Question

You are working a night shift in the emergency department (ED) when the security staff yells for help at the ED entrance. As you grab a pair of gloves and race to the entrance you find a young adult white male lying on the pavement of the drive, unconscious and bleeding from his torso. He does not respond to verbal or painful stimuli but he has respirations of approximately 14 breaths/min and a weak and thready pulse of 120bpm. Two more staff members appear with a stretcher and a backboard and as the team log rolls the patient onto the backboard you see tears in his shirt where the bleeding is coming from. The patient is taken into the emergency department into a trauma bay where trauma assessments and interventions are employed.

Upon examination you find that the patient has a blue discoloration with an abrasion to the left forehead above the left eye. It measures 5cm x 3cm. Swelling and a 3cm x 1cm abrasion is noted to the bridge of the nose with epistaxis. Three torso wounds are noted that line up with the tears in the shirt. He is bleeding heavily from the largest…it appears with smooth edges and appears deep. A constant ooze of blood is flowing. It is found on the right lateral chest mid axillary line at the 4^th rib 3cm x 2cm x 5cm deep. A 3cm x 2cm x 2cm wound is found at the mid clavicular line, 2^nd rib above nipple on the right side. A linear cut is noted lateral to the right nipple 4cm x 2cm x 1/2cm deep. Bleeding is controlled by provider and a metal fragment pulled from the wound. A large amount of dried blood covers the patient’s torso. The palm of the right hand has two linear cuts that are parallel and 4cm x 2cm and 4 1/2cm x 2cm.

The patient is taken to surgery and planned to transfer to the ICU.

No information has accompanied this patient other than another ED patient stating that as they were walking in they saw a dark car open the passenger door and the patient fell out.

1. It is decided to photograph the injuries. What type of tools and techniques are advisable when photographing injuries?
2. According to the injuries found on the victim’s body, what type of force or cause of injury does it appear caused trauma to the victim? Why?
3. Explain chain-of-custody. How would you handle chain of custody in this case?
4. Provide an example of the documentation of the evidence recovered with chain-of-custody in mind.
5. During the life-saving interventions on the patient such as IV insertion, intubation, central line placement, or chest tube insertion what forensic considerations can the nurse take to preserve evidence? Consider the location of injuries.

Answer 1

1. The tools and techniques required to take the photographs of the injury are a camera , a photographer , and the photography must be done according to the norms and protocols of the hospital and should be documented so that the doctors can assess the improvement in the follow up and also this information can be used for research purposes .

2. According to the injuries found on the victim's body ,the cause of the injury is assualt - somebody has tried to harm this person because the person has been injured too badly every where and as an evidence a metal fragment is pulled out of the wound .

3.Chain of custody is the chronological documentation that records the sequence of custody, control, transfer, analysis, and disposition of physical or electronic evidence. In this case the chain of custody is :-

- Recieved from = The person was found in the pavement of the drive at the entrance of the emergency department

- By whom = The injured person was first seen by the emergency department patient who said that they saw adark car open the passenger door and the patient fell off and then the security of the emergency department saw him .

- when ( time ) = in the night shift .

- date = is not mentioned .

4. The evidence recovered from the chain of custody is that some person has harmed him and left him in the emergency department .