Fatal Hemorrhage from an Arteriovenous Fistula.

In this study, we present two cases of sudden deaths of people with end-stage kidney with arteriovenous fistulas for long-term hemodialysis treatment. This procedure is associated with a number of known complications. While stenosis, thrombosis, and infection are well known, lethal hemorrhage from arteriovenous fistula is much less commonly encountered. Inspection of the bodies at the scene of the death by a medical examiner suggested that the deaths were due to exsanguination. Autopsies revealed visible defects on the front wall of the arteriovenous fistulas. Microscopic examination showed wall necrosis with infiltration of various inflammatory cells. Deaths were due to exsanguination from the ulcerated arteriovenous fistulas in patients with chronic renal failure. Further investigation revealed that complications in the area around the arteriovenous fistulas were known and were being treated until a sudden rupture of the vessels and hemorrhage from the arteriovenous fistulas resulted in the deaths.

Fatal Ingestion of Chlumsky Disinfectant Solution.

A 32-year-old pregnant woman in the 25th week of pregnancy underwent oral glucose tolerance screening at the diabetologist's. Later that day, she was found dead in her apartment possibly poisoned with Chlumsky disinfectant solution (solutio phenoli camphorata). An autopsy revealed chemical burns in the digestive system. The lungs and the brain showed signs of severe edema. The blood of the woman and fetus was analyzed using gas chromatography with mass spectrometry and revealed phenol, its metabolites (phenyl glucuronide and phenyl sulfate) and camphor. No ethanol was found in the blood samples. Both phenol and camphor are contained in Chlumsky disinfectant solution, which is used for disinfecting surgical equipment in healthcare facilities. Further investigation revealed that the deceased woman had been accidentally administered a disinfectant instead of a glucose solution by the nurse, which resulted in acute intoxication followed by the death of the pregnant woman and the fetus.

[Injuries associated with cardiopulmonary resuscitation in non-survivors after out-of-hospital cardiac arrest (autopsy study)]. / Poranenia vznikajúce v súvislosti s kardiopulmonálnou resuscitáciou pre náhlu zástavu srdca v teréne (autoptická stúdia).

The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 - 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons - findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).Key words: cardiopulmonary resuscitation - cardiac arrest - injuries - autopsy study - sternal and rib fractures.

Fluid content in the pleural cavity protects internal structures against heat.

PURPOSE: In this paper we present a case report of two people who were found dead in a holiday cottage after a fire. The cause of death in these cases was clarified by the presence of blood in the left pleural cavity in both bodies. METHODS: An inspection of the bodies at the scene of the fire and subsequent examination by a medical examiner suggested the deaths were accidental. RESULTS: An autopsy showed that the bodies were those of a man and a woman with severe carbonization of the skin, soft tissues, brain, and some organs of the thoracic and abdominal cavities. There were also isolated stab injuries to the chest, as well as injuries to skeletal structures and intrathoracic organs. The accumulated blood in the pleural cavity had protected the internal organs against thermal destruction and preserved the traumatic findings. CONCLUSION: To the best of our knowledge this is the first description of the protective effect of hemothorax against thermal damage of the intrathoracic organs.

Intra-thoracic injuries associated with cardiopulmonary resuscitation - Frequent and serious.

AIM OF THE STUDY: The aim of the study was to evaluate prevalence, seriousness and risk factors of intra-thoracic injuries (ITI) injuries associated with CPR in non-survivors after out-of-hospital cardiac arrest. METHODS: This was a prospective forensic autopsy cohort study conducted in a single institution. Pathologists recorded autopsy data using standardized protocol which contained data from external and internal examination of the body focused on ITI. RESULTS: In total, 80 persons were included in this study. CPR-associated injuries were found in 93.7% of cases; majority of injuries were skeletal chest fractures (rib fractures in 73.7%, sternal fractures in 66.3%). ITI were identified in 41.2% of cases. Contusion of at least one lung lobe was found in 31.2%, lung laceration in 2.5%, and hemothorax in 5.0% of cases. Transmural heart contusion was identified in 17.5% of cases; hemopericard on the grounds of right atrium rupture of aortic rupture was revealed in 8.7% of cases. Risk factor analysis did not show any statistically significant correlation between ITI and any of general data (age, gender, BMI, cause of death, season of the year or location where the body was found) or CPR specifications (type and duration of CPR, manner of chest compressions). A strong correlation between ITI and skeletal chest fractures was proven. CONCLUSION: ITI present frequent and serious complications of unsuccessful CPR. ITI could contribute to the death only provided the fact that ROSC had been achieved. Correct performance of chest compressions according to guidelines is the best way to avoid ITI.

[Injuries associated with cardiopulmonary resuscitation]. / Poranenia asociované s kardiopulmonálnou resuscitáciou.

INTRODUCTION: Therapeutic procedures performed during cardiopulmonary resuscitation on patients in cardiac arrest or unconsciousness from any other cause can have serious adverse effects. Scale of injuries scale is very wide - from simple skin lacerations up to serious injuries which can even thwart possibility of successful resuscitation and cause death. MATERIALS AND METHODS: Comprehensive review of current literature aimed at injuries associated with cardiopulmonary resuscitation. RESULTS: Authors of this paper offer up-to-date review of possible cardiopulmonary resuscitation associated injuries, which are discussed depending on the method of performed resuscitation - airway management, chest compressions without tools or with automated mechanical devices, and defibrillation. Airway management is frequently associated with subcutaneous hematomas of the neck and head, mucosal membrane lacerations, teeth fractures and airway aspiration. Autopsy findings after cardiac massage are: rib and sternal fractures (very frequent); pleura, lung and cardiac injuries (frequent); cervical spine injuries, pericardial tamponades due to cardiac or aorta rupture, liver, spleen or stomach lacerations (rare). Defibrillation can create skin burns, cardiac or renal injuries due to rhabdomyolysis. CONCLUSION: Forensic pathologists as well as clinical practitioners should be aware of the relevance of possible injuries associated with cardiopulmonary resuscitation. The injuries should be avoided if possible, or distinguished from injuries of other origin if they cannot be prevented.