King County Medical Examiners Office

Seattle, WA, United States

King County Medical Examiners Office

Seattle, WA, United States
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Petersen T.H.,Duke University | Williams T.,King County Medical Examiners Office | Nuwayhid N.,Forensic Laboratory Services Bureau | Harruff R.,King County Medical Examiners Office
Journal of Forensic Sciences | Year: 2012

Isopropanol (IPA) detected in deaths because of diabetic ketoacidosis (DKA) or alcoholic ketoacidosis (AKA) may cause concern for IPA poisoning. This study addressed this concern in a 15-year retrospective review of 260 deaths in which concentrations of acetone and IPA, as well as their ratios, were compared in DKA (175 cases), AKA (79 cases), and IPA intoxication (six cases). The results demonstrated the frequency of detecting IPA in ketoacidosis when there was no evidence of IPA ingestion. IPA was detectable in 77% of DKA cases with quantifiable concentrations averaging 15.1±13.0 mg/dL; 52% of AKA cases with quantifiable concentrations averaging 18.5±22.1mg/dL; and in cases of IPA intoxication, averaging 326±260mg/dL. There was weak correlation of IPA production with postmortem interval in DKA only (r=-0.48). Although IPA concentrations were much higher with ingestion, potentially toxic concentrations were achievable in DKA without known ingestion. © 2012 American Academy of Forensic Sciences.


Buelow B.,University of Washington | Otjen J.,University of Washington | Sabath A.P.,University of Washington | Harruff R.C.,King County Medical Examiners Office
American Journal of Forensic Medicine and Pathology | Year: 2012

Liver rupture is a serious, life-threatening event that is commonly due to blunt abdominal trauma, which should be suspected in a patient who is unconscious or unable to communicate. We report an autopsy case of a 28-year-old woman with severe developmental delay who presented to the emergency department with hemoperitoneum due to massive liver rupture and subsequently died without a diagnosis. An autopsy performed by the hospital pathology department confirmed hemoperitoneum due to hepatic rupture. The case was then referred to the medical examiner to exclude a traumatic etiology. After review of the clinical data, radiological images, and gross and microscopic pathological features, a diagnosis of peliosis hepatis was established. This rare entity has been reported previously as a cause of spontaneous, nontraumatic liver rupture and is reported here to demonstrate its characteristic features and potential to present as fatal hepatic rupture in circumstances in which occult injury must be excluded. Copyright © 2012 Lippincott Williams & Wilkins.


Cimino P.J.,King County Medical Examiners Office | Williams T.L.,King County Medical Examiners Office | Fusaro A.,King County Medical Examiners Office | Harruff R.,King County Medical Examiners Office
Journal of Forensic Sciences | Year: 2011

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington. 2010 American Academy of Forensic Sciences. Published 2010. This article is a U.S. Government work and is in the public domain in the U.S.A.


Schmitt M.W.,King County Medical Examiners Office | Williams T.L.,King County Medical Examiners Office | Woodard K.R.,King County Medical Examiners Office | Harruff R.C.,King County Medical Examiners Office
Journal of Forensic Sciences | Year: 2011

Carbon monoxide (CO) inhalation is one of the leading methods of suicide in the United States. A sharp increase in suicide by inhaling the CO produced from burning charcoal has been reported in parts of Asia; however, the incidence of this method has not been determined in a U.S. population. Thus, we determined trends of CO suicide in the ethnically diverse population of King County, Washington, U.S.A. During the period 1996-2009, we identified 158 cases of suicide by CO poisoning, with 125 because of automotive exhaust, 26 because of charcoal burning, and seven from other CO sources. While historical U.S. data indicate >99% of CO suicides in the United States occurring by automobile exhaust inhalation, in the most recent years analyzed, c. 40% of CO-related suicides in King County, Washington, were because of charcoal burning, indicating a possible shift in suicide trends that warrants further scrutiny in additional populations. © 2011 American Academy of Forensic Sciences.


Yarid N.A.,King County Medical Examiners Office | Harruff R.C.,King County Medical Examiners Office
Journal of Forensic Sciences | Year: 2015

Bilateral globus pallidus necrosis is said to be characteristic of carbon monoxide (CO) poisoning. However, there has been no scientific test of this hypothesis. To examine the assertion that globus pallidus necrosis is typical of CO poisoning, this study examined autopsy cases from the King County Medical Examiner's Office (KCMEO) between 1994 and 2013. Twenty-seven cases with bilateral basal ganglia lesions were identified and examined for associated or causative disease or injury with the following results: 10 cases of drug overdose, seven heart disease, three asphyxia, two chronic ethanolism, two Huntington-like disorder, and one case each of remote trauma, rheumatic heart disease, and cerebral artery gas embolism. Additionally, review of all known cases at KCMEO of CO poisoning found no evidence of globus pallidus or basal ganglia necrosis. Thus, this study provides no support for the assertion that globus pallidus necrosis is characteristic of CO poisoning. © 2015 American Academy of Forensic Sciences.


Harruff R.C.,King County Medical Examiners Office | Park J.,Miami Dade County Medical Examiner | Smelser B.J.,Washington State Patrol Crime Laboratory
Journal of Forensic Sciences | Year: 2013

Wounds of high-energy centerfire rifles and shotguns represent distinctive injuries of forensic importance. Previous studies of contact wounds have shown variability in the potential of these weapons to produce bursting wounds of the head. The present study analyzed contact head wounds owing to 26 centerfire rifles and nine shotgun slugs and compared them with respect to weapon, ammunition, entry wound site, and projectile kinetic energy. The bursting effect, defined for this study as disruption of at least 50% of the head, occurred in 25/35 of cases and was related to kinetic energy. Bursting was associated with energies <2700 ft-lbs in 12/22 cases and energies >2700 ft-lbs in 13/13 cases. The volume of gunpowder gas injected into the wound was considered as contributing to the bursting phenomenon. There was no relation of bursting to the specific entrance wound site, type of ammunition, or projectile fragmentation. © 2012 American Academy of Forensic Sciences.


PubMed | King County Medical Examiners Office
Type: Journal Article | Journal: Journal of forensic sciences | Year: 2013

Wounds of high-energy centerfire rifles and shotguns represent distinctive injuries of forensic importance. Previous studies of contact wounds have shown variability in the potential of these weapons to produce bursting wounds of the head. The present study analyzed contact head wounds owing to 26 centerfire rifles and nine shotgun slugs and compared them with respect to weapon, ammunition, entry wound site, and projectile kinetic energy. The bursting effect, defined for this study as disruption of at least 50% of the head, occurred in 25/35 of cases and was related to kinetic energy. Bursting was associated with energies <2700 ft-lbs in 12/22 cases and energies >2700 ft-lbs in 13/13 cases. The volume of gunpowder gas injected into the wound was considered as contributing to the bursting phenomenon. There was no relation of bursting to the specific entrance wound site, type of ammunition, or projectile fragmentation.


PubMed | King County Medical Examiners Office
Type: | Journal: Journal of forensic sciences | Year: 2011

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiners Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedents residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.


PubMed | King County Medical Examiners Office
Type: Journal Article | Journal: Journal of forensic sciences | Year: 2016

Bilateral globus pallidus necrosis is said to be characteristic of carbon monoxide (CO) poisoning. However, there has been no scientific test of this hypothesis. To examine the assertion that globus pallidus necrosis is typical of CO poisoning, this study examined autopsy cases from the King County Medical Examiners Office (KCMEO) between 1994 and 2013. Twenty-seven cases with bilateral basal ganglia lesions were identified and examined for associated or causative disease or injury with the following results: 10 cases of drug overdose, seven heart disease, three asphyxia, two chronic ethanolism, two Huntington-like disorder, and one case each of remote trauma, rheumatic heart disease, and cerebral artery gas embolism. Additionally, review of all known cases at KCMEO of CO poisoning found no evidence of globus pallidus or basal ganglia necrosis. Thus, this study provides no support for the assertion that globus pallidus necrosis is characteristic of CO poisoning.


PubMed | King County Medical Examiners Office
Type: Journal Article | Journal: Journal of forensic sciences | Year: 2011

Carbon monoxide (CO) inhalation is one of the leading methods of suicide in the United States. A sharp increase in suicide by inhaling the CO produced from burning charcoal has been reported in parts of Asia; however, the incidence of this method has not been determined in a U.S. population. Thus, we determined trends of CO suicide in the ethnically diverse population of King County, Washington, U.S.A. During the period 1996-2009, we identified 158 cases of suicide by CO poisoning, with 125 because of automotive exhaust, 26 because of charcoal burning, and seven from other CO sources. While historical U.S. data indicate >99% of CO suicides in the United States occurring by automobile exhaust inhalation, in the most recent years analyzed, c. 40% of CO-related suicides in King County, Washington, were because of charcoal burning, indicating a possible shift in suicide trends that warrants further scrutiny in additional populations.

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