Bryan Wickham Page | of 11 AUTOPSY PROTOCOL JACKSON COUNTY NAME OF DECEASED: BRYAN WICKHAM CASE NUMBER: J22-4 GENDER: Male AGE: 55 Years RACE: White DATE OF DEATH: December 29, 2021 TIME: 7:59 P.M. PLACE OF DEATH: Hospital DATE PRONOUNCED: December 29, 2021 TIME: 7:59 P.M. PLACE PRONOUNCED: Henry Ford Allegiance Health DATE OF AUTOPSY: January 6, 2022 TIME: 1:35 P.M. CAUSE OF DEATH: MULTIPLE BLUNT FORCE INJURIES AND COMPLICATIONS THEREOF MANNER OF DEATH: UNDETERMINABLEBryan Wickham Page 2 of 11 EXTERNAL EXAMINATION The bodys that of a white male, 76 inches in length, residual weight of 265 pounds status post organ removal by Gift of Life, normally developed, overweight, and appearing consistent with the stated age of 55 years. The body is received without accompanying clothing. There are no accompanying personal effects. The body is cold. Rigor mortis is full. Livor mortis is light purple red, dorsally distributed, and is fixed. The head and face appear to have been normally and symmetrically developed. Injuries are described below. The scalp hair is light brown and up to approximately % of an inch in length except those areas that were shaved for craniotomy. There is a brown mustache. There is a brown with gray-white goatee. There is gray-white stubble in the cheeks and upper neck regions. The irides are blue. The comeae are clear. The sclerae are white. The conjunctivae show no petechiae or hemorthage. The teeth are natural and in fair to poor condition. There is mucus within the oral cavity. The nose is intact and there are no contents within the nares The mouth and ears are normally developed. The neck is normally developed. The chest is normally and symmetrically developed. The abdomen is soft. The penis is circumcised with both testes descended. The extremities are normally and symmetrically developed. The fingemails are short, slightly dirty, and intact. The toenails are short, clean, and intact. The back is normally developed.Bryan Wickham. Page 3 of 11 SCARS: None. TATTOOS: None. EVIDENCE OF THERAPY: There is a recently sutured scalp incision over the top of the scalp that extends to the posterior scalp and continues to the left posterior parietal/occipital regions. There is bulb suction within the posterior parietal scalp. There is a properly positioned endotracheal tube. There is a recently sutured incision extending from the sternal notch to the midline lower pelvis. There is an intravenous catheter on the dorsal right hand. There is an intravenous catheter in the right radial wrist. There are intravenous catheters in the right and left femoral regions. There is a foley catheter. EVIDENCE OF INJURY: MULTIPLE BLUNT FORCE INJURIES BLUNT FORCE INJURY OF HEAD AND FACE: There is an abrasion above the left eye. There is a 2 % inch by 2-inch abrasion/contusion of the left temporal scalp. There is organizing subdural hemorrhage over the right cerebral hemisphere and the posterior left parietal region. BLUNT FORCE INJURY OF CHEST AND EXTREMITIES: There are remote light green to light purple contusions on the right upper arm, right lower chest, right lateral lower abdomen/hip, and the left chest. There are contusions of the posterior left 4-10 intercostal regions and the posterior right 10-11 intercostal regions. There are multiple contusions of the right upper lobe and the left lower lobe.Bryan Wickham Page 4 of 11 INTERNAL EXAMINATION BODY CAVITIES: The body cavities are entered in the usual manner. Injuries have been previously described. There are no abnormal adhesions or fluid collections in the chest or abdominal cavities. The serosal surfaces are unremarkable. There is no evidence of penetrating injury to the thoracic or abdominal cavities. All the organs are in their normal anatomical positions except those that have been previously surgically removed. HEAD AND BRAIN: The brain weighs 1740 grams. Injuries have been previously described. There are no skull fractures. The skull is status post craniotomy. There is no evidence of epidural hemorrhage. The leptomeninges are thin and bloody. The cerebral spinal fluid is clear. The vessels at the base of the brain are normally developed and positioned. The cerebral cortex appears to have been symmetrically and normally developed. There is global cerebral edema with blunting of the gyral-sulcal grooves. Serial sectioning of the cerebral hemispheres reveals no evidence of mass lesions or infections. The ventricles are decreased in size. The parenchyma appears to have been normally developed, There is adequate pigmentation. The cerebellum and brain stem appear to have been normally developed. NECK: The soft tissues and muscles of the neck are normally developed. The laryngeal cartilages are intact. The pharynx and larynx are unremarkable, The hyoid bone is intact. The cervical vertebral bodies are intact.Bryan Wickham Page 5 of 11 CARDIOVASCULAR SYSTEM: The heart weighs 550 grams. The valves measure as follows: Tricuspid 12.4 cm, Pulmonic 7cm, Mitral 10.1 cm, Aortic 7.1 cm. The thickness of the left ventricle measures 1.4 centimeters. The thickness of the right ventricle is 0.4 centimeters. The pericardium is unremarkable. The epicardium is unremarkable. The myocardium is red-brown and unremarkable. The endocardium is unremarkable. The ventricles are normally sized. The coronary arteries are normally distributed. The proximal to mid left anterior descending coronary artery demonstrates approximately 10-20% atheromatous luminal narrowing with calcification of the vessel walls. The intima of the aorta is smooth. The aorta's major veins and branches are patent and unremarkable. RESPIRATORY SYSTEM: The tight lung weighs 1270 grams, and the left lung weighs 820 grams. The pleural surfaces are smooth and glistening. There is mild to moderate anthracosis. The airways are free of obstruction. The parenchyma is markedly edematous and congested with copious amounts of purple-red, frothy fluid expressed upon serial sectioning. Serial sections of the parenchyma reveal no mass lesions or gross signs of infection within the lobes. There are metastatic nodules around the right hilum. The pulmonary arteries are patent but with some narrowing due to tumor compression DIGESTIVE SYSTEM: The tongue appears normally developed. The esophagus is unremarkable. The stomach contains approximately 3 milliliters of light-yellow green fluid. The gastric mucosa is unremarkable. There is no hemorrhage orBryan Wickham Page 6 of 11 perforation. The small and large intestines appear normally developed. The pancreas is normally developed. LIVER: The liver has been previously removed. SPLEEN: The residual spleen weighs 300 grams. The parenchyma is congested. GENITO-URINARY SYSTEM: The kidneys have been previously removed. The urinary bladder is empty due to foley catheter. The urinary bladder mucosa is unremarkable. The prostate gland is unremarkable. LYMPH NODES: There are small hilar and mediastinal lymph nodes that are normally developed and unremarkable. ENDOCRINE SYSTEM: The pituitary gland and thyroid glands are normally developed. The adrenal glands have been previously removed. MUSCULOSKELETAL SYSTEM: The skeletal muscles appear to have been normally developed and unremarkable. The bony skeleton is intact. AUTOPSY FINDINGS: 1. Blunt force injury of head and face a. Contusions and abrasions of the left eye and left temporal region b. Subdural hemorrhage, right cerebral hemisphere and posterior left parietalBryan Wickham Page 7 of 11 AUTOPSY DINGS CON’ EI 2. Blunt force injury of chest and extremities a, Remote contusions of chest and right arm OPINION: The cause of death of this 55-year-old white male, Bryan L. Wickham, is multiple blunt force injuries and complications thereof. The decedent was admitted to the hospital on December 25, 2021 with injuries of unknown origin. The decedent underwent craniotomy for subdural hemorrhage and his condition continued to decline until his death. In consideration of the autopsy examination, the information known at this time, and the medical records, the manner of death is undeterminable. PATRICK CHO, M.D. DEPUTY MEDICAL EXAMINER po 31512022NMS Labs CONFIDENTIAL, 200 Welsh Road, Horsham, PA 19044-2208 Phone: (215) 857-4900 Fax: (215) 657-2972 emai: [email protected] Robert A, Midéleberg, PhD, F-ABFT, DABCC-TC, Laboratory Director Toxicology Report Patient Name WICKHAM, BRYAN Sof U( Patient ID 30277498 Report Issued 02/08/2022 13:07 Gia Sica Age 55 DOB 11/26/1986 Gender Male To: 10640 Jackson County Medical Examiner Workorder = 22010172 ‘1991 Chanter Road Jackson, MI 49201 Page 1 of 4 Positive Findings: ‘Compound Result Units, ‘Matrix Source Laudanosine Presump Pos ngimmL. 002 - Subdural BloodiClot Naltrexone - Froe 13 ingimmt. 002 - Subdural Blood/Clot 6-Beta-Naltroxol - Free 45 nngimL. 002 - Subdural Blood/Clot ‘See Detailed Findings section for additional information Testing Requested: Analysis Code Description 30518 Posimortem, Basie, Blood (Forensic) 80528 Postmortem, Expanded, Blood (Forensic) ‘Specimens Received: 1D. TubelContainer Volume! Collection Matrix Source Labeled As Mass Date/Time 007 Gray Top Tube o5mt Not Given ‘Subdural BloodiGiot 3027746 (002 Homogenate Container Not Given Not Given Subdural BloodiCiot Not Applicable 003. Gray Top Tube 7m Not Given Subdural BloodiGiot 30277498 004. Gray Top Tube 6.5ml Not Given ‘SubduralBloodiGiot 30277488 (005. Gray Top Tube 45mL Not Given Subdural BloodiGiot 30277498 (008 Red Top Tube 4ml 01/06/2022 14:00 Vitreous Fluid 30277498 001 BLOOD SAMPLE TAKEN FROM SUBDURAL HEMORRHAGE FROM APPROX. 12/24 OR 12/25 2021 002 BLOOD SAMPLE TAKEN FROM SUBDURAL HEMORRHAGE FROM APPROX, 12/24 OR 12/25 2021 (008 BLOOD SAMPLE TAKEN FROM SUBDURAL HEMORRHAGE FROM APPROX. 12/24 OR 12/25 2021 (004 BLOOD SAMPLE TAKEN FROM SUBDURAL HEMORRHAGE FROM APPROX. 12/24 OR 12/25 2021 005 BLOOD SAMPLE TAKEN FROM SUBDURAL HEMORRHAGE FROM APPROX. 12/24 OR 12/25 2021 All sample volumesiweights are approximations, ‘Specimens received on 01/08/2022. NMS v.22.0NMS ae I | Patient ID 30277498 ' rote M24 Bisa Waltham Fo? I Detailed Findings: Rpt Analysis and Comments Result, Units Limit Specimen Source Analysis By Laudanosine Presump Pos nig/mt 100 002 Subdural Blood/Clot LC/TOF-MS. This testis an unconfirmed screen. Confirmation by a more definitive technique such as GC/MS is recommended Naltrexone - Free 13 ng/ml. 0.50 002 Subdural Blood/Clot_ LC-MS/MS. 6-Beta-Naltrexol - Free 45 g/m 0.50 002 Subdural Blood/Clot_ LC-MS/MS Other than the above findings, examination of the specimen(s) submitted did not reveal any positive fi toxicological significance by procedures outlined in the accompanying Analysis Summary. ings of Reference Comments: 1. 6-Beta-Naltrexol - Free (Naltrexone Metabolite) - Subdural Blood/Clot: 6-bete-natrexolis the primary metabolite of naltrexone. The peak plasma concentrations of 6-betanallrexol at approximately one hour folowing a single oral dose of naltrexone were: 99 (+ 30) ngfmk after 50mg 210 (7 78) ngimL after 100 mg 440 (4 140) ng aftr 200 mg The average peak plasma concentration of 6-beta-natrexol was 34 ng/ml following four doses of 380mg naltrexone given by depo intramuscular injection every 28 days. The blood to plasma rato of 6-beta-nalirexol is approximately 0.5. 2. Laudanosine (Atracurium Metabolite) - Subdural Blood/Clat: Laudanosine is a biotransformation product of atracurium, a non-depolarizing skeletal muscle relaxant used with endotracheal intubation and during surgery or mechanical ventilation. Laudanosine has an average half- Ife of 1.8 hours in patients with normal liver and kidney functions, Ina group of patients that received a bolus dose of atracurium of 0.075, 0.18 or 0.30 mg/Kg, the concentration of laudanosine ranged from a peak of approximately 10-100 ngiml. shortly after injection to approximately 1-40 ‘ng/ml at approximately 8-hr post-dosing. In apparent intentional overdose situations involving atracurium, laudanosine blood concentrations are reported to range from 390-1000 ng/mL. 3. Naltrexone - Free (Depade®,; ReVia®; Trexan®; Vivitr®) - Subdural Blood/Clot Naltrexone is an opioid antagonist used to reduce cravings for alcohol or opioid drugs such as heroin. Normal oral dosages are 60 mg per day to treat addiction and 20 to 100 mg per day to treat pain. The peak plasma concentrations at approximately one hour following a single oral dase of naltrexone were: 9 (41-5) ngimL after 50 mg 20 (+/- 18) ngimL after 100 mg 36 (+/- 20) ngimL after 200 mg The average peak plasma concentration of naltrexone was 28 ng/mL folowing four doses of 380 mg naltrexone given by depot intramuscular injection every 28 days, Naltrexone is also used to deter tampering with controlled release morphine formulations (Embeda®). Naltrexone plasma concentrations in patients compliant with their Use of Embeda® were below 0.5 ng/mL. The blood to plasma ratio of naltrexone is approximately 0.9. Adverse effects of naltrexone may include dizziness, fatigue, anxiety, somnolence, insomnia, precipitation of withdrawal In opioid dependent patients and increased risk of suicide. Excessive doses of naltrexone may cause liver failure, ‘Sample Comments: 001 Blood specimen required homogenization: 22010172-001 002 NMS Labs generated homogenized Blood sample: 22010172-002 Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded one (1) year {rom the date ofthis report; and generated data will be discarded five (6) years from the date the analyses were performed, NMS v.22.0Patient ID 30277498 CONFIDENTIAL Workorder 22010172 A N MS hain 30277498 a pagers — Brey Waltham 10 of I Workorder 22010172 was electronically ‘signed on 02/08/2022 12:07 by: eae Y Meaghan M. Ringel, M.S.F.S Certifying Scientist Analysis Summary and Reporting Limits: All ofthe following tests were performed for this case. For each test, the compounds listed were included in the scope. The Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being positive. Ifthe compound is isted as None Detected, itis not present above the Reporting Limit, Please refer to the Positive Findings section ofthe report for those compounds that were identified as being present. ‘Acode 24978 - Naltrexone and Metabolite - Free (Unconjugated) Confirmation, Blood - Subdural Blood/Clot Analysis by High Performance Liquid Chromatography! Tandem Mass Spectrometry (LC-MS/MS) for: Compound Bo_Limit ‘Compound Rot Limit 6-Beta-Naltrexol -Free 0.50 ng/ml. Naltrexone - Free 0.50 ng/mt. ‘Acode 80518 - Postmortem, Basic, Blood (Forensic) - Subdural Blood/Clot Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: ‘Compound Rot Limit ‘Compound ‘Rot Limit ‘Amphetamines 20 ngimt. Fentanyl / Acetyl Fentanyl 0,50 ng/ml. Barbiturates. 0.040 megimt. Methadone / Metabolite 25 ng/ml. Benzodiazepines 400 ng/mL. Methamphetamine / MDMA 20 ngimt. Buprenorphine / Metabolite 0.50 ng/ml. Opiates 20 ngimt. Cannabinotds 40 ngimL Oxycodone / Oxymorphone 410 ngiml. Cocaine / Metabolites 20 ngimt. Phencyclidine 40 ngimL Analysis by Headspace Gas Chromatography (GC) for: ‘Compound ‘Rot Limit ‘Compound ‘Rot Limit Acetone 5.0 mgidl. Isopropana! 5.0 mg/dL Ethanol 10 mglat Methanol 5.0 mgidL ‘Acode 80528 - Postmortem, Expanded, Blood (Forensic) - Subdural Blood/Clot Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: ‘Compound Rot Limit Compound Rot Limit Barbiturates 0.040 megimt. Gabapentin 5.0 mogiml. Cannabinoids 10 ngimt. Salicylates: 120 megimt. -Analysis by Headspace Gas Chromatography (GC) for: Compound Rot Limit ‘Compound ‘Rot Limit Acetone 8.0 mg/d. Isopropanol 5.0 mg/d. Ethanol 40 mg/dL Methanol 5.0 mg/dl. NMS v.22.0, CONFIDENTIAL Workorder 22010172 dH N MS Chain 30277408 Patient ID 30277498 re Bryon Werke Ul oft Analysis Summary and Reporting Limits: -Analysis by High Performance Liquid Chromatography/Time of Flight-Mass Spectrometry (LC/TOF-MS) for: The following is @ general list of analyte classes included inthis screen. The detection of any specific analyte is ‘concentration-dependent. Note, not al known analytes in each specified analyte class are included. Some ‘specific analyles outside of these classes are also included, For a detailed ist ofall analytes and reporting limits included in this screen, please contact NMS Labs. Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Antipsychotic Agents, Benzodiazepines, CNS Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemic, Muscle Relaxants, Non-Steroidal Ant-Inflammatory Agents, Opiates and Opioids. pe 3.5.22 NMS v.22.0