Trauma associated with cardiopulmonary resuscitation based on autopsy reports after the 2015 ERC guidelines.

INTRODUCTION: Cardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established. AIM: To describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries. METHODS: This multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS). RESULTS: Among 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS-low risk of fatal injury. CONCLUSION: CPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.

The comparison of cardiopulmonary resuscitation-related trauma: Mechanical versus manual chest compressions.

INTRODUCTION: AIM:: To compare injuries after cardiopulmonary resuscitation (CPR) caused by manual or mechanical chest compressions in resuscitated patients with non-traumatic cardiac arrest. METHODS: This retrospective, multicenter study was based on autopsy reports of patients who died after CPR; individuals with a traumatic cause(s) of cardiac arrest were excluded. Patients were divided into two CPR groups: mechanical and manual. The Abbreviated Injury Scale was used to objectively evaluate the most serious injuries and the New Injury Scale Score was used to summarize all injuries. RESULTS: Of 704 patients, data from 630 individuals were analyzed after exclusion of those with trauma-related cardiac arrest. Manual CPR was performed in 559 patients and mechanical in 64 subjects. There were no differences in sex, bystander CPR, or etiology of cardiac arrest between the two groups, however, mechanical CPR was significantly longer (X vs. Y, p = 0.0005) and patients in this group were younger (X vs. Y, p = 0.0067). No differences were found in the incidence of CPR-related injuries between the groups. The median number of the most serious injury (according to Abbreviated Injury Scale) was 3, which was not statistically different; the median number of injuries according to the New Injury Severity Score was 13 in both groups (low probability of fatal injury). Type of injuries were also similar with the exception of pericardial damage that was more prevalent in mechanical CPR group. Only age and bystander CPR were found to be independently associated with the autopsy-documented trauma. CONCLUSION: Our results suggest that mechanical chest compressions do not increase the incidence and severity of CPR-related injury in comparison with manual methods despite significantly longer CPR duration.

[Epidemiologic study of fatal injuries autopsied at the Institute of Forensic Medicine of the 3rd Medical School of Charles University Hospital in Vinohrady, Prague, from 1996 to 1999]. / Epidemiologická studie smrtelných úrazu pitvaných v Ustavu soudního lékarství 3. LF UK a FNKV v Praze v letech 1996-1999.

In our study comprising 1010 persons who died as a result of injury death at the age of 15-97 years and were autopsied in the Institute of Department of Forensic Medicine of the 3rd Faculty of Medicine and University Hospital Královské Vinohrady, were 748 men and 262 women. 717 died at the site of injury and 293 died from the consequences of the injury in hospital. The most frequent cause of injury death was unintentional deaths (56.14%), followed by suicide (26.83%), murder (12.48%) and occupational injuries (4.55%). Road traffic accidents accounted for 51% of unintentional injury deaths. The most frequent cause of death was traumatic shock (32.67%), followed by injuries of the brain and spinal cord (30.50%). Injuries affect most frequently the head (60.5%) and chest (56.9%). The presence of alcohol in blood was detected at 30.2% of deceased.

A rare case of evisceration.

A case of homicide is described where the body of a young woman was found in the countryside in a state of advanced decomposition. The autopsy revealed that almost all the internal organs were missing, but not due to putrefaction. The thoracic cavity was opened in the professional manner normally used during an autopsy. The remains of the small intestine were tied with strands of hair braided into a thin cord.

Idiopathic tibial mononeuropathy with conduction block: an unusual case and review of the literature.

Tibial mononeuropathies most commonly occur at the popliteal fossa or tarsal tunnel. We present an unusual case of nontraumatic tibial neuropathy of uncertain etiology occurring in the mid lower leg. External neurolysis resulted in an excellent recovery.

An unusual case of diabetic cellulitis due to Pasturella multocida.

Pasturella multocida is a well known potential cause of infection following bites or scratches by animals. The organism causes the usual clinical manifestations of a rapidly developing cellulitis at the site of injury. The resultant infection is dangerous and can progress on to a deep infection, osteomyelitis, and septicemia. In compromised patients, the source and etiology of the infection may be obscure making definitive diagnosis difficult. This paper reviews a very unusual case of a foot infection in a diabetic patient that was due to a domestic pet licking an excoriation on the foot.

[Burns caused by electrical current injuries]. / Popálení pri úrazu elektrickým proudem.

A group of patients who died after thermal injuries was compared with those who died as a result of burns caused by electric current. Attention was focused on the survival time and the most frequent complications. In those who died as a result of electric current the mean survival period was shorter. More frequent complications were pneumonia, shock, severe dystrophic changes of parenchymatous organs, necrosis of the heart muscle, venous thrombosis and embolism of the pulmonary artery.

Residual calcaneovalgus deformity: review of the literature and case study.

The treatment of pediatric deformities is relatively common in the typical foot and ankle practice. Talipes calcaneovalgus deformity represents one of the more prevalent deformities. This postural deformity, which is present at birth, is characterized by marked dorsiflexion and valgus position of the foot in relation to the leg. It is essential that an accurate diagnosis is established early and conservative treatment instituted. In most cases, the deformity is highly responsive to conservative therapy consisting of manipulation and casting. Deformity not identified at birth or soon thereafter, or residual deformity treated later in life, presents a greater challenge to the physician. This paper is intended to provide an overview of the deformity of calcaneovalgus including a discussion of etiology, incidence, clinical and radiographic manifestations, differential diagnosis, and recommended treatment. The authors present an unusual case of residual talipes calcaneovalgus left untreated since birth and the approach to management.

[Complications of thermal injuries leading to death]. / Komplikace termických úrazu vedoucí ke smrti.

The authors analyzed a group of 194 decreased subjects, 119 men and 75 women aged 15.96 years who suffered thermic damage in the years 1981-1989. As compared with the source of burns in 1966-1974, there was a striking increase of subjects who suffered burns during propane-butane explosions. In the foreground of thanatological findings was pneumonia in 49%, shock in 28.3%, sepsis in 26.8% damage of the upper gastrointestinal tract in 23.7% and thrombotic embolism in 18% of the subjects who died. More than half of them died with normothermia, 25% with hyperpyrexia and more than 20% with hypothermia. As compared with values of LA50 in 1966-1974 an increase occurred which implies a more favourable prognosis of burns. The values of LA50 were higher in particular in in the age group from 15-50 years.

Does the trimeric form of the Photosystem 1 reaction center of cyanobacteria in vivo exist?

When isolating Photosystem 1 from the thylakoid membranes of cyanobacteria, a multiplicity of photosystem complexes can be encountered, which has not yet been observed in any other phototrophic organisms: After solubilisation of thylakoid membranes with detergents, trimeric, dimeric and monomeric forms of Photosystem 1 can be separated. The question must now be answered, which of the stable Photosystem 1 forms is the functional form in vivo-monomeric or trimeric? The two possibilities are discussed, though we mainly present arguments for the existence of the trimeric form of Photosystem 1 in cyanobacterial thylakoid membranes.

Incorporation of reaction centers into submitochondrial particles resulting in light induced electron transfer.

Conditions for the incorporation of reaction centers, isolated from Rhodospirillum rubrum, into submitochondrial particles have been studied. Incorporation of the reaction centers into the lipid bilayer occurs in both orientations. Electron flow from the light activated reaction center to the b-c1 complex is demonstrated. Preliminary data on the reaction kinetics of the b cytochromes are given.