Cook County Medical Examiner Research Articles

Sudden Cardiac Deaths in Adults with Congenital Heart Disease with Structural Abnormalities: A Retrospective Review of Cases in the Cook County Medical Examiner's Office.

Sudden cardiac death is a significant cause of mortality in adults with congenital heart disease (CHD). The Cook County Medical Examiner's Office database was queried for cases of CHD as a cause of death in the period between July 2008 and April 2019. Twenty-two cases were identified, including 11 decedents with simple defects and 10 decedents with complex defects. All of the subjects were in apparent good health at the time of death. In the absence of other obvious causes of death, simple defects were considered cases of sudden cardiac death. Significant cardiac morphological changes were common in complex defects. While 16 cases had known, diagnosed/treated CHD, 5 cases had no diagnosis prior to autopsy. In these cases, the ability to recognize CHD (sometimes subtle) helped in determining the causes of death. Therefore, forensic pathologists must be able to properly recognize various forms of CHD and request consultations, when needed.

Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases

ObjectiveDescribe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. MethodsWe performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel® were used to analyze the data and create figures. ResultsWe identified a spike in opioid-related EMS responses during an 11-day period from September 30–October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. ConclusionOur data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data.

Deaths Due to Child Abuse: A 6-Year Review of Cases in The Cook County Medical Examiner's Office.

Case files from the Cook County Medical Examiner's Office from 2007 to 2012 were reviewed to analyze homicides due to physical child abuse in children <3 years old. Fatal cases mostly involved younger subjects. Intracranial injuries were the leading cause of death, while death due to extracranial injuries was uncommon. Eyes were involved in most of the cases. Spinal cord was involved in about 1/3 of the cases, mostly in the thoracic area. In some cases, previous injuries were present. There were significant differences in the pattern of injuries between age groups. Subjects showing signs of impact to the head and subjects with no evidence of an impact showed no significant difference in internal injuries. The association of multiple injuries is highly suggestive of child abuse. In suspected child abuse, a postmortem examination including neuropathological, ophthalmological, and radiological information should be always evaluated, together with investigative reports and the medical history.

Determined to Die! Ability to Act Following Multiple Self‐inflicted Gunshot Wounds to the Head. The Cook County Office of Medical Examiner Experience (2005–2012) and Review of Literature

Cases of multiple (considered 2+) self-inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent's psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self-inflicted gunshot wounds to the head from the Cook County Medical Examiner's Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self-inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide.

Fentanyl epidemic in Chicago, Illinois and surrounding Cook County

Introduction. Epidemics related to illicit fentanyl abuse have been reported and the potential exists for a national epidemic associated with high mortality. This report describes emergency department visits for opioid toxicity and a recent outbreak of illicit fentanyl fatalities in Chicago, Illinois and surrounding Cook County. Methods. Retrospective chart review of opioid-related overdoses seen in our emergency department and a retrospective review of data from the Cook County Medical Examiner's Office Fentanyl Fatality Database from April 2005 through December 2006. Results. Our emergency department treated 43 patients with a total of 55 emergency department visits during this time. Paramedic transport was utilized for 83.6% of the emergency department visits and naloxone was administered during 80.4% of transports. Naloxone was administered during 47.3% of emergency department visits witwh total doses ranging from 0.4 mg to 12 mg. Eighty percent of cases were treated and discharged from the emergency department. During this same time frame, the Medical Examiner's office identified 342 fentanyl-related fatalities. In 2006, illicit fentanyl fatalities represented 6.9% of all Medical Examiner cases for that year. Approximately 80% of deaths occurred in Chicago. A peak in fentanyl-related deaths occurred in the spring of 2006 and again in the fall of 2006 while the number of emergency department visits peaked during May of 2006. Conclusion. Chicago and surrounding Cook County experienced an outbreak of 342 fentanyl-related deaths between April 2005 and December 2006. The experience demonstrated a clear need for an interdisciplinary approach to identifying, communicating, and managing an outbreak.

Ethnography, the Ecological Fallacy, and the 1995 Chicago Heat Wave

In Chicago in July 1995, the Cook County Medical Examiner classified 739 heat-related deaths after one week of record high heat and humidity. In the 2002 book Heat Wave, Eric Klinenberg provides an influential account of these deaths. Klinenberg specifically contrasts mortalities in two neighboring communities, black North Lawndale and Latino South Lawndale. He explains the mortality difference by focusing on how elderly black residents, including those in “literal isolation,” were impacted by neighborhood conditions. However, Klinenberg's book provides no data on the individuals who died. The author of this Research Note reports more data obtained by traveling to these two communities and to the bordering white community of Archer Heights. The author compares his findings against data available on death certificates for all decedents. At the time of the heat wave, many of the people who died were not elderly and only two elderly victims in North Lawndale were living alone. In the bordering white community, most decedents were living alone during the heat wave and none had ever married. The author questions whether Klinenberg's theory operates at the individual level in North Lawndale and assesses whether Robinson's “ecological fallacy” pertains to Klinenberg's study.

Deaths Due to Foreign Body Aspiration in Children: The Continuing Hazard of Toy Balloons

Asphyxia due to aspiration of a foreign body is a common cause of accidental death in children. Foreign body aspiration is the most likely cause of accidental fatalities in children under 1-year-of-age. Children may die due to airway obstruction by food objects such as hot dogs, nuts, candies, grapes, seeds, and egg shells. Non-food objects such as balloons, coins, pop tops of beverage cans, pills, safety pins, ball bearings, marbles, and baby powder also may be fatally aspirated. To better understand and help prevent this well recognized health risk to children, we reviewed 10 years of cases at the Cook County Medical Examiner's Office in which deaths in children 14-years-of-age and younger were due to aspiration of foreign objects. The most common item that caused fatal aspiration in our series was a toy balloon.

Heat-Related Mortality—Chicago, July 1995

During July 12-16, 1995, Chicago experienced unusually high maximum daily temperatures, ranging from 93 F to 104 F (33.9 C to 40.0 C). On July 13, the heat index peaked at 119 F (48.3 C)--a record high for the city. This report describes the heat-related deaths reported by the Cook County Medical Examiner's Office (CCMEO) during this heat wave.

Probe of Heat Wave Deaths Under Way

WHEN FEDERAL epidemiologists arrived in Chicago, Ill, late last month to investigate the city's massive heat-related death toll, Cook County Medical Examiner Edmund Donoghue, MD, made their work a bit easier. He handed over a computer disk containing names, ages, addresses, and the cause of death of hundreds who succumbed during mid-July's record-high temperatures in a city better known for snowscapes and heart-stopping cold. "Usually they just get a story about what happened. This will speed up their analysis," Donoghue said as investigators from the Centers for Disease Control and Prevention (CDC), Atlanta, Ga, sifted through the data. See also page 602. Chicago's heat wave and the CDC study will yield insight into heat-related mortality for some time to come. An initial report on demographics and descriptions of the deaths is in CDC's<i>Morbidity and Mortality Weekly Report</i>. More in-depth reports will focus on identifying risk factors and preventing such

Trauma

The records of the Cook County Medical Examiner were reviewed for the period January, 1986, to December, 1989. Ninety-five maternal deaths were identified. The causes of maternal death were categorized as direct maternal, indirect maternal, or nonmaternal. Direct maternal causes of death (18.9%) were the result of complications of pregnancy, labor, delivery, or its management. Indirect maternal causes of death (12.6%) occurred when preexisting health problems were exacerbated by pregnancy. All other maternal deaths were the result of nonmaternal causes. Nonmaternal causes of maternal death were further classified as traumatic or nontraumatic. Traumatic maternal deaths (46.3%) were attributed to homicide in 57% and suicide in 9%. The mechanism of injury in traumatic maternal deaths included gunshot wounds (22.7%), motor vehicle crashes (20.5%), stab wounds (13.6%), strangulation (13.6%), blunt head injuries (9.1%), burns (6.8%), falls (4.5%), toxic exposure (4.5%), drowning (2.3%), and iatrogenic injury (2.3%). Trauma was therefore the leading cause of maternal death, accounting for 46.3% of deaths in this series.

Accidental Toddler Drowning in 5-Gallon Buckets

We have identified a previously unrecognized source of accidental drowning in infants and toddlers: 5-gal (19-L) industrial buckets. Twelve cases of drownings in these large-capacity buckets constituted 24% of all infant and toddler (age less than 3 years) drownings investigated by the Cook County (Illinois) Medical Examiner's Office from January 1985 to June 1989. The buckets, all with 5-gal and 18-kg capacity, are constructed of heavy, rigid plastic and are intended for industrial use. Home use, typically as mop buckets, was associated with the toddlers' death. The large size and heavy construction of these buckets as well as the toddlers' cephalad center of gravity and undeveloped coordination prohibit the toddlers from extricating themselves after peering into and falling inside the buckets. Parents and public health officials should be advised that domestic use of these containers poses a serious threat to the safety of curious toddlers. Adults should never leave toddlers unattended around even small amounts of water.

Cyanide Intoxication-Reply

In Reply.— We appreciate Dr Wald's and Dr Goldfrank's interest in our study. The index case in this outbreak of cyanide intoxication was working in an active production area of the silver-reclaiming facility at the time he was stricken. Autopsy findings yielded blood and spleen cyanide levels of 3.45 and 1.90 mg/L, respectively. These values are consistent with reported fatal cases, although postmortem findings may exhibit a wide range of values.1In this case, the Cook County Medical Examiner's Office determination of cyanide as the cause of death was indeed the basis of later successful criminal action against the owners of the facility. Environmental monitoring during active operations could not be obtained. Given the obvious imminent hazard to the workers, it would not have been ethical to continue exposure for the purpose of obtaining such samples. Since airborne cyanide levels were elevatedaftercessation of operations, it is likely