County of Sacramento Department of Coroner 4800 Broadway, Suite 100 Sacramento , CA 95820-1530 Kimberly D. Gin Coroner External Examination NAME : MILES , MARSHALL POSTMORTEM DATE : 11/07/18 INVESTIGATOR : Eli Carroll CASE NO. 18-05720 TIME : 09:45 AUTOPSY FINDINGS : 1. Complications ofcardiopulmonary arrest during restraint and mixed drug intoxication A. Methamphetarnine , Amphetamine , Cocaine metabolite and Cannabinoids present in blood ( See Toxicology report) B. Torso and extremities , Blunt force injuries Brain , edema D. Heart , Myocardialinfarction , interventricular septum andleft ventricle , acute E. Lung , bronchopneumonia , acute , bilateral 2. Heart , cardiomegaly with hypertrophic changes 3. Lung , emphysematous changes CAUSE OF DEATH : Complications of Cardiopulmonary arrestDuring Restraint and Mixed Drug Intoxication Jasone M.D. Chief Forensic Pathologist/ Pediatric Pathologist December 18, 2018 JPT / D : 11/07/18 T : 11/07/18 CO_000109
Transcript
County of SacramentoDepartmentofCoroner4800 Broadway, Suite 100
Sacramento, CA 95820-1530
Kimberly D.GinCoroner
ExternalExamination
NAME: MILES,MARSHALL
POSTMORTEM DATE : 11/07/18
INVESTIGATOR : Eli Carroll
CASE NO. 18-05720
TIME: 09:45
AUTOPSY FINDINGS:1. Complicationsofcardiopulmonaryarrest during restraintand mixeddrug intoxication
A. Methamphetarnine , Amphetamine , Cocaine metabolite and Cannabinoids present in blood(See Toxicology report)
B. Torso and extremities, Blunt force injuriesBrain, edema
D. Heart, Myocardialinfarction, interventricular septum andleftventricle , acute
E. Lung, bronchopneumonia, acute, bilateral2. Heart, cardiomegaly with hypertrophic changes
3. Lung, emphysematous changes
CAUSE OF DEATH : Complications ofCardiopulmonary arrestDuring RestraintandMixed DrugIntoxication
Detective R.Garcia (Badge# 232) and DetectiveG. Petree (Badge# 681) of the Sacramento CountySheriff'sDepartment.
IDENTIFICATION :The body is identified by a Sacramento County Coroner's tag attached to the zipper pull of the body
bag, labeled with the decedent's listed name and case number.
EVIDENCE OF MEDICAL INTERVENTION :Hospital identification bands are present around the leftwrist and on the right great toe There is gauzetaped in place on the right side of the neck in the supraclavicular region covering a sutured round woundconsistent with a vascular access site . The underlying soft tissue of the right side of the neck showshemorrhage of the right sternocleidomastoid muscle at the attachment to the clavicle , right Omohyoidmuscle , right Sternothyroid muscle and surrounding the right jugular vein which shows a punctateperforation within the vessel. There is gauze taped in place over the right antecubital fossa covering apunctate abrasion. There is gauze taped in place on the back of the left hand. No identifiable injury orpuncture mark is identified in this region of the hand. There is a single EKG pad on themedial left thigh .
CLOTHING:
Thedecedentis cladin a hospitalgown.
EXTERNAL EXAMINATION
Thebody is thatof an unembalmed, refrigerated, adultmanwhoappearsconsistentwith the reportedage
of 36 years. The bodyweighs pounds, measures75 inchesin length, and is wellbuilt and wellnourished. The skin is remarkablefor bluntforce injuries, as describedbelow in " Evidenceof TraumaticInjury" , andis freeoflacerations, andburns. Nowristscars are identified. There arewellhealed scarspresenton the elbows and rightshin. There arenumerous tattoos on the upperextremitiesbilaterally
focally across the upperportion of the chest, and on theupperportion of the back. Rigormortis ispresent Livormortisis notappreciated.
Thehead is normocephalic and traumatic, as describedbelow in " Evidence of Traumatic Injury". Thescalp is covered by black hairworn in long dreadlocks. There is nobalding. There is a stubble lengthmustache and goatee typebeard. The irides are brown. There are no petechialhemorrhages of theconjunctivae, lids, or sclerae. The oronasalpassages are unobstructed. The teeth are natural and ingood repair. The earlobes are unremarkable. There is no hemorrhage or discharge in the externalauditory canals. The neck is unremarkable. There is no chest deformity . Thereis no increasedanteriorposterior diameter. The abdomen is flat. The genitalia are those of an adultmale. The penis iscircumcised. The externalgenitaliaare withouttrauma or lesions. The extremitiesshow no edema, jointdeformity, abnormalmobility, non- therapeutic punctures, orneedle tracks. Thereis no cyanosis of thenailbedsof the fingers.
EVIDENCE OF TRAUMATIC INJURY:
Theright cheek anteriorly has a inch abrasion
There is hemorrhage of the base of the tongue, which may representeffects of intubation. There ishemorrhageof the rightside ofthe tongue.
The right side of the chestin the soft tissue has an area ofhemorrhagemeasuring 3 2 inchesoverlyingthe rib cage, beneathwhich are fracturesof thethird, fourth, and fifth anterolateralribs. Thereis fracture ofthe left anteriorfourth rib . These anterolateraland anterior rib fracturesmayrepresentinjurydueto resuscitativeefforts. Theleftlateralchesthassoft tissuehemorrhagein the axillaryregion.
There is hemorrhage on the back extending from the midline and toward the rightcovering an areaof 3 incheswithin the deep soft tissues. There ishemorrhage in the posterior left axially region in the soft
tissue. There is pleuralhemorrhage surrounding the posterior right second rib medially, butno fracture is
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identified . There are posterior fractures of the left first and second ribs on the near the midline, withassociated pleural hemorrhage
Erythemais identifiedon themedialaspectof the rightarm atthelevelof the elbow. There is abrasiontotherightelbow on thelateralaspectmeasuring1 inch. There is focalhemorrhagein the soft tissueof therightelbow
The right wrist has near circumferential cluster ofmultiple linear abrasions. The abrasions spare theanterior wrist and are most pronounces on the medial and lateral aspects of the wrist The individualabrasions are less than 1/16 of an inch but coalesce to form larger abrasions. The lateral cluster coversan area up to 1 inch in width in greatest dimension . On the medial aspect of the rightwrist they create a
area of abrasion . There is hemorrhage in the soft tissue of thewrist.
The posterior proximal interphalangeal joint ofthe third right finger has a 3/16 inch abrasion.
Themedialleft arm at the elbow joint has an area of erythemameasuring 7 inches. Themedialleft upperarm has soft tissue hemorrhage There is hemorrhage of the left anterolateral shoulder in the muscleTheposteriormedialleft forearm has soft tissue hemorrhage.
There is a round abrasion on the anteromedialleftwristmeasuring 1/8 inch: Thereis a linear abrasionson the lateralaspectof the left wristmeasuring1 inches in length x width. There is anabrasionmeasuring 1 on themedialaspect of the leftwrist. There is hemorrhagein the softtissue ofthe leftwrist.
The anteriorrightthigh at the hip has soft tissuehemorrhage. The anterior rightknee skin hasa inchabrasionand themedialrightknee has a 3/8 inch abrasion. The anteriorrightupper leg atthe kneejointhassofttissuehemorrhage There ishemorrhageof themedialrightleg in the softtissue focallyfrom thekneedownto theankle. The lateralrightlegatthe anklehassoft tissuehemorrhage.
The right ankle has a cluster of multiple circumferentiallinearabrasions individuallymeasuringless than1/16 inch that coalescein areas to create areas ofabrasionmeasuringfrom in greatestdimension. There is hemorrhageofthesoft tissue ofthe ankle.
There isan abrasion with scab on the dorsum ofthe first great toe.
The anteriorlefthip has soft tissuehemorrhage. The left anterior has a and abrasion.There is a round, punctate abrasion on the left shin measuring inch. There is focalanterior andmedialsoft tissuehemorrhageextending from the left knee to the ankle. The posterolateralleftleghashemorrhagein the soft tissue.
There is a cluster ofmultiplenearly circumferentiallinearabrasionson the left anklemeasuringlessthan1/16 inch individually thatcoalesce focally to create abrasionsmeasuring1/16 to inchesin greatestdimension. The leftmedialankle is spared of these abrasions. There is hemorrhage in the softtissue ofthe leftankle.
INTERNALEXAMINATION
Thefollowing observationsare limited to findings other than injuries, ifdescribedabove.
INITIAL INCISION:Thebody cavities are entered through the standard coronalincision and the standard Y -shaped incision.Additionalincisionsaremadeon the body to examine the soft tissues.
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CHESTIABDOMINAL CAVITY :
The soft tissues of the thoracic and abdominal walls are well preserved. The subcutaneous fat of theabdominalwallmeasures 1 inch . The pleural cavities are smooth and glistening. There is serous fluid
present in the pleural cavities: 350 cc on the right and 100 cc on the left. The organs of the abdominal
cavity have a normal arrangement and none are absent There is no fluid collection . The peritoneal
cavity is without evidence ofperitonitis . There areno adhesions.
HEAD AND CENTRALNERVOUSSYSTEM:
There is no subcutaneous or subgalealhemorrhage of the scalp. The externalperiosteum and dura
mater are stripped, showing no fracture of the calvarium or base ofthe skull. There are no tears of the
duramater. There is no epidural, subdural, or subarachnoid hemorrhage
The brain weighs 1260gm and is soft and edematous. The leptomeningesare thin and transparent. Anormalconvolutionarypattern is observed. Coronalsectioningdemonstratesa uniformity of corticalgraythickness The cerebralhemispheres are symmetrical. There is no softening, discoloration, orhemorrhage of the white matter. The basal ganglia are intact. Anatomic landmarks are preserved.
Cerebral contusionsarenotpresent. Theventricularsystem has a normal appearance, withoutdilation ordistortion. The pons, medulla, and cerebellum are unremarkable. There is no evidence ofuncal or
cerebralherniation. Vessels atthe base of the brain have a normalpattern of distribution. There are noaneurysms. Cranialnerves are intact, symmetrical, and normal in size, location, and course. The
cerebralarteries are withoutarteriosclerosis.
SPINAL CORD:
The entire cord is not dissected .
NECK:
Theneck organsare removedenblocwith the tongue. Noforeignmaterialispresentin themouth, upperairway, or trachea. No lesionsarepresentand thereis no traumaof the gingiva, lips, or oralmucosa.There is no edemaof the larynx. Both hyoid bone and larynx are intact and without fractures. No
hemorrhageis presentin the adjacentthroatorgans, investingfascia, thyroid, or visceralfascia. There
are no prevertebralfascialhemorrhages.
CARDIOVASCULAR SYSTEM :
Within the pericardialsac, there is a minimalamount of serous fluid. The heart weighs 420 gm and isnormalenlarged. The right ventricle is 0.3 cm thick; the left ventricle is 1.0 cm thick; and the septum is0.8 cm thick . The chambers are normally developed and are withoutmuralthrombosis. The valves arethin, leafy, and competent The circumferences of the valve rings are: tricuspid valve 14.0 cm , pulmonicvalve7.5 cm , mitralvalve and aortic valve 7.5 cm . The septalsurface of the left ventriclewallhas an area ofhemorrhagemeasuring 2 x 1 % inches. The anterior and posterior left papillary muscleshaveareas of hemorrhage. There is no endocardialdiscoloration. There are no lesions of the remainingmyocardium. There are nodefects of the septum . The greatvesselsenter and leave in a normalfashion.
The ductus arteriosus is obliterated. The coronary ostia are widely patent. The rightcoronary artery isthe dominantvessel. Thereis no atherosclerosis of the major coronary arteries. No focal endocardial,valvular, ormyocardiallesions are seen . The aorta is elastic and of even caliber throughout, with vessels
distributed normally from it. The thoracic aorta is unremarkable. There isnotortuosityorwidening of thethoracic segment. The abdominalaorta is unremarkable. There is no dilation of the lower abdominal
segment. No aneurysm is present. Themajorbranches ofthe aorta show no abnormality. The inferior
vena cava is unremarkable . The blood within the heart and large blood vessels is liquid.
RESPIRATORYSYSTEM :
Scant secretions are found in the lowerbronchialpassages. The mucosae are smooth and glistening.The lungs are subcrepitantand there is dependent congestion. The rightlung weighs 1000 gm . The leftlungweighs 1030 gm The visceralpleura are smooth and glistening. The parenchymais congested and
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edematous . The pulmonary vasculature is without thromboembolism . Focal emphysematous blebs are
identified on the apices of the lungs bilaterally .
GASTROINTESTINAL SYSTEM :
The esophagus is.intact throughout The stomach isnot distended . Itcontains 160 gm ofbrown food
material. The mucosa is smooth and glistening . Portions of tablets and capsules cannot be discerned in
the stomach . The external and in situ appearance of the small intestine and colon are unremarkable .
The small intestine and colon are opened along the anti-mesenteric border and are unremarkable . The
appendix is present.
HEPATOBILIARY SYSTEM :
The liver weighs 1860 gm and is yellow - tan in color and normal in size . The capsule is intact and the
consistency ofthe parenchyma is soft. The cut surface is smooth . There is a normal lobular arrangement
and mild steatosis. The gallbladder ispresent. Thewall is thin and pliable . It contains 30 cc of bile and
no stones. There is no obstruction or dilation of the extrahepatic ducts . The periportal lymph nodes arenot enlarged .
PANCREAS:
The pancreas occupies a normalposition. There is no necrosis. The parenchyma is lobularand firm .
Thepancreaticducts arenot ectatic andthere is no parenchymalcalcification.
URINARYSYSTEM:The rightkidneyweighs 190 gm . The leftkidneyweighs 200 gm . The kidneys arenormallysituated andthe capsules strip easily, revealing a surface that is smooth. The corticomedullary demarcation is
preserved. The pyramidsareunremarkable. The peripelvic fatis notincreased. The ureters are without
dilation or obstructionand pursue theirnormalcourse. The urinarybladderisunremarkableand is empty.
GENITAL SYSTEM :
The prostateis unremarkable. Both testesare in the scrotum and areunremarkableandwithouttrauma.
HEMOLYMPHATICSYSTEM
The thymus is inconspicuous. The spleenweighs 150 gm and is normal in size. The capsule is intact.
Theparenchymais firm . There is no increased follicular pattern . Lymph nodes throughout the body are
smalland inconspicuous. The bone is unremarkable. The bonemarrow of the rib isunremarkable.
ENDOCRINE SYSTEM :
The thyroid is red- tan in color . Theparathyroid glands are not identified. The adrenals are unremarkable .
Lung: The lungs show emphysematous changeswith areas of atelectasis. Focally the rightlung ( 4 )shows focalacute inflammationconsistingof neutrophils andmacrophagesin the alveoli. Similarlythe leftlung(# ) shows acute inflammation in the alveolar spaces in a more confluentpattern than thaton the
right
Heart: The heart showshypertrophic changes consisting of thickenedmyocytes containing enlargedhyperchromaticnuclei. The interventricularseptum and left ventricle show areas of and
necrosis ofwith neutrophilic infiltrate and some areas containingmacrophagesconsistentwith acute
myocardialinfarction hours old. Additionally there are areas of myocardialfibrosis with occasionalmacrophages
