The entity, Excited Delirium Syndrome, has been the focus of much discussion over the past 10 to 15 years. Typically, this entity is used as the cause of death of highly agitated persons who are in police custody, who are not uncommonly restrained and or incapacitated by electrical devices. Following a complete autopsy, the forensic pathologist cannot define a specific anatomic cause of death, but frequently identifies psychostimulant intoxication, such as methamphetamine and cocaine, often in the presence of alcohol, as a contributing factor underlying causation of death.
Due to these individuals presenting in such an agitated and bizarre manner, police officers are often called to the scene. The usual course of events is after the police have witnessed their behavior, there is an effort to restrain the individual using various methods of force, such as maximal restraints, baton strikes, chemical “pepper” sprays or electrical devices. Not uncommonly, during or after the use of such methods of restraint, the individual suddenly experience a cardiac arrhythmia, which culminates in sudden cardiac death.
Pathophysiologic process which leads to sudden death in Excited Delirium Syndrome
Excited Delirium Syndrome-2018
William A. Cox, M.D., FCAP Forensic Pathologist/Neuropathologist
October 18, 2017
At this point in my career I have practiced Forensic Pathology for 43 years and Neuropathology for 41 years. Some of the most contentious cases I have had to deal with are those involving the death of a child in which non-accidental injury, child abuse, is believed to be the under lying causation of death. The determination of the cause of death in a child requires the forensic pathologist performing the postmortem examination to have a thorough understanding of the investigatorial information surrounding the circumstances, which led to the child’s death, as well as their past and present medical records. It is also essential the forensic pathologist approaches the clinical history, medical records and the findings of a very thorough autopsy in an unbiased and objective manner, free from all prejudice, and exercising eminent fairness in evaluating all facts of the case. It is equally important the forensic pathologist consider all literature related to the issues deemed responsible for the child’s death and not just the child abuse literature. It is important in the evaluation of alleged cases of child abuse that there be consideration of the non-CAC (child abuse community) peer- reviewed literature that challenges, if not refutes many of the unproven CAC teachings. Consensus statements from the American Academy of Pediatrics and the Society for Pediatric Radiology in-of-themselves do not create or validate science. Continue reading Child Abuse and the Lack of Intellectual Integrity
This blog article is a synopsis of our latest Forensic Science Newsletter ‘Rifled Weapons.’ If you wish to receive the full article and additional forensic pathology newsletters, please sign up using the form at the bottom of this page.
Rifled weapons include handguns, pistols and revolvers, and rifles. These are weapons in which spiral grooves have been cut into the length of the interior or bore of the barrel (Fig. 1). Rifling consist of ‘lands’ and ‘grooves’ (Fig. 2). The ‘lands’ grip the bullet as it passes down the barrel, giving the bullet a rotation, which has a gyroscopic effect that increases the stability of the bullet’s trajectory and thus its accuracy (Fig. 3). In contradistinction to rifled weapons, shotguns are smooth bored. This is because rifling in a shotgun barrel would cause the shot to disperse to quickly in a 360 degree arc.
Continue reading Rifled Weapons: A Forensic Analysis
What is gunshot residue, and how does it help investigators understand crime scenes?
Our most recent Newsletter “Gunshot Residue Analysis” provides a detailed analysis of the topic while the following blog article provides a cursory review of the topic. You can also sign up here to receive our Forensic Science Newsletter by email.
Gunshot residue – often abbrevieated as GSR – is the material that is deposited on the hands or clothing of someone who has:
- Discharged a firearm.
- Was near a firearm as it was discharged.
- Handled a recently discharged firearm.
- Touched an object that was handled by a person who has discharged a firearm.
In addition, GSR may be present on an entrance or exit wound, or on materials that were targeted by a firearm. Continue reading What is Gunshot Residue?
Recently, an advisory committee to the FDA has recommended codeine be contraindicated for pain and cough management in children and adolescents due to concerns for respiratory depression and death. This FDA warning was also extended to prescriptions of codeine to nursing mothers.
In Europe, codeine is contraindicated in children under age 12 for cold or cough, and the European Medicines Agency recommends against using the drug in those age 12 to 18 years-of-age who have breathing difficulties.
This article explores the foundation for the necessity of this recommendation.
Understanding the metabolism of codeine is important for the clinican and forensic pathologist