Archive for March, 2009

Evidence of Violence in Bones

March 30, 2009

Bright Surf Science News, March 9, 2004

Evidence of Violence in Bones

After reading this article, I have a clearer view of the immense benefit that DNA sequencing has had on humanity.  The ability to sequence DNA fragments is still a marvel.  In this article it talks about how investigators in San Juan ante Portam Litinam ( Basque County) have found an Archaeological site containing a communal grave.  Three hundred people were found in this grave.  They found out that the bones were about 5,000 years old, from the Neolithic period.  They were thought to be  non-violent.  Arrowheads made from flint were found embedded into their bones.  The bodies were found twisted together as if they were tied together.  All of these signs indicated violence.
The investigators figured that since this Neolithic period was a hunting/gathering society, it was beginning to change to a society composed of animal husbandry and agriculture, that they were developing more of a sense of property and having things.  This would cause some confrontations amongst the different groups, which could lead to violence.  The bones found at this site have opened new doors, with more hope for the future of humankind.

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Organ Donation

March 30, 2009

I am both a OR nurse and an ICU nurse. When it comes to death and dying and making sure that pts are comfortable, it can quickly become a heated issue. At our hospital, we started participating in DCD cases a few years ago. Many of the anesthesiologists, and other staff members that work here were bothered by the DCD protocol. When these pts family members decide to donate their loved ones organs, the Gift of Life team begins orchestrating where these organs will go. When the time comes, the patient is extubated and we must wait until the patient is asystole. Then the organs may be harvested. Many times the family members are present when extubation occurs. I believe that there is no max to give a pt, I believe it is our duty to make sure that the family is at peace and believes that their loved one is pain free. Having watched a loved one be extubated and pass away, sometimes those first few breaths after extubation can seem strenuous, and painful, they gasp, and cough. Family members deserve to not see a family member suffer. Most of the time the family members are the ones that have made the final decision.

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Identification of Christopher Columbus Remains

March 25, 2009

World of Forensic Science, March 19,2009

Identification of Christopher Columbus Remains

After reading this article, I found that DNA analysis is a marvel in Forensic Science.  The scientists are able to identify someone through their mitochondrial DNA, which is passed down from their mother.  The DNA is able to remain intact for hundreds of years.  This case was about identifying Christopher Columbus’s remains.  It was said that Columbus’s remains were in Serville Cathedral, Spain.  The article also stated that his bones were buried in Santo Domingo Cathedral in the Dominican Republic.

Spanish researchers were going to extract DNA from both sights, back in 2005, in order to identify the bones.  The article did not state whether they were able to identify which sets of bones were Christopher Columbus’s.  I find it intriguing that two different sets of bones are stated to his.  I can’t wait to find out which ones they are.

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“Articulating a Concise Scientific Methodology for Bloodstain Pattern Analysis”

March 24, 2009

Journal of Forensic Identification
Vol. 55 No. 4 July/August 2005

“Articulating a Concise Scientific Methodology for Bloodstain Pattern Analysis”

There have been an increasing number of challenges in our court system encompassing many areas of forensic science. It is more imperative now to be as articulate as possible in describing a methodology for any forensic discipline. Therefore many forensic scientists are re-examining their methods of explaining analyses.

This article attempts to describe a bloodstain pattern analysis in a way that judges and attorneys can understand, in an attempt to decrease the questioning of its scientific validity. Although Bloodstain Pattern Analysis is considered a “pseudoscience” and less scientific than other areas of science, there are some basic and accepted scientific principles that can be identified when examining the process of “B.P.A.”. The methodology typically used has eight steps, which falls in the range of four to eleven steps in a scientific method. In this forensic discipline there is not one single or definite method used, however simply by following a method shows that they are based on solid scientific principles.

The eight-step method described in this article is as follows:
1-Data collection
2-Case review
3-Isolation /Description of patterns
4-Formulation of hypothesis
5-Testing of hypothesis
6-Formulation of theories
7-Testing of theories
8-Conclusion and results

Although the data collection is extensive, it may include photos of the crime scene and it’s victims, lab and autopsy reports, witness interviews with rough sketches and all physical evidence, once you proceed to step three all blood stain patterns which were collected are isolated and analyzed objectively with no attempt to infer any meaning until all testing is done.

In my opinion this is a challenging subject to try and articulate to judge and jury, because there can be so many scenarios resulting from all the patterns and theories tested. It is few and far between when a bloodstain analyst can come up with a single definitive scenario that can explain everything. When you have one or more “what ifs” it lessens the credibility of your testimony. I think they should focus on the facts being that most cases can provide definite elimination or exclusion of particular scenarios, which is valuable information when validating either the prosecution’s or defense’s case. Therefore, the conclusion given is the most likely scenario based upon the evidence and testing done.

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Improper Medication Administration

March 23, 2009

Recently at the hospital where I work and this apparently is in all hospitals it is required to check insulins before administering the insulin to the patient. We have always used the multiple use vials drawing up the amount of units required and then having another RN check the dose and the correct insulin. Approxmmately 2 weeks ago, we went to the insulin pens. I, like a lot of my co-workers are not to fond of the pens however not many like change. Recently on one of my shifts the pens came up from the pharmacy, patients drawers are changed every 24 hours. When getting ready to administer insulin on my morning med pass I was getting ready to set the pens when I noticed the Lantus label was on the humolog pen and the Humolog label was on the lantus pen. It was definetly a good catch as the patient could have gotten a large dose of Lantus when the Humolog was indicated. The pens went back to the pharmacy and were sent back properly labeled. I have always made it good practice not to assume medications should be what they should be. I have also always had another RN co-sign with me when hanging an IV medication even before it was required. When ever I have to calculate something ,i.e. IV Synthroid, I always have another RN do the calculation to be sure my calculation was and is correct. I have never opened meds at the med care, I always check them 3 times before I administer them and check the patients name band and account number to the MAR. I have on many occasions come accross account numbers for patients that do not match and before administering the medication calling admitting to be sure the account is for the right patient, there could always be another patient in the hospital with the same name but the accounts are obviously going to be different therefore I want to be sure that the patient I have has the correct MARS. You can never be too safe when passing medications.

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Safe administration of medication

March 23, 2009

Before administrating medications to a patient, health-care professionals need to assess the benefits and risks of giving the medication, as well as provide the patient and their family with information about the drug. The individual registered nurse has a legal and professional responsibility for the safe administration of medications. The responsibility and authority of the registered nurse to administer medications and delegate effectively are often compromised in the work environments in which nurses practice. To ensure patient safety in her/his work setting and avoid detrimental effects from unsafe medication administration, the individual nurse requires understanding of the legal, clinical, and ethical standards involved in the administration and/or supervision of the administration of medications.

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Morphine; how much is too much?

March 23, 2009

Many people, including health care workers, believe that morphine is a lethal drug that causes death when used to control pain for a patient who is dying. That is a misconception according to new research published in the latest issue of Palliative Medicine; from SAGE Publications. Doctors should feel free to manage pain with doses adjusted to individual patients so that the patients can be comfortable and be able to live with dignity until the end. How much is too much? This is the big question that we as nurses often consider. From experience I have seen morphine given in small and large quantities to the dying pt, I have often wondered like many health care professionals are we assisting death by administering morphine in large doses? Will we ever know the answer, I want my pt. to be comfortable and free of pain, in the end when death is not preventable who is the most important? The pt.and his family of course, what we think doesn’t really matter.

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Drug Abuse

March 16, 2009

Drug abuse Substance abuse is the number one national health problem, causing more deaths, illness, and disabilities then any other health condition.So, whom does this affect and why is it important for the forensic nurse to be aware of substance abuse history. It can affect anyone, neonates can die from a mothers drug abuse, children and spouses, strangers can be beaten to death by an abuser. The abuser can die from substance abuse, mixing of medications, the list is endless. I wonder how many deaths are actually investigated for potential abuse or is the victim actually written off as dying of natural causes. How important is this anyway, if we are to change the system and teach the population the dangers of abuse it is critical that we have the facts.

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Improper medication administration

March 9, 2009

The administration of medications is one of the most important roles for the Nurse. We as nurse should never administer a drug until we have become familiar with its therapeutic intent, dosage, mode of administration and potential side effects. One of the most common errors I have seen throughout my career is the improper administration and follow up of epinephrine, it seems simple enough to use an epi-pen; but most health care professionals don’t know you have to hold it in place for 10 seconds, yes, I have seen this many times unfortunately, some people still give it s/c. I have talked to pts who have had an anaphylactic reaction and they have told me they didn’t go to hospital for follow up because they didn’t know. A young girl died in my home town, she had an allergy to peanuts and although she was given her epi-pen by a teacher, it was not given correctly or the teacher didn’t know to check the needle after. The paramedics didn’t check the pen either when they arrived on scene.

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Forensic Nursing in the Emergency Department

March 8, 2009

Many patients treat the emergency department as a doctor’s office for various reasons.  I believe the top two reasons are lack of insurance and the patients know that the emergency department can’t turn them away for inability to pay. The other reason is that if they are medicine shopping or trying to hide certain things such as domestic or child abuse then they can go to various emergency departments without a true paper trail. The likelihood that a doctor or nurse is going to remember a particular patient in a crazy setting such as the emergency department is rare unless it is a rural emergency department.

Unfortunately many staff members of the emergency department have grown calloused to the “repeat offenders” and don’t actually look for issues.  I can think of a time when I was working midnights in an emergency room in a small town hospital in South Carolina when we had the same drunks and druggies come in almost religiously every Friday and Saturday nights.  However, we also had this one woman who came in with various complaints that ranged from becoming dizzy and falling down stairs to playing with her kids and the ball striking her.  Being a new nurse I had just had the equivalent to a forensic nursing class prior to graduation and I questioned her repeat visits and the fact that the husband would never leave the room for us to examine or question her.  The more experienced nurses just shrugged their shoulders and said “well, at least he brings her in for treatment.”  I was appalled.  Not really knowing what to do I just ignored it also.  Then one night she came in by herself via ambulance in critical condition from what the EMS gathered was a stranger altercation.  Knowing that she came in regularly and for various injuries I grabbed the police officer investigating the complaint and told him my suspicions.  Like everyone else he started to ignore my concerns when I asked him how he would feel if this were his mother or sister and people ignored possible serious signs of abuse.  He talked with the husband and various family members who had shown up and then he called in a social worker who pulled the lady’s medical records. She had been seen somewhere around 100 times in that year for various injuries most were minor. 

This case has stuck with me over the years because I never found out what became of the lady after I moved away. My guess is she either stayed in the relationship and continues to visit the ER or she is dead.   Either way the shame of it all is that because most of the staff was calloused to seeing such things and they had never had a proper forensic nursing class to know the obvious and hidden signs of abuse this lady was continually placed back into harms way. 

The emergency department is sometimes the only place a person has to go for help.  This means that we must work as our patient’s advocate to ensure they receive the care they need.

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