SOFT - TIAFT 1998 Scientific Session 4 Thursday October 8, 1998
Click Picture Kari E. Blaho, Stephen L. Winbery, Lynda J. Park, Steven B. Karch1, Barry Logan2, Wendy Gunther3

Department of Emergency Medicine, UT Medical Group, Memphis, TN, USA
1. San Francisco Medical Examiners Office, San Francisco, CA, USA
2. University of Washington, Seattle, WA, USA
3. Department of Pathology, University of Tennessee, Memphis, USA

A 35 year old man was brought to the emergency department at an inner city hospital because he was throwing objects from a balcony and was eating dirt and glass. His medical history was significant for cocaine abuse and a psychiatric illness. On arrival he was noted to be combative and was placed in an isolation room. At this time, his vital signs were: blood pressure 120/60 mmHg, heart rate: 60 bpm, respiratory rate 18/minute, temperature 98.0°F. The patient was found to be pulseless and without respiratory effort one hour after his last evaluation by a nurse. Resuscitative efforts were unsuccessful. The cause of death was listed as cardiopulmonary arrest from an unknown cause. Postmortem findings were significant for the presence of cocaine, petichae, an enlarged heart and areas of myocardial fibrosis consistent with chronic cocaine use. Review of the medical record revealed several discrepancies that make it difficult to determine a cause of death. The patient had presented with two prior episodes of acute cocaine intoxication that had similar features except on the two previous occasions the patient was hypertensive and tachycardiac. Sudden death within 48 hours of cocaine use is usually attributed to cardiac arrhythmia. It is most likely that this patients death was related to cocaine use. The etiology of sudden, unexplained death in the clinical and forensic setting, the importance of chart interpretation and the role of postmortem analysis will be discussed in light of other cases and animal studies.

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