DeKalb County Medical Examiner's Office

Monday's Case Brief Answer ?? Case Brief: A 32-year-old woman presents to the emergency department complaining of a one day history of severe abdominal pain and vaginal bleeding. She states her last menstrual period was six weeks ago but that she has been experiencing brown vaginal discharge for the past two days. She appears pale, but denies any fever, chills, or recent illnesses. She has no significant medical history but notes a prior surgical history of one cesarean delivery and an appendectomy for childhood appendicitis. The patient becomes unresponsive and despite aggressive care, the patient passes. Shortly afterward, a blood pregnancy test taken earlier in the day returns positive. At autopsy: Peritoneal Cavity: 2.2 L of fluid and clotted blood, Uterus: Empty, Right Fallopian Tube: Enlarged with a 1x1 cm tear on the anterior aspect containing placental tissue, All Other Organs: Pale and normal. What is the likely cause of death? ?? C. Ruptured Ectopic Pregnancy An ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity - most commonly in the fallopian tube. Prompt diagnosis and timely management is life saving! ?? Botulism Symptoms: Positive Pregnancy Test or Amenorrhea, Abdominal Pain, and Vaginal Bleeding Diagnosis: Transvaginal Ultrasound: Demonstrates no embryonic tissue in uterine cavity - may see a gestational sac with a yolk sac or embryo outside of the uterus Serum hCG: positive measurements of pregnancy hormone Treatment: Medical Management: Intramuscular methotrexate Surgical Management: Laparoscopic surgery to treat an ectopic should be guided by the clinical and laboratory findings. Surgical management is required when a patient is demonstrating hemodynamic instability, symptoms of a ruptured ectopic mass, or signs of an intraperitoneal bleed.

Defenestration is the act of throwing someone or something out of a window. The word comes from the Latin "fenestra," meaning window, and "de-" meaning "down from" or "away from." It's often used in a historical or figurative sense, but it literally refers to the physical action of ejecting someone through a window. One famous example is the Defenestration of Prague in 1618, which played a role in sparking the Thirty Years' War. (Pictured) In forensic death investigations, defenestration can be a key factor in determining the cause and manner of death. It’s particularly important in cases where someone has been found dead or injured after falling or being thrown out of a window. Investigators must carefully assess whether the event was accidental, suicidal, or homicidal.

The DeKalb County Medical Examiner's Office recently participated in Avondale Elementary School's Career Day, offering students an engaging and informative look into the important work of forensic science. Inv. Trey Robinson and forensic lab tech, Marquel Johnson shared insights into the role of a medical examiner, including how they investigate causes of death, how your body functions, and what they can do to live a long, healthy life. The interactive session sparked curiosity and encouraged students to explore careers in science, law, and medicine, highlighting the diverse opportunities within the field. It looks like we already have a future doctor in the making!?

It’s not work when you love what you do.

We hope everyone has a fantastic Terrier Tuesday!

Happy St. Patrick’s Day!

Medical Student Monday ?? Case Brief ?? Case Brief: A 32-year-old woman presents to the emergency department complaining of a one day history of severe abdominal pain and vaginal bleeding. She states her last menstrual period was six weeks ago but that she has been experiencing brown vaginal discharge for the past two days. She appears pale, but denies any fever, chills, or recent illnesses. She has no significant medical history but notes a prior surgical history of one cesarean delivery and an appendectomy for childhood appendicitis. The patient becomes unresponsive and despite aggressive care, the patient passes. Shortly afterward, a blood pregnancy test taken earlier in the day returns positive. At Autopsy: ??: Peritoneal Cavity: 2.2 L of fluid and clotted blood ??: Uterus: Empty Right Fallopian Tube: Enlarged with a 1x1 cm tear on the anterior aspect containing placental tissue ??: All Other Organs: Pale and normal What is the most likely cause of death? ?? A) Subchorionic hemorrhage B) Spontaneous miscarriage C) Ruptured ectopic pregnancy D) Ruptured ovarian cyst The answer will be revealed on Friday ?? #CaseBrief #WeAreME #MedicalStudentMonday #MedicalExaminer

?? This post contains a photo of an educational specimen. ?? Wischnewsky spots (WS) are gross pathologic findings seen at autopsy. These reddish-brown to black punctuate hemorrhages are found on the inner lining of the stomach (gastric mucosa). WS is pathognomonic for hypothermia, diabetic ketoacidosis (DKA), and sepsis, meaning if these lesions are visible on autopsy then it is a very high chance the individual passed from one of these three conditions! WS was coined by Dr. Wischnewsky in 1800 after he discovered these lesions in >90% of hypothermia-related autopsies he conducted. However, this finding is also seen in DKA, sepsis, and severe physical stress marked by prolonged agony and painful, traumatic events. Hypothermia - The body's physiologic functions cannot continue due to the core temperature being less than 35 degrees Celsius (or 95 degrees Fahrenheit). DKA - The pancreas does not produce enough insulin and so glucose cannot travel inside the cell. As a result, glucose remains high, but the body thinks it's starving and starts to break down fats for fuel, producing acids called ketones. These ketones in turn make the blood acidic. Sepsis - This is an extreme, life-threatening dysregulated overreaction to an infection which ends up harming the organs instead of successfully fighting off the source of the infection. It is unknown why WS develops under these circumstances, but one hypothesis points to stress-related increased gastric acid secretion being responsible for developing these lesions. Another hypothesis claims the color could be secondary to the destruction of red blood cells. A medical examiner's autopsy report may describe this finding as follows: "The gastric mucosa is remarkable for numerous black, diffuse, ovoid to irregular lesions consistent with Wischnewsky ulcers which range from from 0.1 cm - 0.7 cm." However you describe it, you know it when you see it!

Last month, 11Alive came our office to speak to Director Beoncia Loveless and Chief Medical Examiner Dr. Gerald Gowitt, about the ongoing fentanyl crisis and it's deadly impact in DeKalb county. Dr. Gowitt outlined staggering statistics, revealing that of the more than 200 drug overdose deaths reported annually in DeKalb County, roughly 150 involve fentanyl — either alone or mixed with other substances. Both Dr. Gowitt and Director Lovelace stress the urgent need for awareness, education and stronger measures to curb the flow of fentanyl into communities. Our office is working to combat opioid deaths by conducting opioid overdose and Naloxone training events. If you are interested in more information about scheduling a training event, Please contact our Public Education Specialist, Brittany Godfrey, by email at [email protected] . https://lnkd.in/eJTQy_VX

A big thank you to all the funeral directors and morticians for your compassionate care and support during some of the most difficult times in people's lives. Your professionalism, empathy, and dedication to helping families honor their loved ones are truly appreciated. You provide a vital service with grace and respect, and your work doesn’t go unnoticed. Thank you for all that you do.