Autopsy and toxicology report?
I'm not sure where I should be posting this question.
I have a autopsy and toxicology report of a 26 yr old male who weighed 65 kgs.
Paramedic were called to his home where he was found unconscious. They administered diazepam, atrophine, epinephrine because he was seizing. He went into cardiac arrest, he was given 1.5 mg/kg lidocaine via IV and he was resuscitated and intubated. When he arrived at the hospital he was unresponsive. Girlfriend says there is no use of any alcohol or illicit substances.
His ABG came back with the results of metabolic acidosis.
He went into cardiac arrest and died later that night
Autopsy report says:
- acute ischemic injury brain, pituitary gland, liver, stomach, small bowel, colon and adrenal gland
- acute bronchitis
- bacterial colonies lungs
- portal chronic inflammation liver
- chronic persistent hepatitis
- multiple linear rows puncture scars right left hands
- punctured dorsal left foot and right forearm
organizing linear thrombus, superior vena cava
- circular burn skin chest
Toxicology report says:
- diazepam 0.14 ug/ml
- alcohol 0.02 mg/100ml
- lidocaine 4.2 ug/ml
- benzoylecgonine 1.3 ug/ml
- benzoylecgonine 28 ug/ml
- caffeine 9.2 ug/ml
-ephedrine 8.6 ug/ml
- benzoylecgonine 1.6 ug/g
And from the autopsy findings the family is now suing the hospital for negligence.
My questions are:
- On what grounds would the family have to sue? This confuses me.
- Are the toxicology levels high?
- Is there anyway I can determine when he used cocaine and/or how much he used?
- The puncture scars on hands represents injection sites? Injection of cocaine maybe? I'm thinking he was a chronic drug abuser and/or alcoholic.
If anyone can help my try and figure out any of these questions or if you have input in to what you think these results indicate please do so.
Thanks in advance
- mildred fLv 77 years agoBest Answer
It would be important for his family to review this report carefully with the attorney. One of the attorney's probably has an investigator, a nurse probably, that can tell this family that he had died of a cocaine overdose. It shows he was self-medicating and had been for a long time.(Hands and feet.) Hepatitis is not a cause for immediate death. So that means he was doing this for a while. What he died of was a severe cardiac failure, a constriction of sorts, caused by illegal drug use. Cocaine is a powerful vasoconstrictor. It keeps the heart from pumping. This caused the development of large blood clots that ultimately killed him. Blood was not moving. In the ACLS protocol, there are reasons why people have an arrest. Clots is a biggie! Cardiac vasoconstriction means the heart is not really beating (effectively), certainly not pumping. is another.
The family can sue anybody if they wish. Winning is not going to happen. His hepatitis indicates he had been doing this, probably for years. He had bronchitis, maybe he had this before, maybe it was very recent, say from aspiration recently. It did not happen with the resuscitation.
I can see the EMS guys using the diazepam for the seizure. People have a seizure at death sometimes. Sometimes they throw-up. Or both. A dose of magnesium would have been a better agent to use IV to relieve this cardiac vasoconstriction. But I bet they had no time to add this.
All the blood levels look reasonable, those that the EMS gave. No one is supposed to have alcohol in their system. But sometimes, everyone has a drink. He had one or more drinks within hours of this. He also took an energy drink that was loaded with caffeine.
The ischemia in several organs happens to everyone, so you expect that with an arrest. Metabolic acidosis would be expected and normal in this situation.
People who do cocaine will often do an upper together with cocaine. This is called speed-balling. A way to organsm much longer. John Belushi, if you remember him on SNL in the 70's, did this and it killed him, the speed-balling. A lot of people have too much money and so do cocaine. So it is really a case of the fittest that survive.
You can tell his family that the hospital cannot revive someone in this state. Cardiac arrest/resuscitation is not a high percentage kind of thing even on a good day. Give them stats about that. They are poor. Then talk to them about the stats of survival from cardiac arrest with Cocaine. They won't believe it isn't the hospital's fault. So present them with his lab reports and an internet article about the metabolite of cocaine.
* * *
The husband of one of my bosses died in a similar manner. No one said what the reason for this was. he had been fine, had played golf with his buddies that very afternoon. Then we found out through the grapevine. Cocaine. Looked and acted perfectly normal for years. Died of it. Not even an organ donor.Source(s): RN, retired firstname.lastname@example.org