The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients.

Background: The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged.

Methods: All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed.

Results: Of the 491 PE deaths identified, 36% were surgical and 64% medical.

Central venous catheterization using a perfused human cadaveric model: application to surgical education.

Objective: The purpose of this article is to present a unique training model using a perfused human cadaver for central line placement training with the ultimate goal of reducing central venous catheter mechanical complications.

Design: The applicability of the fresh tissue cadaver model for central line placement was assessed using a 10-item questionnaire with a 5-point Likert-type scale. Respondents were asked to rate their opinions as strongly agree, agree, neutral, disagree, or strongly disagree.

Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives.

Background: Transmediastinal gunshot wounds are associated with a high mortality and frequently require operative intervention. The purpose of this study was to identify the diagnostic and therapeutic challenges of these injuries in a mature trauma system with decreasing prehospital time intervals.

Methods: Patients admitted to a large urban Level 1 trauma centre between 1/2006 and 12/2010 sustaining a firearm injury to the torso were identified.

Optimal positioning for emergent needle thoracostomy: a cadaver-based study.

Background: Needle thoracostomy is an emergent procedure designed to relieve tension pneumothorax. High failure rates because of the needle not penetrating into the thoracic cavity have been reported. Advanced Trauma Life Support guidelines recommend placement in the second intercostal space, midclavicular line using a 5-cm needle.

Fatalities of the 2008 Los Angeles train crash: autopsy findings.

Introduction: Train crashes represent a devastating multicasualty event. The purpose of this study was to analyze the injury severity, specific organ injuries, and cause of death in the fatalities of the 2008 Chatsworth, Los Angeles train crash.

Methods: This is a review of the medical examiner records of the 25 fatalities in the train crash.

Blunt thoracic aortic injuries: an autopsy study.

Objective: The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries.

Methods: All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries.

Blunt cardiac trauma: lessons learned from the medical examiner.

Objective: The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries.

Methods: All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis.

Preventable or potentially preventable mortality at a mature trauma center.

Objective: The objective of this study was to analyze the preventable and potentially preventable deaths occurring at a mature Level I trauma center.

Methods: All trauma patients that died during their initial hospital admission during an 8-year period (January, 1998 to December, 2005) were analyzed. The deaths were initially reviewed at a weekly Morbidity and Mortality (M&M) conference followed by a multidisciplinary (Trauma Surgery, Critical Care, Emergency Medicine, Neurosurgery, Nursing, and Coroner) Combined Trauma Death Review Committee, and were classified into nonpreventable, potentially preventable, and preventable deaths.

Restraint asphyxia in in-custody deaths Medical examiner's role in prevention of deaths.

In the United States, the office of the Medical Examiner-Coroner is responsible for investigating all sudden and unexpected deaths and deaths by violence. Its jurisdiction includes deaths during the arrest procedures and deaths in police custody. Police officers are sometimes required to subdue and restrain an individual who is violent, often irrational and resisting arrest.

Quality improvement of patient care - forensic pathologists' perspective.

In the U.S. today, the pathologists, both hospital-based and forensic, are regularly involved in quality assurance (QA) programs, the evaluation of patient safety at all levels of medical care, including treatments in walk-in clinics and medical offices.

[Preparedness for terrorist attack in the United States--the role of forensic pathologists and medical examiners].

Long distance airplanes hijacked by terrorists suddenly struck the World Trade Center in New York City on September 11, 2001. The city responded with efficient emergency service and there were a number of learning points for future planning. Early activation of the Disaster Mortuary Operation Response Team (DMORT) provided efficient family assistance by setting up a comprehensive Information Database Center and assisted the Medical Examiner in identifying the deceased.

The role of the forensic pathologist in quality assurance and safety of patient care.

During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures.

Alcohol and illicit drugs in traumatic deaths: prevalence and association with type and severity of injuries.

Background: My colleagues and I studied alcohol and illicit drug intoxication in trauma fatalities and their association with the nature and severity of injuries.

Study Design: We examined the trauma registry and autopsies of all trauma fatalities at an academic Level I trauma center. Statistical analysis was performed to evaluate the association of substance use with the Injury Severity Score, body areas with severe trauma (Abbreviated Injury Score >/= 3), and spinal injuries.

Medical malpractice claims and quality improvement program as viewed by a forensic pathologist.

This is a review article dealing with the half-century evolution of the quality assurance program to improve patient care in the United States. The author attempted to point out some differences in approach to solving the medical error and medical malpractice problems between Japan and the U.S.