Accidental death from hydromorphone ingestion

Abstract: A 15‐year‐old male orally consumed an unknown but fatal amount of sustained release hydromorphone. He was naïve to opioid use. No other drugs or alcohol were involved. The cause of death was acute aspiration‐related bronchopneumonia, secondary to hydromorphone ingestion; the manner of death was accidental. Hydromorphone and hydromorphone‐3‐glucuronide were quantified in postmortem fluids by tandem liquid chromatography–mass spectrometry. The hydromorphone concentrations in the peripheral blood, urine, and vitreous humor were 57, 4460, and 31 ng/mL, respectively. The hydromorphone‐3‐glucuronide concentrations in the corresponding three fluids were 459, 36,400, and 40 ng/mL. Hydromorphone‐3‐glucuronide accumulation probably did not contribute significantly to the opiate toxicity. The proposed minimum lethal hydromorphone blood concentration in the nontolerant user is in the vicinity of 60 ng/mL.     

Accidental death resulting from acetylene cylinder impact

Acetylene is an inflammable gas commonly used for welding in small-scale industries. We present a case of a 34-year-old male welder who died following injuries sustained from explosion of an acetylene gas-welding cylinder. In this case report, we discuss the circumstances leading to the explosion of the welding cylinder, the autopsy findings, and a brief review of the literature on deaths resulting from blasts of acetylene cylinders.     

Accidental death by nitrous oxide inhalation

Nitrous oxide is a popular inhalation anesthetic-analgesic agent. Its euphoric action and its availability have led to its abuse. We report a case of fatal accidental asphyxia due to nitrous oxide abuse. The deceased was a hospital worker who had access to the hospital supply of nitrous oxide. His death was due to hypoxemia and asphyxiation, secondary to nitrous oxide inhalation.     

Suicidal gunshot to the nape from a small-bore rifle

A 55-year-old man was found dead on the bed lying on his side in a pool of blood with a bullet entrance hole in the nape. Behind his body, a semi-automatic rifle Remington Nylon, cal. .22 LR, was detected. As the gunshot entrance site was rather unusual for suicide, a forensic autopsy was performed, which showed a contact shot to the nape with the bullet path running upward to the left frontal area. The man had been treated with citalopram for delusional depression, so that a suicidal act seemed plausible, and the autopsy and criminalistic findings were also compatible with this assumption. A remarkable fact of the present case is that a long firearm had been used. Reports on suicidal shots to the nape are comparatively rare in the medicolegal literature and usually refer to pistols or revolvers.     

Accidental death due to falls at work

The phenomenon of accidental death due to falls at work was studied: 15 cases that occurred during the years 1983-1987, in which a worker died from a job-related fall, are presented in some detail. A discussion follows in which risk factors for these incidents are presented along with suggestions about how to investigate such cases.     

Accidental death with tear gas pen gun: a case report.

A case of accidental death resulting from a dropped tear gas pen gun is described. Tear gas pen guns can be easily altered to fire regular ammunition and can accommodate a variety of ammunition. Other similar pocket-sized weapons are mentioned.     

Accidental death by gunshot wound — fact or fiction

Accidental deaths by firearm injury were studied over 11 years, 1972–1982, in Metro-Dade County. A total of 54 cases were studied. After noting the percentage of the cases that occurred by year, the age, race, sex, of the victim were tabulated. Type of weapon, body part involved, whether self-inflicted or not, blood alcohol of victim were also studied along with scene circumstances. A final admonition to the reader on how to handle such cases is discussed.     

Accidental death of disoriented persons in long term care facilities

Five cases of accidental death occurring in connection with physical restraints in long-term care facilities are reported. The position in which the deceased were found, autopsy findings, police investigations as well as the evaluation of each case under criminal law are described. The investigations by the prosecution as well as the attention of the public media have meanwhile contributed to an improvement of the technical standards and a reduction of the risk in applying such restraints under the Law on Medical Devices.     

The nature of the deposit of substances in gunshot injuries from a smooth-bore hunting rifle]

Direct microscopic examinations of plain-barrel hunting gun-shot wounds may reveal on the victim's skin or clothes starch or paraffin particles or impressions thereof (a secondary shell trace). These data may evidence a specific charge of the cartridge and be used to specify the distance from which the shot was made, with an obligatory experimental shot made in each case.     

Accidental dichloromethane fatality: a case report

A case of accidental dichloromethane poisoning by inhalation is presented. It is of interest that carboxyhemoglobin levels were within the normal range, suggesting that the narcosis and respiratory depression were due to the direct effect of DCM on the central nervous system. The accidental death was attributed to improper ventilation of vapors in the working area.     

Accidental electrocution during autoeroticism: a shocking case

A case of atypical autoerotic death is described. An 18-year-old white man clad in two brassieres was found dead in his bedroom by his brother. Two wet green terry cloths were under the brassiere cups, connected to the house current via two metal washers and a bifid electrical cord. Literature depicting nude women was found near the victim. Autopsy revealed second-degree and third-degree burns of the mammary regions. Death was attributed to accidental self-electrocution. The authors will discuss typical and atypical forms of autoerotic death.     

Penetration of a piece of World War II rifle grenade initially suspected as a stab wound

The authors report the case of a 58-year-old man found dead by his son in the forest where he had gone to cut wood for winter. Initial examination showed an upper left laterocervical wound compatible with a stab wound. Radiography and autopsy performed the next day showed a piece of metal located in the left part of the occipital bone, associated with a half-ring fracture of the occipital bone and consequent diffuse subarachnoid hemorrhage. Death was attributed to a spinal shock after impact at the cervicocephalic junction. Investigators returned to the scene and found a few more metal elements and also a 20-cm deep and 40-cm wide crater underneath a fire the deceased had set. Army experts concluded that the metal pieces belonged to an ATM 9 antitank rifle grenade used by the U.S. Army during World War II. Death was considered accidental, the deceased having unfortunately set a fire over the grenade.     

Accidental ligature strangulation due to a roller-type massage device

A case is reported in which a woman was accidentally strangled when her blouse became entangled in a roller-type electric massage device that she was using to massage the back of her neck. Accidental strangulation in adults, outside of the workplace, is uncommon, and to our knowledge this is the first reported case of a strangulation due to this type of device. The findings of this interesting and unusual case are presented.     

Accidental hanging by a sweater: an unusual case

An accidental atypical hanging with the collar of a sweater is reported. A 67-year-old man was found dead in the sitting position with the collar of his sweater hanging off the brake handle of a motorcycle. Autopsy findings revealed a ligature mark on the surface of the neck; hemorrhages in the sternohyoid muscles; submucosal hemorrhages in the left greater horn of the hyoid bone; a large degree of submucosal petechial hemorrhages in the larynx, oral mucosa, and palpebral conjunctivae; and dark-red liquid blood with little clotting in the heart cavities. The alcohol levels in the blood and urine were 2.84 mg/ml and 3.52 mg/ml, respectively. It was concluded that the man had died from hanging by the sweater, and it was speculated that when he became inebriated, he might have lost consciousness and then fell with the collar of his sweater hanging from the brake handle of the motorcycle.     

Sudden death from asthma

Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, University of Bergen during the period 1977-1986 were recorded. There were 11 cases with information in the police report of the use of pressurised bronchodilating aerosols prior to death. Seven of the victims were found with the aerosol in the hand or close by the body. Overdosage due to excessive inhalation were suspected in several of the victims. The possibility of side effects due to overuse is discussed. Other mechanisms of death are also discussed.     

One-in-a-million shot: a homicidal thoracic air rifle wound, a case report, and a review of the literature

A homicidal shooting with an air gun is reported. The history, mechanisms of action, and crime scene implications of air guns are discussed. The wounds produced by air guns are compared to those produced by powder firearms.     

Sudden death from tubercular myocarditis

Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.     

Diagnosing death from burn shock

Morphological changes were studied in the organs of 28 victims dead from burn shock at the age of 20-65 years and in rabbits in which burn shock was induced. Histological sections were stained with hematoxylin and eosin, Sudan III, by Regaud's method; brain sections were stained by Nissl's and Brachet's methods and examined by electron microscopy. Morphological criteria of burn shock were determined, underlying the specific features of thermal injury.