Medical Intervention

Question 1

What can medical intervention lead to

Answer 1

spurious findings and misinterpretations without adequate history

Question 2

Information you should get

Answer 2

Including time of intervention relative to the time of sampling
Hospital or autopsy samples
Type of intervention
Rationale for intervention

Question 3

Tox. specimens after hospitalization with survival time

Answer 3

Not unusual for a person to be hospitalized for hours or days before death
Time for significant metabolism
Important to document date/time of draw
Subdural hematoma
Blood sequestered from general circulation

Question 4

Stomach lavage

Answer 4

Physical removal of a drug by nasogastric suctioning

Question 5

IV artifacts

Answer 5

Many drugs are administered via an existing IV line
If blood at autopsy or the scene is drawn thru the in-dwelling line
Potential for an artificially elevated drug concentration in the collected sample

Question 6

Fluid resuscitation

Answer 6

Significant variation in Heart Blood Alcohol concentrations as compared to vitreous, femoral, and/or urine concentrations at the agonal stage
Other drugs as well
diluting due to central line

Question 7

Tracheal Lidocaine

Answer 7

Endotracheal intubation for cardiopulmonary resuscitation
Tubes coated with xylocaine [2% lidocaine] jelly
Short period of time during unsuccessful resuscitation sufficient for significant diffusion from the trachea to heart blood
can get high concentration

Question 8

Lidocaine in Urinary Bladder

Answer 8

Lidocaine gel is widely used as a local anesthetic lubricant on various forms of transurethral instrumentation [e.g., catheters]
Positive urine samples

Question 9

Carbon monoxide poisoning

Answer 9

Greater than 50% COHb sat lethal
Oxygen therapy shorten half life
can use high O2 therapy
Atherosclerotic coronary vascular disease
Low conc CO may result in death [20-30%]
Hyperbaric chambers

Question 10

Other drugs that you can see due to medical intervention

Answer 10

benzo- sedation/agitation and intubation
Lidocaine
Atropine
Pressor agents
Ketamine- sedation and adjunct in chronic pain
Anticonvulsants-tx for prophylaxis for seizures
Fentanyl or propofol -surgical anesthesia

Question 11

End of care

Answer 11

Withdrawal of life support from critically ill patients
Hospice care
Sedatives and narcotic analgesics routinely utilized
Pain treatment,Air hunger,Agitation

Question 12

Elderly hospice pts

Answer 12

Dx: bone cancer with metastases
Medications supervised by nurse
Ativan
Morphine
Last hour of life increased pain and air hunger