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True or False: It is always obvious at the scene that the death was caused by drugs or toxins.
Most often there is no visible indication of drug exposure.
What are some examples of drugs or paraphernalia you might find at a scene?
Packaging and transport material, syringes, homemade pipes, scales, prescriptions medications not belonging to the decedent, packets of powder, tablets, "cooker" (spoon or bottle cap used to heat the powder), tourniquets, etc.
What is a 'body packer'?
Someone who ingests packets of drugs in an attempt to smuggle them somewhere. Death results when the packets, usually condoms or ballons, leak or burst inside the gastrointestinal tract resulting in an overdose.
What are some of the key indicators at autopsy of intravenous injection?
Recent needle puncture wounds, Needle tracks or track marks, and skin popping
What are the most common places to finding injection sites?
forearms, antecubital fossae, hands, feet
concealed places like: within a tatoo, the genitals, skin folds, under the tongue, between fingers or toes
Linear raised scars overlying sclerotic and scarred subcutaneous veins are known as what?
Needle tracks or track marks
What are track marks the result of?
the deposition of carbonaceous material present on the needle from flaming it
What is skin popping the result of?
- -subcutaneous of intramuscular injection
- -the drug is injected without attempting to enter a vein
A chronic snorter of cocain will develop a _______ _______ septum.
With intravenous injection, what autopsy findings are observed with respect to the liver?
liver disease, cirrhosis, enlarged lymph nodes around the lever
Microscopic foreign material can be found in the skin of the injection site, the lungs, or liver. Where does this material come from?
- -talc used to cut powdered drugs
- -fragments of cotton used to filter the drug mixture
- -filler materials in tablets crushed then injected
What does IVDA stand for?
intravenous drug abuse
Endocarditis, tetanus, hepatitis, lung damage and scarring, cellutlitus, and deep tissue infections are all possible complications of_____?
intravenous drug abuse
What are the routes of administration of cocaine?
injection, nasal insuffiation or snorting, smoking, ingestion, topical
What are the different forms of cocaine?
- cocaine hydrochloride
- -rock cocaine
- -snorted or injected
- free base cocaine or 'crack'
Benzoylecognine and cocaethylene are metabolites of which drug?
How long can cocaine metabolites be detected in urine?
True of False: A dose of cocaine must be at least 1 gram to be lethal.
Any dose of cocaine can be lethal.
True or False: Cocaine causes one of the strongest psychological compulsions for continued use of any drug.
Excited delirium, euphoria, increased alertness, loss of appetite, and paranoia are all possible psychological effects of cocaine.
Opium can be processed to make ______ which can then be processed to make ______.
The routes of administation for opiates are:
injected, ingested, smoked, snorted
Hydrocodone, methadone, and codeine are semi-synthetic forms of what type of drug?
What are the other street names for heroine?
brown tar, china white, black tar, and speed ball
What is the legal ethanol limit for driving?
0.08- 0.10 gm% depending on jurisdiction
What is the lethal concentration of ethanol for fatal CNS depression?
What are some of the medical problems that can be caused by ethanol abuse?
fatty liver (steatosis), cirrhosis of liver, esophageal varices, ascites
What is the over-the-counter brand name for acetaminophen?
What is acetaminophen?
non-opiate analgesic and antipyretic
What is the lethal dose of acetaminophen of children and adults?
- Children - 4gms
- Adults - 20gms
What are the four phases of acetaminophen poisoning?
- 1) 24 hrs - gastrointestinal distress
- 2) 1-2 days - quiescence with apparent recovery
- 3) 3-4 days - jaundice; elevated liver enzymes
- 4) 4 days- 2 weeks - liver failure
- -analgesic, antipyretic, anti-inflammatory, anti-clotting effects
- -lethal dose 2-5 gms
What effects can aspirin poisoning have?
respiratory alkalosis and metabolic acidosis
What are some of the challenges with postmortem toxicology?
- -lack of historical information
- -changes in drug levels after death
- -improper sampling
- -contaminated sample
- -some drugs not identified in a routine screen
What kinds of samples are collected for toxicology?
blood, urine, bile, vitreous fluid, gastric contents
sometimes: tissue near injection site, liver, kidney, brain, lung, muscle
What does toxicology look at in exhumed bodies?
heavy metals (arsenic), morphine, carbon monoxide, barbiturates