Wednesday, March 30, 2016

Rape Kit Testing

Stan Asks:

My question for you is would a rape kit routinely be used to test for evidence of chemicals found in a condom in addition to DNA or would further tests be required? My plot has a woman getting even with a man by having her girlfriend have sex with the guy (he’s using a condom). She then gives the material to her friend who applies the sperm and claims she was raped.

Amryn Says:

Rape kits are routinely tested for the presence of semen and sperm and maybe saliva depending on the story the victim gives. Chemicals found in spermicide and other condom components aren't something an analyst would test for. Depending on how long of a time lapse between intercourse and the woman applying the sperm, it's possible the spermicide on the condom would have already degraded the sperm to the point that it isn't detectable, but that would only occur after a long time.

 More likely, when DNA testing was performed, it would yield a mixture of 3 profiles: the man, the woman's friend, and the woman. This is because the woman's friend's profile would likely be present on the condom from the intercourse she had from the man. This might raise a red flag but it would be up to the investigator to look into it further.


Amryn Cross is a full-time forensic scientist and author of romantic suspense novels. Her first novel, Learning to Die, will be released in September. In her spare time, she enjoys college football, reading, watching movies, and researching her next novel. You can connect with Amryn via her websiteTwitter andFacebook.

Wednesday, March 23, 2016

Can a Pregnant Woman be an Organ Donor?

Carol Asks:

Can a pregnant woman be an organ donor?

Situation: The woman is in her first trimester. She's been in a car accident and the pregnancy terminated itself as a result of the accident. She's been kept alive on machines for several days with no hope of recovery. Can she donate organs?

Jordyn Says:

I don't see why not because she's technically not pregnant anymore. My only drawback is if law enforcement thinks the death is suspicious in any way and it becomes a corner's case for some reason.

That being said, I do find the question intriguing-- like could a pregnant woman who is further along still donate organs? My gut instinct would be that they would keep the "body" alive until the infant was viable or deliver if past 24 weeks. Then the woman should be able to donate organs.

Wednesday, March 16, 2016

Alleged Patient Exposure to HIV/Hepatitis After Drug Diversion

I want to start this post by saying "Oops, it happened again." The problem is, I shouldn't have to blog about this topic considering how serious it is and the potential risk to patients.

I live in Colorado. In February, 2016, it hit the news that one of the Denver areas largest hospital, Swedish Medical Center, was testing close to three thousand patients for possible exposure to HIV and Hepatitis after a surgical tech was suspected of diverting drugs.

What is drug diversion? Drug diversion is using a narcotic for anything other than its intended use. The most mildest form is not wasting drugs properly. It requires two licensed personnel to waste a drug and sometimes you just can't find another person at that moment and then you forget. Not excusable but understandable. The most serious form is healthcare workers using the drug themselves and not giving them to the patient or using the "waste" or overage for themselves.

The problem is, a relatively similar scenario happened at another Colorado hospital in 2008 and 2009. This was the case of Kristen Parker, a surgical tech who is currently serving a thirty year prison term for infecting three dozen patients with Hepatitis C. She was stealing unlocked Fentanyl set aside for surgery, injecting it into herself, and then drawing up saline into the same syringe where then an unsuspecting provider injected it into the patient causing transmission of the virus.

In fact, one of the anesthesiologists involved in this case went public and even wrote a novel based upon her experience. This wasn't a quiet news story.

In this blog piece from The Daily Beast in February, 2013, Gorman states:

“At that time, we didn’t think about locking drawers,” she says. “No one ever told me I was doing anything wrong. If there were rules to enforce locking the drugs up, they were not enforced.” Rose has said it sent memos to its anesthesiologists in 2001 and again after Parker’s crime, warning them “never leave controlled substances unlocked or unattended.”

In light of this incidence, it is unbelievable to me that a case of suspected drug diversion involving a surgical tech could happen again in this state and it makes me wonder if potentially the same process of drug diversion was used as Kristen Parker employed-- unsecured narcotics awaiting injection for surgical procedures.

The tech, Rocky Allen, has been arrested and has pleaded not guilty. Thus far, it appears two patients have tested positive for Hepatitis B.-- although the hospital currently denies they transmitted the virus as part of this case.

So please, hospital OR's everywhere, can we please develop a system where narcotics can be dispensed safely to surgical patients?

Wednesday, March 9, 2016

EMS and ER Response for an Unconscious Female Trauma Patient

Ginger Asks

I have a 23-year-old woman with an obvious head wound (she got hit with the butt of a gun, but the first responders don’t know that) who’s been outside in 20’ish degree weather without a coat for an undetermined amount of time. She’s unconscious. Obviously an IV is started, but what else will paramedics do to treat her? Warming blankets? What would happen when she got to the ER?

Jordyn Says:

Thanks for sending me your question.
EMS Response:

For an unconscious patient with an obvious head wound, but is unable to tell how her injury happened should be placed in C-spine precautions. That means C-collar and backboard. IV-- yes. And warming. They'd get a set of vital signs, put her on a monitor and then do a full assessment to look for other injuries.

Checking her blood sugar is warranted because why is she unconscious? Did the injury to her head happen because she passed out from low blood sugar? Or is it too high? Looking for medical alert bracelets as well. They'd probably key in on a good neuro exam like are her pupils equal and reactive to light? What type of stimulation does she respond to (voice, touch or pain?) They might even give a dose of Narcan to rule out opiate overdose (like heroin.)  

In the ER:

Full assessment as above and we'll look for other injures. We'll maintain C-spine precautions. She would be completely undressed (again-- looking for other injuries.) We have a better ability to monitor temperature so we'll know exactly where she's at and work to rewarm her. This could range from warm blankets to warming lights and heated IV fluids. Full set of vital signs. We'd place her on the monitor as well to watch her HR, breathing and oxygen levels continuously.
As far as testing and procedures go, if she remains unconscious, I would say the following:

1. Spine X-rays. 
2. CT of the head (to look for bleeding, stroke, tumor.)
3. Labs: Full metabolic panel (this will check blood sugar again), complete blood counts, alcohol level, aspirin level, Tylenol level. Tylenol and aspirin are drugs people will overdose on that can be very serious.
4. Urine toxicology panel (this would pick up on major substances of abuse but not everything.) Also urine pregnancy test. 
5. ECG. To see if a heart arrhythmia or heart attack could be an explanation for her passing out.
Unless we know the exact mechanism of the injury we have to consider both inflicted wounds from another person but also that she might have just passed out and hit her head and what the reason for that might be.

If she's truly unconscious and doesn't respond to pain-- she'd likely get a tube in every orifice as they say and they'd have to consider whether or not to intubate her (put a breathing tube in) to protect her airway. If that happens, then NG tube (placed probably through the mouth into the stomach) and a Foley catheter which drains your urine into a bag.

If she's somewhat responsive but immediately drifts off-- they could hold off on tube placements, check the tests I've listed, and give her some time to see if she wakes up on her own if she's breathing well on her own.

Wednesday, March 2, 2016

Surviving a Shipwreck Post Hurricane

Jocelyn Asks

I’ve written a hurricane scene, and I don’t think I got the medical details right, so I thought I should check with you.

I have characters abandon their ship as it goes down. They stay afloat using planks of wood, but just holding on to them in the water, not lying on top of them. This takes place in the Gulf of Mexico in September.

When they are rescued several hours later, what will their condition be? Will they be fully conscious? Would they be cold? My heroine’s brother dies in the water, so is that enough to put her into shock, along with the ordeal of surviving the hurricane?

While one character is floating in the water, a piece of bowsprit breaks off from another ship and flies through the air, hitting him. I want to injure him enough for him to lose his grip on the plank he’d been holding onto, but I don’t want him to die from this injury. I was thinking if the wood hits him in the arm or shoulder, either breaking his arm or dislocating his shoulder, that would be good enough. Is that realistic though? Or does it just depend on the angle and the velocity?

Jordyn Says:

First thing to determine is the temperature of the water in the Gulf of Mexico in September. I found a table from the National Oceanic and Atmospheric Administration with water temperature tables for the Gulf of Mexico  that lists temperatures for September in the mid to upper 80s.

The next question is how long does it take hypothermia to set in when you’re submerged in water at this temperature?

This table gives an "indefinite" time frame where as it lists time limits for cooler water temperatures. For instance, in water that is 32.5 degrees, it gives a time of under fifteen minutes for exhaustion or unconsciousness to set in.

Considering this information, your characters should be conscious when they are rescued. Just because they don't die from hypothermia doesn't mean there aren't other risk factors like getting eaten by ocean creatures, sheer exhaustion, or dehydration and malnourishment from not eating or drinking.

If the rescue is under twelve hours, I'd imagine they would be in pretty good shape. An adult can probably survive three days without water but it would also depend on what environmental factors are present. You'll dehydrate faster in sunny weather than a cool, overcast day. I would imagine they would still feel cold. Your normal body temperature is 98.6. Hot bath water ranges from 99-104 degrees. Bathwater temperatures vary depending on the source and hot tubs are around 104 degrees. So, being immersed in 80 degree water will still feel cool. Patients getting room temperature IV fluids always get chilly.

Emotional traumas like the death of a loved one AND surviving a cataclysmic weather event can put someone into shock.

I think it's reasonable to give your character a fracture after being hit by the bowsprint. But then he'd be unlikely to use that arm at all to hold onto things but it should be a survivable injury if a closed fracture and the rescue is fairly soon. I would think an open fracture, where the bone comes through the skin, would put him more at risk for complications and lower his survivability if the rescue is delayed by a few days or more.