Acute Excited States and Sudden Death Authors Reply

AUTHORS: Frank R Farnham, Lecturer in forensic psychiatry;
Henry G Kennedy, Consultant forensic psychiatrist

An EDITORIAL LETTER, published in the, British Medical Journal
BMJ October, 1998;317:1154

(CHAS COMMENT:)
Farnham and Kennedy demonstrate how CLUELESS they are!

In his letter Pounder(1) relies on physiological research by Reay et al(2) that has recently been shown to be methodologically incorrect.(3) Chan et al showed that even the most extreme (hogtied) restraint positions combined with exercise do not produce hypoxia or any other clinically relevant change in oxygenation or ventilation, provided that correct methods of measurement are used.(3) [That would be the truly CLUELESS comment! LOL] We do not of course recommend hogtying as a form of restraint.

We thank Karch and Stephens for drawing attention in their letter to the interesting neurochemical associations between cocaine use, hyperthermia, and sudden death. We agree that prudent postmortem management should include neck dissection to rule out neck compression as well as measurements of brain drug concentrations, but as psychiatrists we are more interested in the living than the dead and how to prevent the living becoming the dead.(5)

[Somehow ... I missed that concern for wanting to "to prevent the living becoming the dead" ... If that were TRUE, Farnham and Kennedy would not be so quick to attribute more weight upon a single, biased, and inaccurate study (Chan et al's), than to the huge bulk of several studies achieved by Reay et al. Ah, well. Nuff said!]

Pounder D. Acute excited states and sudden death. BMJ 1998; 316: 1171. (11 April.)

Reay DT, Howard JD, Fligner CL, Ward RJ. The effects of positional restraint on oxygen saturation and heart rate following exercise. Am J Forens Med Pathol 1988; 9: 16-18.

Chan TC, Vilke GM, Neuman T, Clausen JL. Restrain position and positional asphyxia. Ann Emerg Med 1997; 30: 578-586.

Karch SB, Stephens BG. Acute excited states and sudden death. BMJ 1998; 316: 1171. (11 April.)

Farnham FR, Kennedy HG. Acute excited states and sudden death. BMJ 1997; 315: 1107-1108.

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"