heroin and Drowning

Topics: Altitude Sickness; Central Nervous System Diseases; Dextropropoxyphene; Drowning; Ethchlorvynol; Hemodynamics; Heroin; Humans; Lung; Oxygen; Pancreatitis; Pulmonary Edema; Respiratory Distress Syndrome; Respiratory Therapy; Salicylates; Smoke; Syndrome

Experience with several, previously unreported, intentional face-first immersion burns led us to evaluate the distribution of inflicted and unintentional immersion scald burns in a hospital series.. (1) Authors' clinical and legal practices; (2) Burn center at regional Level 1 trauma hospital.. : (1) Case series of face-first, inflicted immersion burn victims; (2) Consecutive hospitalized scald burn victims younger than 5 years old, 1/3/1996 to 3/25/2000.. (1) Individual case reports; (2) Retrospective records review. Simple descriptive statistics, Fisher Exact test and t test.. (1) Six cases of inflicted head and neck immersion injury are described. Four were tap water and 2 food/drink scalds. (2) 22/195 hospitalized victims had sustained immersion burns, 13 from tap water and 9 from other fluids. Six (46%) tap water immersions and no (0%) other immersions had inflicted injuries (P = 0.05). Two of the tap water immersions and one other source immersion included burning of the head and neck. Of these, one tap water immersion, but no other immersion, was inflicted. In no patients were head and neck injuries the sole or predominant site of scalding. In all, 9 children sustained inflicted scalds. Bilateral lower extremity tap water immersion scalds occurred in 100% (6/6) of abusive and 29% (2/7) of unintentional injuries (P = 0.02). Buttock and perineal injuries occurred in 67% (4/6) inflicted versus 29% (2/7) unintentional tap water immersion scalds (P = 0.28). Other fluids caused bilateral lower extremity immersion burns in 3/9 (33 %) unintentionally injured patients, but no abused children (NS).. Craniofacial immersion injury, although seen by the authors in legal cases, is infrequent. It was present incidentally in one inflicted tap water burn in the consecutive hospital series. This series affirms the predominance of bilateral lower extremity burns in inflicted tap water immersions. Buttock/perineal immersions were more common with abuse than with unintentional injury.

Topics: Accidents, Home; Baths; Burns; Buttocks; Child Abuse; Child, Preschool; Craniocerebral Trauma; Drinking; Drowning; Facial Injuries; Fatal Outcome; Female; Heroin; Homicide; Humans; Immersion; Infant; Leg Injuries; Male; Perineum; Washington; Water

To investigate the possible causes of unexplained hemorrhage into the neck musculature in deaths due to drowning, all cases of drowning between the years 1985 and 1995 examined by members of the Department of Forensic Pathology, University of Sheffield were reviewed. Cases were selected in which hemorrhage was found within the neck musculature but in which no apparent explanation for the hemorrhage, such as compression of the neck or trauma, was present. Eight cases were identified from a total of 99 deaths from drowning. Postmortem hypostasis was distributed in the back or diffusely in 6 cases and in the face in 3 cases. The degree of decomposition varied but was severe in only 1 case. A raised blood alcohol level was detected in 3 cases. Anterior neck compartment hemorrhage is probably due to hypostasis in a high proportion of cases. The Prinsloo and Gordon artifact may be an operative factor in at least some cases. Hemorrhage may result from violent neck movements during the process of drowning. Apparent "bruising" of the neck musculature does not always indicate compression of or trauma to the neck.

Topics: Adult; Aged; Aged, 80 and over; Depressive Disorder; Drowning; Ethanol; Hemorrhage; Heroin; Humans; Middle Aged; Muscular Diseases; Neck Muscles; Prevalence

Both acute overdose reaction and near-drowning may present as pulmonary edema. With both, the heart is usually not enlarged and clearing occurs within 48 hours, unless complicated by infection or aspiration. In near-drowning there is metabolic acidosis, whereas in acute overdose reaction there is combined respiratory and metabolic acidosis.

Topics: Adult; Barbiturates; Carbon Dioxide; Cardiomegaly; Dextropropoxyphene; Diagnosis, Differential; Drowning; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Oxygen; Pulmonary Edema; Radiography; Substance-Related Disorders