Asthma

Asthma is a common condition a careful history and objective recording of simple severity markers, such as pulse and respiratory rate, blood pressure, speech, chest auscultation, mental state, and peak expiratory flow rate, should identify patients who require hospitalization or urgent treatment (Table 4) (12). Detainees with asthma should be allowed to retain bronchodilators for the acute relief of bronchospasm (e.g., salbutamol or the equivalent), with instructions left with the custody...

General Information and Epidemiology

There are five serogroups of Neisseria meningitidis A, B, C, W135, and Y. The prevalence of the different types varies from country to country. There is currently no available vaccine against type B, but three other vaccines (A+C, C, and ACWY) are available. Overall, 10 of the UK population carry N. meningitidis (25 in the 15-19 age group) (59). In the United Kingdom, most cases of meningitis are sporadic, with less than 5 occurring as clusters (outbreaks) amongst school children. Between 1996...

Transmission Through Contact With Lesions or Organisms 61 Varicella Chicken Pox 611 Epidemiology and Prevalence

Cases of this highly infectious disease occur throughout the year but are more frequent in winter and early spring. This seasonal endemicity is blurring with global warming. In the United Kingdom, the highest prevalence occurs in the 4- to 10-years age group. Ninety percent of the population over the age of 40 is immune (30). A similar prevalence has been reported in other parts of Western Europe and the United States. In South East Asia, Varicella is mainly a disease of adulthood (31)....

YHydroxy Butyrate

Y-hydroxy butyrate (GHB) is a naturally occurring substance in the human brain structurally related to GABA that may be a neurotransmitter (100). It has been used as an anesthetic (although it has little analgesic effect), to alleviate narcolepsy, and to treat alcohol and opiate dependence (101). There have been reports of abuse in the United Kingdom and United States within the dance scene and gay clubs and with body builders because it is said to promote slow-wave sleep during which growth...

Dementia

Dementia is a large-scale problem in the elderly. It has been estimated that 5-8 of patients aged 65 yr and older suffer from dementia to an appreciable degree, with the proportion probably exceeding 20 in 80-yr-olds (98). However, in many of these patients, dementia is not recognized until there is some form of crisis in their lives. Such a crisis may be precipitated by sudden illness, bereavement, or police arrest. Individuals seem able to develop strategies to cope with their daily tasks and...

Other Body Building Drugs

Other drugs may be used by body builders (93), including tamoxifen to reduce or prevent gynecomastia diuretics to counteract the fluid retention caused by anabolic steroids thyroxine to increase the rate of metabolism, which might theoretically increase the ability of anabolic steroids to boost physical strength (94) and P human chorionic gonadotrophin to alleviate testicular atrophy (95). Nalbuphine (Nubain) is an opioid agonist antagonist analgesic used for the treat ment of...

References

Police and Criminal Evidence Act 1984 (s.60 (1)(a) and s.66) Codes of Practice A-F for England and Wales. Her Majesty's Stationery Office,Norwich, London, 2004. 2. British Medical Association's Medical Ethics Committee and Association of Forensic Physicians. Health Care of Detainees in Police Stations. British Medical Association, London, 2004. 3. Stark, M. M., Rogers, D. J., Norfolk, G. A. Good Practice Guidelines for Forensic Medical Examiners. Metropolitan Police. GPG Editors, Oxford, 2004....

Diabetes

It is often desirable to obtain a baseline blood glucose measurement when detainees with diabetes are initially assessed and for this to be repeated if necessary throughout the detention period. All doctors should have the means to test blood glucose, using either a strip for visual estimation or a quantitative meter. Several small portable meters are now available. Oral hypoglycemics and insulin should be continued and consideration given to supervision of insulin injections. Regular meals and...

Types of Injury

It is important that anyone who is involved in injury assessment understand the range of terms that can be applied to different injury, and this may depend on certain factors, such as country of origin or medical specialty. Thus, each practitioner should have a system of his or her own that ensures that the nature of each injury is described clearly, reproducibly, and unambiguously in note form, using accepted terms of classification. The most common reason why medical evidence on injuries...

Antidepressants

There are many side effects associated with the use of the tricyclic antidepressants (TCAs) (e.g., amitriptyline), that are relevant to the ability to drive, such as blurred vision, slow visual accommodation, disorientation, and eye-hand coordination the most important are the induction of drowsiness, lethargy, and sedation. An analysis of 500 road traffic accidents showed that victims who had taken TCAs had a relative accident risk 2.2 times greater than non-TCA users and that patients using...

Anabolic Steroids

Anabolic steroids may be taken orally or intramuscularly by body builders or other individuals who want to enhance their physical appearance. Research has shown that injections of testosterone enanthate increase muscle size and strength, especially when combined with exercise (83). To achieve the desired effect, different steroids are taken in cycles, with rest periods in between, a regime known as stacking, or, alternatively, increasing doses of the same steroid are taken, a so-called drug...

Drink Drugs Driving Impairment Assessment Form

ASSOCIATION OF FORENSIC PHYSICIANS SECTION 4 RTA ASSESSMENT FORM (Version 6 1 1 04) Note This form has been designed by Dr Ian F Wall on behalf of the Education and Research Committee of the Association of Police Surgeons for use by Police Surgeons (also known as Forensic Medical Examiners or Forensic Physicians) who have been trained in the use of Standardised Impairment Tests, The form is provided to assist Police Surgeons in determining whether a person has a condition, which may be due to...

Treatment of Opiate Withdrawal

Symptomatic treatment of the opiate withdrawal syndrome can often be achieved using a combination of drugs, such as benzodiazepines for anxiety and insomnia loperamide or diphenoxylate and atropine for diarrhea promet-hazine, which has antiemetic and sedative properties and paracetamol or non-steroidal antiinflammatories for generalized aches. Substitution treatment may be required in more severe cases of opiate dependence using a choice of methadone, buprenorphine, or dihydrocodeine. Because...

Alcohol Withdrawal

Many alcoholics develop symptoms of withdrawal when in custody. Their acquired tolerance to and physical dependence on alcohol is a manifestation of compensatory neuropsychological changes that offset the drug's CNS depressant effects. When alcohol intake is abruptly stopped on incarceration, the compensatory changes give rise to signs and symptoms of withdrawal (176). The severity of the symptoms depends mainly on the amount and duration of alcohol intake, although other factors, such as...

Alcohol Dependence

Alcohol abuse and dependence is a major risk factor for serious health, social, and economic problems (167). Early identification of those who are dependent on alcohol increases the possibility of successful treatment, and brief intervention by the forensic physician seems both feasible and acceptable (124,168). Although not yet validated in police custody, brief interventions show a high acceptance among drinkers in licensed premises (169). However, obtaining accurate and reliable information...

Complications of Alcohol Withdrawal

Several complications of alcohol withdrawal have been recognized, any one of which may be encountered when alcoholics are detained in police custody (176). Seizures are typically single and generalized. They usually occur between 6 and 48 hours after the last drink and although in themselves are not life threatening, their importance lies in the fact that about one-third of those with seizures will go on to develop alcohol withdrawal delirium. 4.6.3.2. Alcoholic Hallucinosis This is an...

Alcohol Withdrawal Delirium

The essential diagnostic feature of this disorder is a delirium that develops after recent cessation of or reduction in alcohol consumption. Traditionally referred to as delirium tremens, this withdrawal state typically begins 72-96 hours after the last drink, so it is uncommon within the normal span of detention in police custody. The delirium is characterized by impaired attention and memory, disorganized thinking, disorientation, reduced level of consciousness, perceptual disturbances, and...

Uncomplicated Alcohol Withdrawal

This is the most frequent and benign type, usually occurring some 12-48 hours after alcohol intake is reduced, although it can develop as early as 6 hours after drinking has stopped. The essential features are a coarse tremor of the hands, tongue, and eyelids, together with at least one of the following Autonomic hyperactivity (raised blood pressure and tachycardia). Anxiety, depressed mood, and irritability. Transient hallucinations and illusions. If symptoms are mild, it is safe to recommend...

Cocaine and Crack

Cocaine occurs naturally in the leaves of the coca plant Erythroxylum coca, which grows predominantly in South America. Cocaine hydrochloride is a white powder that is usually snorted but can be taken orally. Crack is prepared by mixing cocaine hydrochloride with sodium bicarbonate and water and heating it. The cocaine base precipitates out and forms small rocks as it cools. Crack may be smoked in a pipe or heated on foil with the vapor inhaled. Both crack and cocaine may be injected. The...

Hymenal Laceration

The hymen must be examined in detail after an allegation of a nonconsensual penetrative act. When the hymen is fimbriated, this assessment may be facilitated by the gentle use of a moistened swab to visualize the hymenal edges. When the hymenal opening cannot be seen at all, application of a few drops of warm sterile water or saline onto the hymen will often reveal the hymenal edges. Foley catheters are also a useful tool to aid hymenal visualization in postpubertal females 138 . A small...

Types of Injury 31 Bruises

Tramline Bruises

The terms contusion and ecchymosis have been used to differentiate between different types of injury that can more simplistically be called bruising. These terms have been used variously to describe different injury sizes but do not enhance understanding of either causation or mechanism of injury and should no longer be used. A hematoma is best used to refer to a collection of blood forming a fluctuant mass under the skin and may be associated with substantial trauma. The difference between...

Anal Fissures Tears and Lacerations

The most frequent injuries that are documented after allegations of nonconsensual anal penetration are anal fissures, tears, and lacerations. Use of these different terminologies is confusing and makes comparing the different data impossible. A consensus should be reached among forensic practitioners worldwide regarding what terms should be used and what they mean. Clinically, an anal fissure refers to a longitudinal laceration in the perianal skin and or mucosa of the anal canal. Anal fissures...

Oleum Capsicum

Autopsy Vomitus Irritation Face

OC selectively stimulates nociceptors in exposed mucous membranes, releasing substance P, bradykinin, histamine, and prostaglandins. The physiological effects of these mediators' results in vasodilation, increased vascular permeability, pain, and altered neurotrophic chemotaxis. Other common symptoms are listed in Table 2. Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents a Initial response believed to...

Method of Sampling

Two samples must first be obtained from the perianal area. Just as when sampling the skin elsewhere, if the perianal skin is moist, the stain should be retrieved on dry swabs. If there is no visible staining or the stain is dry, the double-swab technique should be used 28 . The forensic practitioner should use as many swabs as are necessary to remove any visible stain repeating moistened swab followed by dry swab . If no stain is visible, two swabs will suffice the first wet, the second dry ....

Injuries From Handcuffs

Injuries from handcuffs either reflect relative movement between the cuff and wrist or are the result of direct pressure from the cuff to the tissues of the wrist. It is important to remember that injuries may be unilateral, especially where there has been resistance to their application. The most common injuries found are erythema, abrasions, and bruising, particularly to the radial and ulna borders of the wrist 2 . The erythema is often linear and orientated circumferentially around the wrist...

Toluidine Blue

Toluidine blue stains nuclei and has been used on the posterior fourchette to identify lacerations of the keratinized squamous epithelium that were not apparent on gross visualization 128,129 . Use of toluidine blue increased the detection rate of posterior fourchette lacerations from 4 to 58 in adult older than 19 years complainants of nonconsensual vaginal intercourse, from 4 to 28 in sexually abused adolescents 11-18 years old , and from 16.5 to 33 in pediatric sexually abused patients 0-10...