Medicolegal

Question 1

What are body packers and body stuffers?

Answer 1

• BODY PACKERS deliberately ingest a large amount of well packaged drugs for the purpose of smuggling.
• BODY STUFFERS swallow small amount of illicit drugs usually poorly packaged to avoid detection by the police at the point of arrest.
• PARASCHUTING intentional ingestion of drugs wrapped in a covering that is intended to dissolve to release the drug for later absorption.

Question 2

Indications for urgent surgical removal of suspected drug packages.

Answer 2

1. Obstruction or illeus
2. perforation
3. Amphetamine or cocaine toxicity.

Question 3

List never events which can happen in ED

Answer 3

1. Medications
   - Miss selection of strong potassium solution
   - Administration of medication by wrong route
   - OD of insulin due to abbreviations
   - Miss selection of high dose midazolam for conscious sedation
   - Transfusion of ABO incompatible blood products
   - Unintentional connection of patient requiring oxygen to air flow meter
2. Surgical
   - wrong side surgery or procedure
   - Retained foreign objects post procedure
   - Missed placed orogastric or NGT
3. Mental health
   - Failure to install functional collapsible curtain rails
   - Chest or neck entrapment in bed rails
   - Falls from poorly restricted windows
4. Others
   - Scalding of patients

Question 4

When a death is reported to a coroner?

Answer 4

1. cause of death is unknown
2. death was violent or unnatural
3. death was sudden and unexplained
4. Person who died was not visited by a medical practitioner during their final illness
5. Medical certificate is not available
6. Person who died was not seen by the doctor who signed the medical certificate within 14 days before death or after they died
7. Death occurred during an operation or before the person came out of anaesthetic
8. Medical certificate suggests the death may have been caused by an industrial disease or industrial poisoning

Question 5

When can the Police be contacted to forcibly bring the patient back to ED?

Answer 5

1. Substantial risk to the patient if they are not brought back for assessment / treatment.
2. The risk requires urgent action
3. All other efforts to contact the patient has failed
4. No other persons or agency can facilitate the return or ongoing management of the patient.
5. Both senior nurse and senior doctor on duty agree it is necessary.