in Europe, three in the United States, and one in Taiwan. Two additional cases were reported in news articles that did not correspond to known case reports, indicating that this method of suicide is more common than the scientific literature would suggest. We present the case of a 44-year-old male who learned about this method of chemical suicide online and filmed the suicidal act while verbally recording carbon monoxide levels prior to losing consciousness. © 2019 The Authors.We report a case of homicidal paraquat poisoning preceded by attempted manual strangulation. The poison had been forcibly ingested when the victim was unconscious due to pressure on the neck. The victim survived for ten days and died due to development of fibrosing alveolitis. The autopsy showed classic features of proliferative stages of paraquat poisoning and healing signs of ligature strangulation. © 2019 The Authors.INTRODUCTION To better understand the forensic implications of death with a left ventricular assist device (LVAD), we reviewed all deaths that were reported to a regional medical examiner jurisdiction involving patients who had an LVAD. METHODS Medical examiner case files between January 2012 and September 2018 were searched for "LVAD" and "left ventricular assist device" to identify deaths that were reported to the medical examiner involving a decedent who had an LVAD at the time of death. RESULTS During the study period, a total of 14 deaths were reported to the regional medical examiner involving decedents who had an implanted LVAD at the time of death. The average age at death was 64 years, with a range from 40 to 81 years. The underlying cardiac disease leading to LVAD implantation was ischemic heart disease (n = 9), nonischemic dilated cardiomyopathy (n = 4), and chemotherapy-related cardiotoxicity (n = 1). Of these 14 deaths, 2 deaths were due to loss of power to the LVAD, 1 death was due to traumatic subdural hemorrhage occurring in the setting of anticoagulation therapy required by LVAD implantation, and 1 death was due to femur fracture following a fall. DISCUSSION Medical examiners should be familiar with the potential complications of LVADs, especially those complications that may prompt consideration of non-natural manners of death. Medical examiners should also be aware of the tools and investigative strategies that may assist in the investigation of LVAD-related deaths. © 2019 The Authors.A 34-year-old male was reported to be snorting a white powder that was believed to contain heroin. Toxicological analysis revealed free morphine (356 μg/L), fentanyl (34.7 μg/L), alprazolam (64.9 μg/L), and acetylfentanyl (32.9 μg/L) in femoral blood and 6-monoacetylmorphine (6-MAM, less then 10.0 μg/L) in vitreous fluid. Norfentanyl was only detected in stomach contents ( less then 1.00 μg/total). Heroin, fentanyl, and acetylfentanyl were also detected in solid dose evidence submitted by law enforcement. The fentanyl and alprazolam concentrations might normally be associated with a fatal outcome and are supported with the distribution of fentanyl and alprazolam being consistent with an acute intoxication. In addition, the presence of 6-MAM and a free versus total morphine ratio of 67.9% provide supporting evidence of a rapid death following intranasal (IN) administration. However, the presence of illicit acetylfentanyl complicates toxicologic interpretation due to overlapping recreational and fatal concentrations of this compound reported in the literature as well as a potential for postmortem redistribution (PMR). Reported acetylfentanyl concentrations have also varied when presented with significant fentanyl concentrations and underscore the need to consider a wide range of illicit opioid compounds when investigating drug-related deaths. Based on our comprehensive toxicologic analysis, the results suggest an acute intoxication primarily by IN administration of acetylfentanyl and fentanyl. In addition, we suggest the presence of alprazolam, 6-MAM, and a percentage free morphine is also consistent with rapid death. The cause of death was officially attributed to an acute combined intoxication of acetylfentanyl, fentanyl, alprazolam, and heroin, with the manner of death as accidental. © 2019 The Authors.