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

The injuries produced in human body when attempting resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or noted in inquest by the investigating law enforcement agency.

Before making an interpretation of these injuries during autopsy, the doctor 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 had been documented in the clinical sheets or not.
A doctor should always document any resuscitative injuries in detail in case of death.
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 nearby to the critical patient is mouth to mouth respiration and manual chest massage may causes contusions.
• Resuscitation in hospitals include bag and mask intubations, endotracheal tube, obdurate airway are used for respiratory ventilation.
• The mechanical methods like thumper, active compression–decompression device, and defibrillator are used in resuscitation. The 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 to the patients 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.
• Resuscitative fractures of rib No. 1, 8 and 12 are very rarely seen in autopsy.
• The number of fractured ribs ranged up to 16, mainly 3-8 ribs was fractured.
• The site of rib fractures after heavy blunt thoracic injuries was preferably found in the dorsal region.
• The injuries which are received/inflicted on body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifact.