Tuesday, 18 December 2012

Emedinews:Insights on Medicolegal Issues:What are resuscitative injuries?

Doctor should always document resuscitative injuries in detail in case of death

The injuries produced in human body during resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

  • The method generally used for life saving attempts by non–medical persons who are near the critical patient is mouth–to–mouth respiration and manual chest massage may causes contusions.
  • Resuscitation in hospitals includes bag and mask intubations, endotracheal tube, obdurate airways used for respiratory ventilation.
  • Mechanical methods like Thumper, active compression–decompression device and defibrillators are used in resuscitation. Closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
  • The injections and closed–chest cardiac massage and other resuscitation procedures may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and of spleen.
  • Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age. The number of fractured ribs ranged up to 16, mainly 3–8 ribs was fractured. Fractures of the 1st and 8th to 12th ribs were very rare.
  • The common site of rib fractures after heavy blunt thoracic injuries was found in the dorsal region.
  • The injuries which are received or inflicted on body prior to death are called antemortem injuries and may or may not be contributing factors in causing death or they may have occurred due to other reasons such as resuscitation/transport of sick/ill person for medical care called artifacts.

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