Evidence. It’s more than blood, hairs and fibers found at the crime scene.
The body can harbor many forms of evidence whether on clothing still worn by the victim upon initial assessment by paramedics or on the skin surface and within the depths of wounds encountered the surgeon. Wound patterns also have evidentiary value. The death of victims of homicidal violence or suspected foul play will come under the jurisdiction of the Medical Examiner or Coroner. Meticulous documentation, collection, and scientific analysis of bodily evidence will follow.
Test your knowledge on this topic with the following PPQ (Practice Pearls Quizlet):
1. A patient is pronounced dead on arrival as a result of multiple gunshot wounds and is placed in the hospital’s secure morgue room. Family members arrive and are told of the tragic news. They request the deceased’s clothing and personal effects.
True or False. All clothing and personal effects may be released to the family.
2. A victim of a single stab wound of the chest expires despite surgical intervention. Blood-soaked clothing accompanies the victim. The clothing should be handled in which of the following manners:
a. The clothing should be washed and given back to the family
b. The clothing should be sealed in a paper bag labeled with the patient’s identifying information, signed and dated, and placed in a secured, monitored room within the hospital
c. The clothing should be sealed in a plastic bag labeled with the patient’s identifying information, signed and dated, and placed in a secured, monitored room within the hospital
3. A patient expires as a result of multiple gunshot wounds and is pronounced dead in the emergency room. A handgun is found in a pocket of the patient’s clothing. The best practice would be to:
a. Give the gun to the next-of-kin for safekeeping
b. Examine the weapon to make sure it is “safe”
c. Refrain from handling the gun and notify law enforcement immediately
4. A patient with a known history of viral hepatitis is the victim of homicidal violence and is pronounced dead 2 hours after arrival despite therapeutic intervention. The patient’s hands are bloody with adherent debris . The best practice would be to:
a. Secure plastic bags over the hands to provide a barrier against blood borne pathogens
b. Secure paper bags over the hands to contain any potential foreign material
c. Wash all blood and debris from the hands with antiseptic soap
5. An 8-month old infant is brought to the emergency room unresponsive by a frantic caretaker. Resuscitative efforts are unsuccessful and the infant is pronounced dead an hour after arrival. On initial clinical assessment, the physician notes a bite-mark-type abrasion the upper right arm and numerous bruises of various ages on the infant’s torso, arms and legs. Imaging also reveals rib fractures of various ages. The parents arrive and are told the tragic news. They ask to hold the infant. The best practice would be to:
a. Remove airway and intravenous tubes, clean the infant, and allow the parents to hold the infant
b. Inform the parents that while they cannot be permitted to hold the infant, pending notification of the Medical Examiner and police, the infant’s clothing will be released to them
c. Swaddle the infant in a clean hospital sheet placed over the sheet used during resuscitation, with all resuscitative devices left in place, and allow parents access to the infant to grieve, but within direct sight of a police officer; notify police and report the death to the Medical Examiner; secure all clothing according the established hospital protocol
6.. A patient presents to the emergency department in extremis as a result of a perforating gunshot wound to the left lateral chest in the region of the 6th intercostal space, exiting the same level on the right lateral chest.
True or False. The chest wounds are ideal ports for placement of chest tubes.
…To be continued and tune in to the next episode of Practice Pearls!