1/23. drowning and near-drowning--some lessons learnt.Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
2/23. mortality in pediatric epilepsy.mortality in pediatric epilepsy is the subject of this review. epilepsy in both adults and children increases the risk of premature death. Conditions that are comorbid with epilepsy may carry an increased mortality risk. patients with neurologic compromise may be at risk for aspiration and critical respiratory disease. epilepsy per se enhances the risks of accidents, particularly drowning. epilepsy may result in unwitnessed or, less frequently, witnessed sudden death. Witnessed sudden death frequently involves an observed seizure. Cardiac and respiratory mechanisms for epileptic sudden death have been proposed. Reducing the number of seizures should reduce the risk for sudden death. awareness of the increased risk for premature death associated with epilepsy may enhance patients' and parents' cooperation with therapy.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
3/23. Diatom numbers around the continental shelf break.Diatom concentrations in seawater were examined monthly at four aquatic areas. Diatom concentrations inside a bay showed a monthly variation, but these were detectable. On the other hand, in the open sea around the continental shelf break, there were few diatoms in any season. When a person drowns in the open sea, the diatom test cannot be expected to function reliably.- - - - - - - - - - ranking = 4keywords = sea (Clic here for more details about this article) |
4/23. Pulmonary interstitial fibrosis following near-drowning and exposure to short-term high oxygen concentrations.Following near-drowning in fresh water, a 19-year-old man experienced severe adult respiratory distress syndrome, necessitating ventilatory support with positive end-expiratory pressure and high oxygen concentrations. Post-extubation, his course was highlighted by persistent hypoxemia and interrupted by a lung abscess which responded promptly to antibiotics. Pulmonary function tests were consistent with severe restrictive disease and chest radiograph revealed persistent bilateral alveolar and interstitial infiltrates. An open lung biopsy on the 26th hospital day showed interstitial fibrosis. Over the ensuing two months, the chest radiograph and pulmonary function tests returned towards normal. We attribute the pulmonary fibrosis to incomplete resolution of the alveolar interstitial pathology secondary to the near-drowning and exposure to high oxygen mixtures.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
5/23. Did he drown or was he murdered?An unemployed, 60-year-old Singaporean gentleman died during a brief overseas trip to another South-East Asian country. He had, presumably, drowned in the bathtub of his hotel room, which he shared with his then 44-year-old companion, who was supposedly his nephew. The relevant public health and medico-legal authorities of the host country conducted an external examination of the body at the scene, whereupon they agreed with the police that his death was probably due to accidental drowning following an episode of syncope. It would appear that this verdict was based almost entirely on circumstantial and hearsay evidence. No autopsy was performed. In its place, considerable reliance was placed on the observation that abdominal compression resulted in the outflow of a small amount of water from the mouth, as being proof of drowning. A few days later, the body was cremated in the host country and the remains (ashes) were subsequently repatriated to singapore. It later transpired that, shortly before they embarked on the ill-fated trip, the deceased's 'nephew' had purchased, on the former's behalf, travel insurance policies (covering accidental injury and death) amounting to a total of S$800,000 from five different insurance companies, as well as a separate life policy for a further S$100,000, most of which had been issued within the fortnight prior to their departure. Interestingly, the beneficiary (later the plaintiff in the ensuing civil trial some three years later) of all of these policies, was the ex-wife of the deceased's 'nephew', with whom he had, in fact, continued to live although they were officially divorced several years ago. Whilst the claim against the life policy had been settled, the first five insurers declined to issue payment on grounds of suspicion that the deceased had been the victim of a homicide, planned or executed by the 'nephew', wherein the beneficiary was a conspirator of sorts. The author was approached by defence counsel (representing the various insurers), for assistance in this matter. It was felt that a proper forensic review was seriously hampered by the lack of a full autopsy which would have been indispensable in ascertaining the actual cause of death and in eliminating other possibilities, apart from drowning, such as death from natural causes, other forms of injury, poisoning, or homicide. It was also emphasized that the mere presence of ingested water is not diagnostic of drowning. Eventually, after a protracted but unsuccessful attempt at mediation (in the course of which, the plaintiff rejected the offer of a reduced, although apparently sizable quantum), the matter came before the High Court, which found in favour of the defendants. It appeared that the judge was more than convinced that the deceased was indeed the victim of a homicide of which the plaintiff was a conspirator and her ex-husband, the perpetrator, as even a cursory perusal of the written judgement would indicate. Accordingly, the court ruled that the plaintiff (in her capacity as both the beneficiary of the insurance policies and executor of the estate) and her ex-husband had, effectively, deprived the insurers of their contractual right (as stipulated in the insurance policies) to have an autopsy conducted on the body of the deceased and they were, therefore, entitled to deny liability. This case illustrates the difficulties inherent in conducting an independent review of a putative instance of drowning, where convincing and reliable forensic evidence and documentation are largely wanting; this being compounded by its occurrence in a foreign jurisdiction whose medico-legal practices differ substantially from that to which one is accustomed. It may even be said that the corpus delecti was destroyed, in this instance, by cremation. It is also unusual in that a de-facto finding of murder was made in a civil court (whose standard of proof is that of a balance of probabilities) and that this had, subsequently, spurred the police to undertake a criminal investigation for conspiracy to murder. In the event, the civil appeal was dismissed by the Court of Appeal, but no charge was laid against any of the suspects for want of sufficient forensic or investigative evidence of a criminal offence having been committed.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
6/23. infant bath seats, drowning and near-drowning.OBJECTIVE: To investigate the possible role of infant bathtub seats in drowning and near-drowning episodes in infants. methods: A review was conducted of the files of the Forensic science Centre and child Protection Unit, women's and Children's Hospital, Adelaide, south australia, for significant immersion incidents in infants involving bathtub seats from January 1998 to December 2003. RESULTS: A total of six cases of drowning occurred over the 6-year period of the study in children under 2 years of age, including two infants. One of these cases, a 7-month-old boy, had been left unattended for some time in an adult bath in a bathtub seat. He was found drowned, having submerged after slipping down and becoming trapped in the seat. Three near-drowning episodes occurred in children under the age of 2 years, including two boys aged 7 and 8 months, both of whom had been left for some time in adult baths in bath seats. Both were successfully resuscitated and treated in hospital. CONCLUSIONS: These cases demonstrate the vulnerability of infants to immersion incidents when left unattended in bathtubs. Bathtubs are particularly dangerous for infants as the slippery and smooth surfaces predispose to loss of balance and make escape from water difficult. infant bathtub seats may give parents and child carers a false sense of security leading to infants being left unattended. Unfortunately, however, infants may fall out of, or slip and become trapped in, such seats. Infants and young children cannot be left unsupervised in water, and devices used as bathing aids such as bathtub seats may contribute to immersion incidents.- - - - - - - - - - ranking = 12keywords = sea (Clic here for more details about this article) |
7/23. drowning of babies in bath seats: do they provide false reassurance?AIMS: To investigate the problem of children drowning in bath seats by examining case reports, by looking at the epidemiology of bath drowning in children under two years of age and by reviewing the literature. methods: We describe two babies: one who drowned and one nearly drowned in the bath whilst in a bath seat. We examined the RoSPA/RLSS UK database of cases of children under two years drowning in the bath for the years 1989-2003. Cases are ascertained through a press cutting system. We conducted an all language literature search of original articles, references, textbooks and conference abstracts 1951-October 2004 in 11 standard databases. RESULTS: The two cases illustrate how parents can have a false sense of security with bath seats. We found six cases of babies under two years drowning in the UK associated with bath seats in the time period 1989-2003. They were all boys: five of the six were under one year of age. This compared with 47 children of similar age drowning in the bath not associated with a bath seat. The literature is sparse with only four papers since 1966. DISCUSSION: A baby drowning after being placed in a bath seats is a rare but definite cause of death. Bath seats appear to give a false sense of security (even if not encouraged by the manufacturers). It is unclear whether putting a baby in a bath seat represents an increased risk of drowning compared with a baby without a seat. Without knowing the numbers of mothers that use bath seats it is difficult to come to firm conclusions on the risks to babies. New research is needed to clarify this issue. Whether in a seat or not it is clear that the main risk to babies in the bath is being left unsupervised.- - - - - - - - - - ranking = 17keywords = sea (Clic here for more details about this article) |
8/23. infection caused by francisella philomiragia (formerly yersinia philomiragia). A newly recognized human pathogen.We evaluated the clinical characteristics of patients with francisella philomiragia (formerly yersinia philomiragia) isolated from normally sterile sites. Isolates from 14 patients were received by the Centers for disease Control between 1975 and 1987: 9 were from blood; 2 from lung biopsies; and 1 each from pleural, peritoneal, and cerebrospinal fluid. Underlying problems included chronic granulomatous disease in 5 patients, near-drowning in 5, and a myeloproliferative disease in 2. All 13 patients for whom records were available had a febrile syndrome compatible with bacterial infection. pneumonia and fever-bacteremia were the commonest clinical syndromes reported. In 7 cases, F. philomiragia was the only sterile-site isolate, and the clinical syndrome did not resolve without appropriate antibiotics. Familiarity with this organism is important because of its ability to cause serious disease in chronic granulomatous disease and near-drowning patients. Further study may yield new insights into pathogenic and host defense mechanisms.- - - - - - - - - - ranking = 5keywords = sea (Clic here for more details about this article) |
9/23. Seafaring bodies.Cases involving two bodies that had drifted for at least 500 km on the high seas are described.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
10/23. diatoms and drowning.An examination is made of the applicability of quantitative and qualitative diatom analysis to the diagnosis of death by drowning, definition of the environment in which drowning occurred, and delimitation of the area where it occurred. the material comprises 107 bodies of subjects known or suspected to have died by drowning together with a control series of 15 bodies of subjects over 30 years of age who had died of various diseases on land. Whenever diatoms were found in the greater circulatory organs they were also found in the lungs, and when none were present in the lungs none were found in the other organs either. No diatoms or fragments of diatoms were found in the samples from the control subjects. All the fresh, well-preserved bodies for which death by drowning could be regarded as certain from the macroscopic autopsy findings and police reports, the cases used to test the method, gave quantitative diatom results that supported a diagnosis of water aspiration. The diatoms identified in the qualitative analyses served well to describe the ecological properties of the environments in which death had taken place, and the site of drowning could be defined by means of comparative water samples provided that sufficient diatoms were present, the local environment was not too homogeneous or the diatoms were not of quite different species due to a completely unknown location of death.- - - - - - - - - - ranking = 1keywords = sea (Clic here for more details about this article) |
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