Our evening supervisor is leaving our facility because she is going to be our county nurse coroner. Nurse death examiners work for the medical examiner and investigate the circumstances of a death before the body can be released. Nurse coroners can perform death investigations, as well as issue death certificates, a responsibility that differentiates them from nurse death investigators. This nurse is excited to begin her new career. She gets to use nursing in a new light. The nursing process is always the same- assess, diagnose, plan, implement, evaluate. She will just be using these procedures in the after life. She will gain new assessment skills from the head to toe exam. She will not be able to ask questions so will have to rely on what the body can tell her. How interesting is that? I someday think I might be interested in that. I do have a major concern. That is getting shot at with a gun or stabbed with a knife. I feel safe when armed officers are present. Another thing that helps me feel safe is when I wear ballistic armor. The agency that I work for must have and buy Teflon fabric armor.
Posts Tagged ‘Death Investigation’
County Nurse Coroner
June 26, 2013Deep Vein Thrombosis
February 11, 2009Chronic Inflammation
February 11, 2009Technorati Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Diagnosis, Death Investigation, Forensic Toxicology
Autistic boy, 5, dies after controversial therapy; comment
January 9, 2009It is my understanding that chelation therapy is a safe and effective method for drawing out toxins and heavy metals. There are screening protocols in place to insure that the patient is in good health. During the therapy, blood pressure and lab values are checked, if indicated. Although the article doesn’t give the cause of death, it is hard to believe it was caused by chelation therapy.
Original Post:
September 1, 2005
Autistic boy, 5, dies after controversial therapy
taken from:
The Florida Times Union, August 26, 2005
An unproven treatment for Autism was given to a 5 year old boy that subsequently died from cardiac arrest after receiving the treatment. Though some people believe this treatment may cure this condition, it has not been proven.
The treatment is chelation and the boy had received his third treatment right before the cardiac arrest. CPR proved to be unsuccessful and more tests will need to be done to determine the exact cause of death. Many people believe the autism is linked to preservative containing mercury that is used as a preservative in vaccines used in childhood. The belief in this theory has led to people advocating the use of chelation. This substance causes heavy metals to be excreted in the urine.
This is a great article that combines ethics with FDA testing of new medications. Forensic examination may not only identify the cause of death, but the effects of the chelation on the body in general. The outcome of the tests and autopsy results in general may lead to criminal charges since this drug was unproven to help
Chelation therapy is used in the treatment of toxic levels of heavy metals. These heavy metals include iron, arsenic, lead, and mercury. Chelation binds these metals so they can be excreted in the urine. High levels of mercury are thought by some to be related to the development of autism, thus the unapproved use of these drugs in the treatment of autism.
Chelation use is not without its problems. The levels of magnesium, zinc, and potassium should be checked on this child. A decrease in the levels related to the chelation therapy can cause serious fatigue and the effects of hypokalemia could be implicated in the cardiac arrest of this child.
Hypotension is another serious effect from the therapy, and sources cite giving the aminoacid tyrosine to counter that effect. A tyrosine level may also be indicated along with levels of the heavy metals to assess if there was an initial mercury problem prior to therapy. There can also be chelation of essential minerals such as iron, copper, and zinc. All of these levels should be checked, as well as levels of the chelation medication that were identified as remaining in the body.
There are dangers of kidney damage during this therapy, especially if dehydration is present. The kidneys should be evaluated carefully during the autopsy. There is also an established physician protocol, and the manner of administration should be compared to this standard.
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Death Investigation, Forensic Toxicology, Legal Standard & Forensic Nursing
Inflammation
November 25, 2008Inflammation could relate to forensic nursing in that forensic nurses sometimes take tissue samples from the bodies they are performing autopsies on or patients they are working on that may be criminals or victims for evidence of a crime that has been committed. If the mechanism of injury or death was from trauma, there may be lasting evidence of acute inflammation in the tissues. Some signs of acute inflammation are swelling, redness, pain, heat, and loss of function. Obviously if someone is dead, they would probably no longer have those signs I just mentioned. They may however have increased neutrophil or eosinophil levels and possibly an increased amount of macrophages out of the venules and into the interstitial tissues. If there is evidence of MBP (major basic protein) present, that could serve as evidence that the person’s body was trying to fight off a parasite.
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Death Investigation, Autopsy, Forensic Nursing Assessment, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Diagnosis
Stages of Exhumation
November 19, 2008Exhumation of a forensic scene must be done meticulously to preserve evidence. Briefly, the steps are outlined here:
A. Exhumation strategies and recovery methods – All logistical details should be worked out before starting groundbreaking – Exaction grid is placed around the site and proceeded through in an orderly manner – Never mark directly on the evidence; always on the container – Record specific information on each photographic exposure including date, time, and personnel involved.
B. Postmortem identification of remains – Bodies and remains are transported to the lab where they are first radiographed before forensic autopsy – Goals of autopsy are identification, documentation of injury, determination of cause and manner of death.
C. Reconstructing crime scene and criminal events leading to death – It must be determined whether assault took place at the grave or if the bodies had been moved to the grave site after death occurred – 3 stages of change after death: early, late and tissue changes.
D. Identifying and prosecuting the criminal – Obtaining physical evidence.
References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby
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Death Investigation, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Exhumation
Excited Delirium Syndrome
November 19, 2008Excited Delirium Syndrome is a cause of sudden death on an individual who is confused, irrational, delusional and violent. They may present high risk in this manner: a. A prior episode of excited delirium b. Violent and aggressive behavior c. Use of medication that increases the release or blocks reuptake of norepinephrine d. Cardiac disease e. Asthma or any pulmonary disease involving restriction of airway f. Epilepsy g. Use of stimulants such as cocaine and methamphetamine Age is not a factor. Behavior characteristics are: a. Verbal threats of violence b. Screaming, swearing, shouting at others c. Breaking or throwing objects d. Motor agitation, rigid/taut body expressions with poor concentration e. Projecting angry emotions onto another (e.g. blaming) f. Nonverbal behavior of rejecting others g. Pacing, restlessness, inability to sleep or eat, hyperactivity, history of violent behavior with need for physical restraint h. Delusions and confusion of mental state i. Defiance j. Bullying others k. Using stimulants (e.g. cocaine, methamphetamine) l. Paranoid behavior with auditory hallucinations. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby
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Death Investigation, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Diagnosis, Forensic Nursing Mental Health Assessment, Forensic Nursing Theories
Taphonomy
November 19, 2008Taphonomy is the fascinating science of the study of human remains after death. It has been used both as an anthropological sense such as “the Ice Man” from 5300 years ago and King Tut’s remains from 1343 BC. It is also useful as a forensic tool. Anthropologists, archaeologists, botanists, naturalists and climatologists are all team players involved in the process. The key questions that anthropologists must answer are: a. Are the bones from an animal or a human? b. If human, what are the approximate age, race, gender, and stature of the individual? c. Have scavenging animals disarticulated the body or damaged bones? d. If there are defects in the body assemblage, were they caused by premortem or postmortem events? e. What effects have plants, animals, weather, and climate had on the body over time? References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby
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Death Investigation, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Corpse Identification
Sexual Assault Homicides
November 19, 2008It is interesting to note that 44% of sex-related homicides are committed by family members and about one third of these are spouses. This is shocking. Domestic violence laws have come a long way over the past twenty years in this country, but still, the unwillingness of the victim to leave such a situation is heart-breaking. These crimes are said to be repetitive, serious and shocking with the offenders carefully covering their tracks. Of course, the victims have been intimidated and threatened into submission and fear for their lives; this is why they do not flee. They believe they cannot exist without the spouse or significant other in their life. Indeed, these malicious individuals are sexual predators that must be brought to justice. Emergency department nurses need to take a more active stand when victims come in with injuries before the violent outbursts escalate to stop this senseless cruelty. This Forensic Nursing course has opened my eyes to a lot of information. I am much more careful about my documentation and openly direct and blunt with my patients. If I can save one individual, I feel I have done my job. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby
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Death Investigation, Domestic Violence, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Diagnosis, Forensic Nursing Theories, Sexual Assault and Forensic Nursing
Autoerotic Fatalities
November 19, 2008This course has truly revealed my naiveté even though I have considered myself a seasoned emergency department nurse. I was astounded to learn that people indulge in sexual preferences that are of such risk-taking that might lead to their death by asphyxiation, chains, infibulations, or other masochistic behavior. Unfortunately, they can very easily be misconstrued as a suicide attempt. In reading this chapter, I can very well understand how a lonely individual with misguided thinking could indulge in fantasies that could lead to dangerous paths leading to sexual arousal. Unfortunately, when their risk-taking fails due to the lack or inaccessibility of a self-rescue mechanism, all bets are off. One could also wonder if disapproving significant others contribute to the demise – in this case leading to a homicide. I have personally witnessed many “huffers,” cutters, and those who have used bondage and plastic bags for induced suffocation to obtain a high. Fortunately, for the most part, they have been “found” in time, although we did have one girl who I believe was truly suicidal who came in with a note pinned to her nightie that read “this time I did it right.” Autoeroticism is one area I hope I do not bear witness to very often, however. This must be a devastating way to die. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby
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Death, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Diagnosis, Forensic Nursing Theories, Autoerotic Fatalities, Death Investigation
Forensic Nursing Chronicles 