Emedinews:Insights on Medicolegal Issues:Ordinary and extraordinary medical care

The Pope and Catholic teachings advocate a distinction between ordinary and extraordinary care, with ordinary care being mandatory, whereas extraordinary care may be withheld or withdrawn.*

One commentator explicated this distinction in the following way. According to him,

• Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or inconvenience…
• Extraordinary means of preserving life mean all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer reasonable hope of benefit.

Many ethicists and courts have concluded that this distinction is too vague and has "too many conflicting meanings" to be helpful in guiding surrogate decision makers and clinicians As one lawyer noted ordinary and extraordinary are "extremely fact–sensitive, relative terms…what is ordinary for one patient under particular circumstances may be extraordinary for the same patient under different circumstances, or for a different patient under the same circumstances". Thus, the ordinary/extraordinary distinction should not be used to justify decisions about stopping treatment.

*Pope Pius XII. The prolongation of life In: Ethics in medicine. Reiser SJ, Dyck AJ, Curran WJ (Eds), MIT Press, Cambridge 1997.

Emedinews:Inspiration:A Glass of Milk – Paid In Full

One day, a poor boy who was selling goods from door to door to pay his way through school, found he had only one thin dime left, and he was hungry. He decided he would ask for a meal at the next house. However, he lost his nerve when a lovely young woman opened the door. Instead of a meal he asked for a drink of water. She thought he looked hungry so brought him a large glass of milk. He drank it slowly, and then asked, “How much do I owe you?” “You don’t owe me anything,” she replied. “Mother has taught us never to accept pay for a kindness.” He said, “Then I thank you from my heart.”

As Howard Kelly left that house, he not only felt stronger physically, but his faith in God and man was strong also. He had been ready to give up and quit.

Year’s later that young woman became critically ill. The local doctors were baffled. They finally sent her to the big city, where they called in specialists to study her rare disease. Dr. Howard Kelly was called in for the consultation. When he heard the name of the town she came from, a strange light filled his eyes. Immediately he rose and went down the hall of the hospital to her room. Dressed in his doctor’s gown he went in to see her. He recognized her at once. He went back to the consultation room determined to do his best to save her life. From that day he gave special attention to the case.

After a long struggle, the battle was won. Dr. Kelly requested the business office to pass the final bill to him for approval. He looked at it, then wrote something on the edge and the bill was sent to her room. She feared to open it, for she was sure it would take the rest of her life to pay for it all. Finally she looked, and something caught her attention on the side of the bill. She began to read the following words: “Paid in full with one glass of milk”.

Emedinews:Tat Tvam Asi:Indications for liver transplantation:

Tat Tvam Asi……..and the Life Continues…..
(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity, Gurgaon)

 Chronic Liver disease  = 64

•          Cholestatic liver disease:   51(76%)

•          Biliary atresia                                                                            :   40 (78%)

•          Progressive familial intrahepatic cholestasis              :  4         

•          Caroli’s disease                                                                        :  2

•          Allagile syndrome                                                                   :  2

•          Sclerosing Cholangitis sec to Langerhans Cell Histiocytosis : 2

•          Choledochal cyst                                                     :  1

•          Metabolic disorders : 3 (4.7%)

•          Wilson’s disease                                                      : 1

•          Tyrosinemia                                                               : 2

•            Hepatitis  :   8 (14%)

•          Autoimmune hepatitis                                                         :6

•          Chronic hepatitis B                                                                 :1

Cryptogenic – 3  (4.7%)

Emedinews:Insights on Medicolegal Issues:Errors in diagnosis of Death

• Generally, there is no difficulty in the diagnosis of somatic death by doctors. However, in some cases the heart sounds and breath sounds diminish greatly. Errors occur if proper clinical examination is not done or hurriedly done in patients with kidney failure and Cheyne–stokes respiration etc. Nevertheless, there are occasions when the distinction between death and suspended animation poses a real difficulty.
• Suspended animation is a death–like state in which vital functions of the body are at such a low pitch that they cannot be determined by ordinary methods of clinical examination.
• Practitioners of yoga can induce this death like state voluntarily.
• It can be involuntarily due to: (i) Severe shock following accident (ii) Electrical shock (iii) Poisoning (barbiturate) (iv) Drowning (v) Epilepsy (vi) Sunstroke (vii) Cholera and (viii) Hysteria.
• Suspended animation lasts for seconds to hours and distinction is not possible by ordinary clinical methods. However, methods like ECG and EEG can be used to reach a diagnosis.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publisher)

Emedinews:Inspiration:The horse that wanted more beauty

 A cosmic god had a horse. The horse was beautiful and also it had many good qualities. But it wanted to be more perfect in every way. It especially wanted to become beauty unparalleled.

 One day the horse said to the cosmic god, “O Lord, you have given me beauty. You have given me other good qualities. I am so grateful to you. But how I wish you could make me more beautiful. I would be extremely, extremely grateful if you could make me more beautiful.” The cosmic god said, “I am more than ready to make you more beautiful. Tell me in what way you want to be changed.”

The horse said, “It seems to me that I am not well proportioned. My neck is too short. If you can make my neck a little longer, my upper body will be infinitely more beautiful. And if you can make my legs much longer and thinner, then I will look infinitely more beautiful in my lower body.”

The cosmic god said, “Amen!” Then immediately he made a camel appear in place of the horse. The horse was so disheartened that it started to cry, “O Lord, I wanted to become more beautiful. In what way is this kind of outer form more beautiful?” The cosmic god said, “This is exactly what you asked for. You have become a camel.” The horse cried, “Oh no, I do not want to become a camel I wish to remain a horse. As a horse, everybody appreciated my good qualities. Nobody will appreciate me as a camel.”

 The cosmic god said, “Never try to achieve or receive more than I have given you. If you want to lead a desire-life, then at every moment you will want more and more. But you have no idea what the outcome will be. If you cry for a longer neck and legs, this is what will happen. Each thing in my creation has its own good qualities. The camel is not as beautiful as you are, but it carries heavy loads and has a tremendous sense of responsibility.

Emedinews:Insights on Medicolegal Isues:What is contributory medical negligence?

The pregnant woman delivered a child with spina bifida; however, she failed to attend at the regularly advised dates for antenatal ultrasounds that would have identified this problem. The patient was found to be 100% at fault."

• In a medical malpractice/maloccurrence case, medical negligence is the foremost ingredient to establish the liability of damage and dereliction in provided medical care. However, it is important to establish the difference between malpractice and contributory negligence when determining liability.
• Contributory negligence means the patient/legal heirs/parties are partially to blame for the maloccurrence or medical untoward incident. For e.g., a patient is admitted to the emergency room for treatment and they fail to inform the doctor about a pre–existing condition e.g. any allergy to a drug. The patient is guilty of contributing to the negative outcome/damage of the treatment.
• If the victim is found to be even one percent at fault, they will be unable to recover compensation for their injuries. However, comparative negligence is used to determine degree of liability of the doctor/medical care provider.
• Contributory negligence will determine who will receive compensation for their losses and how much they may be entitled to receive in compensation for their injuries. Pure comparative negligence means that in case of an aggrieved patient, damages will be calculated and then reduced to reflect his or her contribution to the injury.

In India, the doctors take the defense against malpractice cases when determining how the parties involved are responsible. In US, 4 categories applied in compensation cases in many of its states: Pure Comparative Negligence/Pure Contributory Negligence/Modified Comparative Negligence—50% Bar Rule and Modified Comparative Negligence—51% Bar Rule. Twenty–one states that recognize the 51% bar rule which means that the party who is less than 51% liable can seek compensation; only 11 US states use the 50% bar rule, which means that if the damaged party is less than 50% responsible, they can collect damages.

Emedinews:Inspiration

An Inspirational Story

When I got home that night as my wife served dinner, I held her hand and said, I've got something to tell you. She sat down and ate quietly. Again I observed the hurt in her eyes.

 Suddenly I didn't know how to open my mouth. But I had to let her know what I was thinking. I want a divorce. I raised the topic calmly.

 She didn't seem to be annoyed by my words, instead she asked me softly, why?

 I avoided her question. This made her angry. She threw away the chopsticks and shouted at me, you are not a man! That night, we didn't talk to each other. She was weeping. I knew she wanted to find out what had happened to our marriage.

 But I could hardly give her a satisfactory answer; she had lost my heart to Jane. I didn't love her anymore. I just pitied her!

 With a deep sense of guilt, I drafted a divorce agreement which stated that she could own our house, our car, and 30% stake of my company.

 She glanced at it and then tore it into pieces. The woman who had spent ten years of her life with me had become a stranger. I felt sorry for her wasted time, resources and energy but I could not take back what I had said for I loved Jane so dearly. Finally she cried loudly in front of me, which was what I had expected to see. To me her cry was actually a kind of release. The idea of divorce which had obsessed me for several weeks seemed to be firmer and clearer now.

 The next day, I came back home very late and found her writing something at the table. I didn't have supper but went straight to sleep and fell asleep very fast because I was tired after an eventful day with Jane.

 When I woke up, she was still there at the table writing. I just did not care so I turned over and was asleep again.

 In the morning she presented her divorce conditions: she didn't want anything from me, but needed a month's notice before the divorce. She requested that in that one month we both struggle to live as normal a life as possible. Her reasons were simple: our son had his exams in a month's time and she didn't want to disrupt him with our broken marriage.

 This was agreeable to me. But she had something more, she asked me to recall how I had carried her into out bridal room on our wedding day.

 She requested that every day for the month's duration I carry her out of our bedroom to the front door every morning. I thought she was going crazy. Just to make our last days together bearable I accepted her odd request.

 I told Jane about my wife's divorce conditions. . She laughed loudly and thought it was absurd. No matter what tricks she applies, she has to face the divorce, she said scornfully.

 My wife and I hadn't had any body contact since my divorce intention was explicitly expressed. So when I carried her out on the first day, we both appeared clumsy. Our son clapped behind us, daddy is holding mommy in his arms. His words brought me a sense of pain. From the bedroom to the sitting room, then to the door, I walked over ten meters with her in my arms. She closed her eyes and said softly; don't tell our son about the divorce. I nodded, feeling somewhat upset. I put her down outside the door. She went to wait for the bus to work. I drove alone to the office.

 On the second day, both of us acted much more easily. She leaned on my chest. I could smell the fragrance of her blouse. I realized that I hadn't looked at this woman carefully for a long time. I realized she was not young any more. There were fine wrinkles on her face, her hair was graying! Our marriage had taken its toll on her. For a minute I wondered what I had done to her.

 On the fourth day, when I lifted her up, I felt a sense of intimacy returning. This was the woman who had given ten years of her life to me.

 On the fifth and sixth day, I realized that our sense of intimacy was growing again. I didn't tell Jane about this. It became easier to carry her as the month slipped by. Perhaps the everyday workout made me stronger.

 She was choosing what to wear one morning. She tried on quite a few dresses but could not find a suitable one. Then she sighed, all my dresses have grown bigger. I suddenly realized that she had grown so thin, that was the reason why I could carry her more easily.

 Suddenly it hit me... she had buried so much pain and bitterness in her heart. Subconsciously I reached out and touched her head.

 Our son came in at the moment and said, Dad, it's time to carry mom out. To him, seeing his father carrying his mother out had become an essential part of his life. My wife gestured to our son to come closer and hugged him tightly. I turned my face away because I was afraid I might change my mind at this last minute. I then held her in my arms, walking from the bedroom, through the sitting room, to the hallway. Her hand surrounded my neck softly and naturally. I held her body tightly; it was just like our wedding day.

 But her much lighter weight made me sad. On the last day, when I held her in my arms I could hardly move a step. Our son had gone to school. I held her tightly and said, I hadn't noticed that our life lacked intimacy.

 I drove to office.... jumped out of the car swiftly without locking the door. I was afraid any delay would make me change my mind...I walked upstairs. Jane opened the door and I said to her, Sorry, Jane, I do not want the divorce anymore.

 She looked at me, astonished, and then touched my forehead. Do you have a fever? She said. I moved her hand off my head. Sorry, Jane, I said, I won't divorce. My marriage life was boring probably because she and I didn't value the details of our lives, not because we didn't love each other anymore. Now I realize that since I carried her into my home on our wedding day I am supposed to hold her until death do us apart.

 Jane seemed to suddenly wake up. She gave me a loud slap and then slammed the door and burst into tears. I walked downstairs and drove away.

 At the floral shop on the way, I ordered a bouquet of flowers for my wife. The salesgirl asked me what to write on the card. I smiled and wrote, I'll carry you out every morning until death do us apart.

 That evening I arrived home, flowers in my hands, a smile on my face, I run up stairs, only to find my wife in the bed - dead. My wife had been fighting CANCER for months and I was so busy with Jane to even notice. She knew that she would die soon and she wanted to save me from whatever negative reaction from our son, in case we push through with the divorce -- At least, in the eyes of our son--- I'm a loving husband....

 The small details of your lives are what really matter in a relationship. It is not the mansion, the car, property, the money in the bank. These create an environment conducive for happiness but cannot give happiness in themselves. So  find time to be your spouse's friend and do those little things for each other that build intimacy. Do have a real happy marriage!

 If you don't share this, nothing will happen to you. If you do, you just might save a marriage.

 Many of life's failures are people who did not realize how close they were to success when they gave up.

Emedinews:Insighst on Medicolegal Issues:Instruments for shooting, stabbing, cutting are dangerous weapons

The doctor is not required to make speculations about the weapon of offence in a MLC case. According to the Section 324 of IPC, any instrument for shooting, stabbing, cutting or any instrument used as a weapon of offence likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance, which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal - are all considered as dangerous weapons.

The duty of the attending doctor is to record all the injuries, their dimensions as far as possible, and the body parts where the injuries are located, the nature of injury, whether simple or grievous, caused by sharp/blunt object, age or duration of injury along with the vital parameters like blood pressure, pulse, respiration and the mental status of the patient. When an investigating officer comes to the hospital, he needs some specific answers for his legal investigation and to book a case under law of the land.

• Are the injuries self–inflicted or fabricated? If yes, please mention the forensic justification.
• Is there any sign, symptom or smell of alcohol or any drug intoxication? If yes, please opine about his mental status due the influence of intoxication; also preserve a blood sample.
• Please opine if the injured or intoxicated patient is fit to record his statement? If no, please give due reasons and an approximate time interval for medical evaluation for his/her fitness for statement.
• Is the condition of patient is critical, severe or serious? If so, the dying declaration must be recorded by the attending doctor in the presence of one or two witnesses.

Emedinews: Inspiration:To love and to be loved

An Inspirational Story

To love and to be loved

Once upon a time, a very poor man lived with his wife. One day, his wife, who had very long hair, asked him to buy her a comb for her hair to grow well and to be well-groomed.

The man felt very sorry and said no. He explained that he did not even have enough money to fix the strap of his watch he had just broken. She did not insist on her request.

The man went to work and passed by a watch shop, sold his damaged watch at a low price and went to buy a comb for his wife. He came home in the evening with the comb in his hand ready to give to his wife.

He was surprised when he saw his wife with a very short hair cut. She had sold her hair and was holding a new watch band. Tears flowed simultaneously from their eyes, not for the futility of their actions, but for the reciprocity of their love.

 Moral of the story: To love is nothing, to be loved is something but to love and to be loved by the one you love, that is everything.

Emedinews:Insights on Medicolegal Issues:What is the nature of bullet wounds of the head?

In most cases of these injuries, the bullet passes completely through the skull. As it enters the skull, it produces a clean cut hole in the outer table and a larger hole in the inner table. At the exit point, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table. These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet. On the other hand, if it remains high velocity at the time of impact with the skull, there may be considerable damage from the cavitation effect within the skull.

• Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.
• In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment.
• When a bullet strikes the head at a tangent, penetration of the skull may fail to occur, but the force of the bullet may be sufficient to fragment the inner table at the site of impact. Delayed pressure effects and cranial edema may be produced as a result of this.

Emedinews:Inspiration:Death of an innocent

An Inspirational Story

I went to a party, Mom, I remembered what you said. You told me not to drink, Mom, so I drank soda instead. I really felt proud inside, Mom, the way you said I would. I didn't drink and drive, Mom, even though the others said I should. I know I did the right thing, Mom, I know you are always right.

 Now the party is finally ending, Mom, as everyone is driving out of sight. As I got into my car, Mom, I knew I'd get home in one piece. Because of the way you raised me, so responsible and sweet. I started to drive away, Mom, but as I pulled out into the road, the other car didn't see me, Mom, and hit me like a load.

 As I lay there on the pavement, Mom, I hear the policeman say the other guy is drunk, Mom, and now I'm the one who will pay. I'm lying here dying, Mom.... I wish you'd get here soon. How could this happen to me, Mom? My life just burst like a balloon. There is blood all around me, Mom, and most of it is mine.

 I hear the medic say, Mom, I'll die in a short time. I just wanted to tell you, Mom, I swear I didn't drink. It was the others, Mom. The others didn't think. He was probably at the same party as I. The only difference is, he drank and I will die. Why do people drink, Mom? It can ruin your whole life. I'm feeling sharp pains now. Pains just like a knife. The guy who hit me is walking, Mom, and I don't think it's fair. I'm lying here dying and all he can do is stare.

 Tell my brother not to cry, Mom. Tell Daddy to be brave. And when I go to heaven, Mom, put "Daddy's Baby" on my grave. Someone should have told him, Mom, not to drink and drive. If only they had told him, Mom, I would still be alive. My breath is getting shorter, Mom. I'm becoming very scared.

 Please don't cry for me, Mom. When I needed you, you were always there. I have one last question, Mom, before I say good-bye, "I didn't drink and drive, so why am I the one to die?" This is the end Mom. I wish I could look you in the eye, to say these final words: "I LOVE YOU AND...GOODBYE"

Emedinews:Insights on Medicolegal Issues:Wisconsin appellate court stated

Perfection is a standard to which no profession can possibly adhere. Doctors are required to exercise reasonable care; they are not required to be perfect.

• In order to establish medical malpractice, it must be shown by a preponderance of evidence that the injury complained of by the patient was caused by the doing of some particular thing that a physician of ordinary skill, care, and diligence would not have done under like or similar conditions or circumstances, or by the failure or omission to do some particular thing that such a physician would have done under like or similar conditions or circumstances…The standard of care for the physician…should be that of a reasonable doctor.
• Illinois Supreme Court refined its opinions about standard of care which in common law is generally understood to mean a measure or rule against which a defendant’s conduct is to be measured.
• The established standard of care for all professionals is stated as use of the same degree of knowledge, skill, and ability as an ordinarily careful professional would exercise under similar circumstances.

Emedinews:Inspiration:A simple gesture

An Inspirational Story

A little boy selling magazines for school walked up to a house that people rarely visited. The house was very old and run down and the owner hardly ever came out. When he did come out he would not say hello to neighbors or passersby but simply just glare at them.

The boy knocked on the door and waited, sweating from fear of the old man. The boy's parents told him to stay away from the house, a lot of the other neighborhood children were told the same from their parents.

As he was ready to walk away, the door slowly opened. "What do you want?" the old man said. The little boy was very afraid but he had a quota to meet for school with selling the magazines.

"Uh, sir, I uh am selling these magazines and uh I was wondering if you would like to buy one." The old man just stared at the boy. The boy could see inside the old man's house and saw that he had dog figurines on the fireplace mantle. "Do you collect dogs?" the little boy asked. "Yes, I have many collectibles in my house, they are my family here, they are all I have." The boy then felt sorry for the man, as it seemed that he was a very lonely soul. "Well, I do have a magazine here for collectors, it is perfect for you, I also have one about dogs since you like dogs so much." The old man was ready to close the door on the boy and said, "No boy, I don't need any magazines of any kind, now goodbye."

The little boy was sad that he was not going to make his quota with the sale. He was also sad for the old man being so alone in the big house that he owned. The boy went home and then had an idea. He had a little dog figure that he got some years ago from an aunt. The figurine did not mean nearly as much to him since he had a real live dog and a large family. The boy headed back down to the old man's house with the figurine. He knocked on the door again and this time the old man came right to the door. "Boy, I thought I told you no magazines."

"No, sir I know that, I wanted to bring you a gift." The boy handed him the figurine and the old man's face lit up. "It is a Golden Retriever, I have one at home, this one is for you." The old man was simply stunned; no one had ever given him such a gift and shown him so much kindness. "Boy, you have a big heart, why are you doing this?" The boy smiled at the man and said, "Because you like dogs."

From that day on the old man started coming out of the house and acknowledging people. He and the boy became friends; the boy even brought his dog to see the man weekly.

This simple gesture changed both of their lives forever.

Emedinews:Insights on Medicolegal Issues:Aruna is clearly not in coma

·         Aruna accepts the food in normal course and responds by facial expressions. She responds to commands intermittently by making sounds. She makes sounds when she has to pass stool and urine which the nursing staff identifies and attends to by leading her to the toilet.

·         Thus, there was some variance between the allegations in the writ petition and the counter affidavit of KEM Hospital. Hon’ble Supreme Court, by order dated 24 January, 2011 appointed a team of three very distinguished doctors of Mumbai to examine Aruna thoroughly and submit a report about her physical and mental condition.

·         The committee after thorough examination gave the opinion that she has evidence of intact auditory, visual, somatic and motor primary neural pathways. However, no definitive evidence for awareness of auditory, visual, somatic and motor stimuli was observed during our examinations.

·         On perusal of the report of the committee of three doctors, Hon’ble SC noted that there are many technical terms which have been used therein which a non–medical man would find it difficult to understand. We, therefore, request the doctors to submit a supplementary report by the next date of hearing in which the meaning of these technical terms in the report is also explained.

Emedinews:Inspiration:The value of knowledge

An Inspirational Story

A giant ship engine failed. The ship’s owners tried one expert after another, but none of them could figure but how to fix the engine. Then they brought in an old man who had been fixing ships since he was a young.

He carried a large bag of tools with him, and when he arrived, he immediately went to work. He inspected the engine very carefully, top to bottom. Two of the ship’s owners were there, watching this man, hoping he would know what to do.

After looking things over, the old man reached into his bag and pulled out a small hammer. He gently tapped something. Instantly, the engine lurched into life. He carefully put his hammer away. The engine was fixed!

A week later, the owners received a bill from the old man for ten thousand dollars. “What?!” the owners exclaimed. “He hardly did anything!” So they wrote the old man a note saying, “Please send us an itemized bill.”

The man sent a bill that read: Tapping with a hammer…… $ 2.00; Knowing where to tap……… $ 9,998.00

Effort is important, but knowing where to make an effort makes all the difference! Keep studying hard. Don’t give up!

Emedinews:Insights on Medicolegal Issues:Immediate first aid may stop serious poisoning and may save life

If breathing and the heart stop, the person will die within a few minutes unless first aid is administered at once. Here is an action list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

• Check if the patient is conscious. Try to keep the patient awake. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
• Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within 4 minutes. In an unconscious patient, the tongue may block the throat and the airway.
• Make sure the airway is open and air can get down the throat. Place the patient on his/her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
• Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient’s breathe on your cheek. Listen for breath sounds. Put your ear close to the patient’s mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

Emedinews:Inspiration:Blessings not packaged as we expected

An Inspirational Story

A young man was getting ready to graduate college. For many months he had admired a beautiful sports car in a dealer's showroom, and knowing his father could well afford it, he told him that was all he wanted.

As Graduation Day approached, the young man awaited signs that his father had purchased the car. Finally, on the morning of his graduation his father called him into his private study. His father told him how proud he was to have such a fine son, and told him how much he loved him. He handed his son a beautiful wrapped gift box.

Curious, but somewhat disappointed the young man opened the box and found a lovely, leather-bound Bible. Angrily, he raised his voice at his father and said, "With all your money you give me a Bible?" and stormed out of the house, leaving the holy book.

Many years passed and the young man was very successful in business. He had a beautiful home and wonderful family, but realized his father was very old, and thought perhaps he should go to him. He had not seen him since that graduation day. Before he could make arrangements, he received a telegram telling him his father had passed away, and willed all of his possessions to his son. He needed to come home immediately and take care of things. When he arrived at his father's house, sudden sadness and regret filled his heart. He began to search his father's important papers and saw the still new Bible, just as he had left it years ago. With tears, he opened the Bible and began to turn the pages. As he read those words, a car key dropped from an envelope taped behind the Bible. It had a tag with the dealer's name, the same dealer who had the sports car he had desired. On the tag was the date of his graduation, and the words...PAID IN FULL.

How many times do we miss God's blessings because they are not packaged as we expected?

Emedinews:Insights on Medicolegal Issues:Antemortem vs postmortem bruises

In some cases, which are brought dead or are dead on arrival, the attending doctor often is not able to differentiate between antemortem bruise and postmortem artefact and the postmortem bruise is often entered in MLC as injuries. I have seen several such cases in AIIMS during conduction of autopsies. However, with closer examination, it is possible to differentiate between the two.

In antemortem bruises, there is swelling and damage to epithelium, coagulation and infiltration of the tissues with extravasated blood and color changes. These signs are always absent in postmortem bruises.

Contusions and abrasions produced immediately after death show a very low degree of changes. Appreciable bruising does not occur after 2–3 minutes of death due to arrest of heart and blood circulation; but, small bruises can be produced up to 3 hours after death by using great force where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle. Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and during transportation; the same is called postmortem artifact.

Emedinews:Inspiration:Barber and the dumbest kid

A young boy enters a barber shop and the barber whispers to his Customer,"This is the dumbest kid in the world. Watch while I prove it to you."

The barber puts a five rupee coin in one hand and two one rupee coins (1+1=2) in the other, then calls the boy over and asks,"Which do you want, son?"

The boy takes the two one rupee coins and leaves. "What did I tell you?" said the barber. "That kid never learns!"

Later, when the customer leaves, he sees the same young boy coming out of the ice cream store. "Hey, son! May I ask you a question? Why did you take two one rupee coins instead of five rupee coin?"

The boy licked his cone and replied, "Because THE DAY I TAKE THE FIVE RUPEE COIN, THE GAME IS OVER"

...........

Moral: When you think the other person is dumb, you are making a fool of yourself.

Emedinews:Insights on Medicolegal Issues:Doctor and care of the terminally ill

The duty of the physician is to heal and, where possible, relieve suffering and act to protect the best interests of his patients. There shall be no exception to this principle even in the case of incurable disease or malformation. This principle does not preclude application of the following rules:

• The physician may relieve suffering of a terminally ill patient by withholding treatment with the consent of the patient or his immediate family if unable to express his will.
• Withholding of treatment does not free the physician from his obligation to assist the dying person and give him the necessary medicaments to mitigate the terminal phase of his illness.
• The physician shall refrain from employing any extraordinary means, which would prove of no benefit for the patient.
• The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
• These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

eMedinewS:Inspiration:A Promise is a Promise

An Inspirational Story

A man’s wife called him, “How long will you be poring over that newspaper? Will you come here and make your darling daughter eat her food?” he tossed the paper away and rushed to the scene.

His only daughter Sindu, looked frightened, tears were welling up in her eyes, in front of her was a bowl filled to its brim with Curd Rice.

Sindu is a nice child, quite intelligent for her age, she has just turned eight; she particularly detested Curd Rice. His mother and his wife are orthodox and believe firmly in the ‘cooling effects’ of Curd Rice! He cleared his throat, and picked up the bowl. “Sindu, darling, why don’t you take a few mouthfuls of this Curd Rice?

Just for Dad’s sake, dear? And, if you don’t, your Mom will shout at me.”He could sense his wife’s scowl behind his back. Sindu softened a bit, and wiped her tears with the back of her hands.

“OK, Dad. I will eat – not just a few mouthfuls, but the whole lot of this. But, you should…” Sindu hesitated, “Dad, if I eat this entire curd Rice, will you give me whatever I ask for?”

"Oh sure, darling’.“Promise?” “Promise.”

He covered the pink soft hand extended by his daughter with mine and clinched the deal.

“Ask Mom also to give a similar promise”, his daughter insisted, his wife slapped her hand on Sindu’s, muttering, “Promise”, without any emotion.

Now he became a bit anxious. “Sindu dear, you shouldn’t insist on getting a computer or any such expensive items, Dad does not have that kind of money right now. OK?”

“No, Dad. I do not want anything expensive.”

Slowly and painfully, she finished eating the whole quantity, he was silently angry with his wife and his mother for forcing my child to eat something that she detested.

After the ordeal was through, Sindu came to him with her eyes wide with expectation, all our attention was on her.

“Dad, I want to have my hair shaved off, this Sunday!’ was her demand.

“Atrocious!” shouted her wife, “A girl child having her hair shaved off? Impossible!”

“Never in our family!” her mother rasped. “She has been watching too much television, our culture is getting totally spoiled with these TV programs!”

“Sindu darling, why don’t you ask for something else? We will be sad seeing you with a clean-shaven head.”

“No, Dad. I do not want anything else”, Sindu said with finality.

“Please, Sindu, why don’t you try to understand our feelings?” he tried to plead with her.

“Dad, you saw how difficult it was for me to eat that Curd Rice.” Sindu was in tears. “And you promised to grant me whatever I ask for, now, you are going back on your words.

Was it not you who told me the story of King Harishchandra, and its moral that we should honor our promises no matter what?”

It was time for him to call the shots. “Our promise must be kept.”

“Are you out your mind?” chorused his mother and wife.

“No. If we go back on our promises, she will never learn to honor her own, Sindu, your wish will be fulfilled.”

With her head clean-shaven, Sindu had a round-face, and her eyes looked big and beautiful. On Monday morning, he dropped her at her school. It was a sight to watch his hairless Sindu walking towards her classroom. She turned around and waved, he waved back with a smile.

Just then, a boy alighted from a car, and shouted, “Sinduja, please wait for me!”

What struck me was the hairless head of that boy. Maybe, that is the in-stuff, he thought.

“Sir, your daughter Sinduja is great indeed!”

Without introducing herself, a lady got out of the car and continued.

“That boy who is walking along with your daughter is my son Harish. He is suffering from leukemia.” She paused to muffle her sobs. “Harish could not attend school for the whole of the last month. He lost all his hair due to the side effects of the chemotherapy.

He refused to come back to school fearing the unintentional but cruel teasing of the schoolmates. Sinduja visited him last week and promised him that she would take care of the teasing issue.

But, I never imagined she would sacrifice her lovely hair for the sake of my son! Sir, you and your wife are blessed to have such a noble soul as your daughter.”

He stood transfixed and then, wept. He said “My little Angel, you are teaching me how selfless real love is!”

Emedinews:Insights on Medicolegal Issues:What are the cases that should be regarded as medicolegal?

The following cases must be labeled as medicolegal by the treating doctor and medicolegal report should be prepared for further legal investigation

• All injury/hurt cases, circumstances of which suggest commission of offence by someone
• All traffic vehicular, railways, aeroplane, ship, boat, factory, construction site or other unnatural accidents
• Self–inflicted injuries/attempted suicide
• Cases of criminal abortion
• Accidents where there is likelihood of death or grievous hurt
• All cases of suspected or evident poisoning
• Suspected or evident homicide, suicide including attempted
• All burn injuries, whatever the cause of burn
• All suspected or evident sexual assaults
• All suspected or evident criminal abortion
• Unconscious cases where the cause is not natural or not clear
• Cases referred by Courts for age estimation
• Cases brought dead with improper medical history
• Dead on arrival cases or patients who die shortly after being brought to the hospital before a definite diagnosis can be made
• Patients dying suddenly after parenteral administration of a drug or medication
• Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital
• Death on the operation table
• Unexplained death after surgery or interventional procedure
• Unexplained ICU death
• Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
• Relatives of the patient assault the treating doctor or other staff of the hospital.
• Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.

In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

Emedinews:Inspiration:When I was a kid,

An Inspirational Story

When I was a kid, I remember my Mom liked to cook food every now & then. I remember one night in particular when she had made dinner after a long, hard day at work. On that evening, my Mom placed a plate of bread, jam and extremely burned biscuits in front of my Dad. I remember waiting to see if anyone noticed!

Yet all my Dad did was reach for his biscuit, smile at my Mom and asked me how my day was at school. I don't remember what I told him that night, but I do remember hearing my Mom apologize to my Dad for burning the biscuits. I'll never forget what he said: "Honey, I love burned biscuits."

Later that night, I went to kiss Daddy & say Good Night and I asked him if he really liked his biscuits burned. He wrapped me in his arms and said,

"Your Momma put in a long hard day at work today and she's real tired. And besides, a burnt biscuit never hurt anyone but harsh words do!

"You know, life is full of imperfect things... And imperfect people.

I'm not the best at hardly anything, and I forget birthdays and anniversaries just like everyone else.

 What I've learned over the years is that learning to accept each others faults and choosing to celebrate each other’s differences, is one of the most important keys to creating a healthy, growing, and lasting relationship.

So...please pass on a biscuit. And yes, the burnt one will do just fine! [Paramjit Chadha]

Emedinews:Insighst on Medicolegal Issues:Contravention of PNDT Act may lead to Imprisonment up to 3 years

• The name of the registered medical practitioner who has been convicted by the court under sub–section (1), shall be reported by the Appropriate Authority to the respective State Medical Council for taking necessary action including the removal of his name from the register of the Council for a period of two years for the first offence and permanently for the subsequent offence.
• Any person who seeks the aid of a genetic counseling center or genetic laboratory or genetic clinic or of a medical geneticist, medical gynecologist or registered medical practitioner for conducting pre–natal diagnostic techniques on any pregnant woman (including the woman unless she was compelled to undergo such diagnostic technique) for purposes other than those specified in clause(2) of section 4, shall be punishable with imprisonment for a term which may extend to 3 years and with a fine which may extend up to ten thousand rupees and on any subsequent conviction with imprisonment which may extend to five years and with fine which may extend up to fifty thousand rupees.

Emedinews:Inspiration:Socrates philosophy

An Inspirational Story

(Mr Ranesh Kumar Sabharwal)

Keep this in mind the next time you are about to repeat a rumor or spread gossip.

In ancient Greece (469 - 399 BC), Socrates was widely lauded for his wisdom. One day an acquaintance ran up to him excitedly and said, "Socrates, do you know what I just heard about Diogenes?" "Wait a moment," Socrates replied, "Before you tell me I'd like you to pass a little test. It's called the Triple Filter Test."

"Triple filter?" asked the acquaintance.

"That's right," Socrates continued, "Before you talk to me about Diogenes let's take a moment to filter what you're going to say. The first filter is Truth. Have you made absolutely sure that what you are about to tell me is true?"

"No," the man said, "Actually I just heard about it."

"All right," said Socrates, "So you don't really know if it's true or not. Now let's try the second filter, the filter of Goodness. Is what you are about to tell me about Diogenes something good?"

"No, on the contrary..."

"So," Socrates continued, "You want to tell me something about Diogenes that may be bad, even though you're not certain it's true?"

The man shrugged, a little embarrassed. Socrates continued, "You may still pass the test though, because there is a third filter, the filter of Usefulness. Is what you want to tell me about Diogenes going to be useful to me?"

"No, not really." "Well," concluded Socrates, "If what you want to tell me is neither True nor Good nor even Useful, why tell it to me or anyone at all?"

The man was bewildered and ashamed. This is an example of why Socrates was a great philosopher and held in such high esteem.

Emedinews:Insights on Medicolegal Issues:What is rape trauma syndrome?

• Rape trauma syndrome describes that rape survivors go through fear experienced during a sexual assault particularly violent sexual assault. Each victim has their own experience; but there are common characteristics the victims possess. These characteristics are the direct result of the fear inherent in sexual assault.
• The acute phase lasts from a few days to a few weeks after an assault. It is a response to a complete disruption of one’s life and the humiliating experience of being sexually assaulted. The acute phase produces as many responses as there are survivors. Some survivors may cry, others may laugh, and still others may be completely silent. It is important that there is no "wrong" way to cope with the immediate after effects of sexual trauma. During the acute phase, survivors may feel disbelief or in some way frozen. It has also been described as if survivors "left their body," forever being unable to reconnect with the woman or man who was raped. Survivors may feel humiliated, confused, dirty, ashamed, or in some way at fault for the assault; especially in the case where the assailant was an acquaintance. Physical concerns may arise during the acute phase as well. These concerns may be the direct result of the assault or fear of the possible physical ramifications of the assault i.e. pregnancy or STDs.
• Following the acute phase is the Reorganization Phase where the survivor attempts to reorganize her life. This phase invites a myriad of emotions such as fear, anxiety, denial, and most of all the loss of security. The shattering of security as well as trust is inherent in sexual assault. This loss of the fundamental need for security wreaks havoc on the survivor’s life. The feeling of being unsafe looms over the survivor causing a heightened state of anxiety, difficulty with intimate relationships, and overcautious such as constantly checking one’s surroundings.
• Chronic reactions to sexual assault include the inability to find peace at the level of soul. Sexual assault can change the individual forever as well as the world as they know it. The end result is a constant state of turmoil in thought process. At times, the survivor may not even recognize what is happening within. Sexual assault causes the body to be an unfriendly environment leading the survivor to at times feel dirty and ashamed. These feelings cause the individual to disconnect from their body entirely. Without a connection to their body, the survivor is unable to listen to internal states which assist her in navigating through the world. This contributes to a feeling inherent in many survivors, the feeling of being "lost." The patient needs close monitoring/treatment by doctor and counselors.

Emedinews:Inspiration:"God Bless You" Speech

"God Bless You" Speech

They walked in tandem, each of the ninety–three students filing into the already crowded auditorium. With rich maroon gowns flowing and the traditional caps, they looked almost as grown up as they felt. Dads swallowed hard behind broad smiles, and moms freely brushed away tears.

This class would not pray during the commencements; not by choice, but because of a recent court ruling prohibiting it. The principal and several students were careful to stay within the guidelines allowed by the ruling.

They gave inspirational and challenging speeches, but no one mentioned divine guidance and no one asked for blessings on the graduates or their families.

The speeches were nice, but they were routine; until the final speech received a standing ovation. A solitary student walked proudly to the microphone. He stood still and silent for just a moment, and then he delivered his speech –– a resounding sneeze! The rest of the students rose immediately to their feet, and in unison they said, "God bless you."

The audience exploded into applause. The graduating class found a unique way to invoke God’s blessing on their future –– with or without the court’s approval.

(Source: http://www.inspire21.com/stories/educationstories)

Emedinews:Insights on Medicolegal Issues:How should biological samples and medical evidences be collected in a medicolegal case?

The analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it and come to an independent conclusion as to its origin.

The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both is required in any investigation of crime against human body such as injury, rape, murder.

The medical examination is carried out in emergency ward of hospitals and treatment of injured and dying patient remains the major focus of the treating doctor. But, in cases of crime against the human body, the medical examination and collection of biological sample/s, its documentation, packaging, and analysis have an important role and should be done by the doctor very meticulously with the high standards of science and the law in mind. These biological materials include: Blood, seminal stains, vaginal smears/slides gastric lavage, chemical substances, poison, hair, fiber, broken glasses, knives, blunt instruments/objects, firearms, bullet, live and empty cartridge cases, wads, clothing etc. This scientific biological evidence becomes legal evidence in prosecution/acquittal of case if collected correctly.

Emedinews:Inspiration:One day, we all will depart on a journey free of cost

An Inspirational Story

(Paramjit Chadha)

One day, we all will depart on a journey free of cost,

Don't worry about seat reservation, it is confirmed

and flight is always on time.

Our good deeds will be our luggage,

Humanity  will be our Passport,

Love will be our Visa,

Make sure, we do our best to travel to Heaven in

Business/ Executive Class.

Emedinews:Insights on Medicolegal Issues:Medical Testimony of Doctor in the Court of law

A doctor should not be dogmatic about his opinion, and lawyers also should not expect him to be so. He should be reasonable in his opinions and should not overstate the likelihood of a relationship between cause and effect. The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. For the purpose of illustrating and clarifying his testimony in the court of law, the medical expert may employ photographs, maps, diagrams, charts, X–rays, skeletons, models, slides, films, tapes, etc., when they are properly verified. The doctor should avoid talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. Courts of law are open to the public and the junior doctors should attend the Courts, where they can follow the proceedings, hear the evidence given by their senior medical colleague as a witness, to familiarize themselves with the procedures of the court of law.

Emedinews:Inspiration:To Believe

An Inspirational Story

To believe… is to know that every day is a new beginning. It is to trust that miracles happen, and dreams really do come true.

To believe… is to see Angels dancing among the clouds, to know the wonder of a stardust sky, and the wisdom of the man in the moon.

To believe… is to know the value of a nurturing heart, the innocence of a child’s eyes and the beauty of an aging hand, for it is through their teachings we learn to love.

To believe… is to find the strength and courage that lies within us. When it is time to pick up the pieces and begin again.

To believe… is to know we are not alone, that life is a gift and this is our time to cherish it.

To believe… is to know that wonderful surprises are just waiting to happen, and all our hopes and dreams are within reach. If only we believe.

Emedinews:Insights on Medicolegal Issues:What is the blast lung?

• When a bomb explodes causes disruptive effect, burns, air blast, flying missiles injuries, falling masonry, fumes and incendiary bombs
• bomb explosion create a pressure of 1000 to 1500 tons per square inch could be generated however 200kg per square inch is enough to cause destructive injuries to human tissues
• The injuries caused due to air blast effect like bomb blast to the pulmonary tissues and alveoli tissues is called blast lung injuries
• In such type of air blast the rupture of tympanic membranes with bleeding and injuries to cochlea is invariable seen in the bomb blast victims. The ENT consultation must be taken in bomb blast cases for internal ear injuries
• In scan lungs of air blast victim lungs shows pleural patchy bleedings
• The reactive pulmonary swelling convert into Bronco pneumonia and may prove fatal in bomb blast cases
• In cases of death due to bomb blast effect the intracranial bleeding along with bleeding and laceration in mesentery and omentum is seen in autopsy. The air embolism become fatal in many cases of air blast injuries
• Multiple injuries, burn, shock and air embolism is seen as cause of death in bomb blast victim

Emedinews:Inspiration:Always remember those who serve

An Inspirational Story

In the days when an ice cream sundae cost much less, a 10 year old boy entered a hotel coffee shop and sat at a table. A waitress put a glass of water in front of him. "How much is an ice cream sundae?" "Fifty cents," replied the waitress.

The little boy pulled his hand out of his pocket and studied a number of coins in it. "How much is a dish of plain ice cream?" he inquired. Some people were now waiting for a table and the waitress was a bit impatient.

"Thirty-five cents," she said brusquely. The little boy again counted the coins. "I'll have the plain ice cream," he said.

The waitress brought the ice cream, put the bill on the table and walked away. The boy finished the ice cream, paid the cashier and departed.

When the waitress came back, she began wiping down the table and then swallowed hard at what she saw. There, placed neatly beside the empty dish, were two nickels and five pennies - her tip.

Emedinews:Insights On Medicolegal Issues:Medicolegal cases & injury, assault and hurt in Indian law

The words injury, assault and hurt are invariably used by doctor in hospital practice and are used as synonymous. But all three have a different meaning as per law. It is defined by the Indian Penal Code as below:

• Injury: Section 44 of IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property.
• Assault: Section 351 of IPC defines assault as an offer or threat or attempt to apply force on body of another in a hostile manner. It may be a common/simple assault or an intention to murder.
• Hurt: Section 319 of IPC defines hurt as whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.

When we as doctors deal with cases of Hurt/body injury, it means bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. These would include abrasions, contusions, lacerations, stab wounds, electric shock, firearm or ligatures etc resulting in human body injury. The doctor who is certifying an injury report should keep in mind the Penal provisions required by police to book the case i.e.

• Simple injury: IPC Section 323
• Simple injury caused by dangerous weapons: IPC Section 324
• Grievous injury: IPC Section 325
• Grievous injury caused by dangerous weapons: IPC Section 326
• Dangerous injury: IPC Section 307
• Injury likely to cause death: IPC Section 304
• Injury sufficient to cause death: IPC Section 302
• Causing hurt by means of poison: IPC Section 328

Emedinews:Inspiration:Don’t let Fear Hold you Back

An Inspirational Story

A man once went to a fortune teller, curious to know what she would say about his future. The fortune teller looked into her magic ball and then her facial expression said it all. The man would die, she said, involved in a bus accident. This would happen within two to three months time, but she couldn’t say exactly when. The man went home, depressed and worried telling himself how he never really believed in fortune tellers. Why should he now?

When two months passed, he had thought about what she said, day in and day out. Now he decided to lock himself in his house where he wouldn’t come close to any buses for the next month.

Another 3 weeks went by when the man came down the stairs from his bedroom to make some coffee. His little son had left his toys on the floor of which one was a little toy bus. The man stepped on the bus, after his last step down the stairs, slipped and knocked his head against the stairway railing and died instantly.

Moral of the story: "Live life on the edge, don't lock yourself away."

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

Doctor should always document in detail the resuscitative injury 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 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. 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/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 artifacts.

Emedinews: Inspiration: Today's Lesson

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey. 

He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. 

At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement he quieted down. A few shovel loads later, the farmer finally looked down the well.

He was astonished at what he saw. with each shovel of dirt that hit his back, the donkey was doing something amazing.

He would shake it off and take a step up.As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!

Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a stepping stone. We can get out of the deepest wells just by not stopping, never giving up! 

Shake it off and take a step up.

Remember the five simple rules to be happy: Free your heart from hatred - Forgive.Free your mind from worries - Most never happen.

Live simply and appreciate what you have.

Give more.

Expect less

NOW .................................Enough of that rubbish . . . The donkey later came back, and bit the farmer who had tried to bury him.

The gash from the bite got infected and the farmer eventually died in agony from septic shock.


MORAL FROM TODAY'S LESSON:When you do something wrong, and try to cover it up, it always comes back to bite you.