Serious complications from active compression-decompression cardiopulmonary resuscitation

Complications arising from techniques of cardiopulmonary resuscitation (CPR) were reviewed by analysing the autopsy protocols of 25 patients who died after standard (Std) CPR and 31 who died after active compression-decompression (ACD) CPR, 15 of them preceded by Std CPR.The results can be summarised as follows:After Std CPR (n = 25) rib fractures were detected in 28%, sternal fractures in 16%, and no injuries in 68%.After ACD-CPR (n = 16) rib fractures occurred in 68%, sternal fractures in 68% and no injuries in 25%.After ACD-CPR following Std CPR(n = 15) rib fractures were detected in 93%, sternal fractures in 93%, and no patients were without thoracic fracture. In two patients severe cardiac injuries occurred clearly attributable to CPR.In conclusion cardiopulmonary resuscitation by the ACD-technique caused rib and sternal fractures more often than Std CPR and has a higher risk for iatrogenic cardiac and possible fatal injury.     

Forensic aspects of starvation

Fatal starvation is a rare cause of death in industrialized countries. However, it may have major medicolegal importance if death results from the deliberate withholding of food, especially from infants. In such cases, the task of the forensic pathologist and the medical examiner, respectively, is to clarify the cause of death and give an expert opinion on the degree and duration of starvation. Several classification systems have been developed to estimate protein–energy malnutrition in developing countries. Simpler classifications, such as the Gomez classification, use the weight expected for the respective age group as the standard. However, smaller infants will be lighter, and therefore the classification may not be accurate in this case. Following the Waterlow classification, the extent of stunted growth (referring to growth retardation in cases of chronic malnutrition) is calculated using the ratio of the measured body height to that expected for the age. Using such classification systems, grading of stunting and wasting can be achieved and may greatly help in the assessment of a given child’s nutritional status in legal cases. The application of the Waterlow classification to the authors’ case material and previously published cases in the literature is herein demonstrated. The Waterlow classification is not only of importance for grading the final stage of fatal starvation, but also for the chronological development of the nutritional status if anthropometrical data have been repeatedly recorded from the affected individual in vivo.     

Gastric trauma following cardiopulmonary resuscitation

Three cases of gastric trauma following cardiopulmonary resuscitation are reported. In two cases there were full thickness lacerations of the gastric wall resulting in pneumoperitoneum and in one case subcutaneous emphysema. In the third case, gastric mucosal lacerations resulted in gastric haemorrhage. In all three cases it was thought that the gastric lesions did not contribute to death and were resuscitation artefacts.     

心肺复苏后的监测与治疗

心脏骤停经复苏自主循环恢复后,机体仍面临着缺血再灌注损伤和全身炎症反应等一系列复杂的病理生理学问题,引起多脏器损伤。系统性的心脏骤停后管理和多学科联合的集束化治疗能改善病死率。这些措施包括密切监护与评估;早期血流动力学优化治疗以保证重要脏器灌注;积极的心血管系统监测,处理急性冠状动脉综合征和心律失常等;气道管理与呼吸支持,优化机械通气策略,控制性氧疗并避免过度通气;应用亚低温等预防脑损伤,积极控制癫痫;实施危重症管理方案等：以期提高神经学正常的出院存活率。     

心肺复苏后的监测与治疗

心脏骤停经复苏自主循环恢复后,机体仍面临着缺血再灌注损伤和全身炎症反应等一系列复杂的病理生理学问题,引起多脏器损伤。系统性的心脏骤停后管理和多学科联合的集束化治疗能改善病死率。这些措施包括密切监护与评估;早期血流动力学优化治疗以保证重要脏器灌注;积极的心血管系统监测,处理急性冠状动脉综合征和心律失常等;气道管理与呼吸支持,优化机械通气策略,控制性氧疗并避免过度通气;应用亚低温等预防脑损伤,积极控制癫痫;实施危重症管理方案等：以期提高神经学正常的出院存活率。     

论战创伤心脏呼吸骤停的精准心肺复苏模式

直接针对战创伤心脏呼吸骤停进行心肺复苏(CPR)是提高战创伤心脏呼吸骤停复苏成功率的重要保证.本文结合不同战创伤心脏呼吸骤停特点,探索战创伤心脏呼吸骤停的规律模式,认识“因人而异、因地制宜”的精准个体化心肺复苏程序、方法及终止时限,以达到降低战创伤心脏呼吸骤停死亡率的目的.     

Angiographic demonstration of complications resulting from the Waterston procedure.

The ascending aorta--right pulmonary artery anastomosis, originally introduced by Waterston as a palliative shunt to increase pulmonary blood flow in certain cyanotic congenital heart diseases, has been found to be associated with late complications in a significant number of cases. These complications include preferential distribution of most or all shunt flow to the right lung, narrowing or obstruction of the right pulmonary artery at the anastomotic site, increasing stenosis or atresia of the right ventricular outflow tract, hypoplasia of the left pulmonary artery, and obstruction of the shunt itself. A properly planned angiocardiographic study is the principal method of detection of these complications.     

Forensic aspects of the aerotoxic syndrome

Three decades ago, cabin air quality was seemingly not an issue in commercial aviation and the incidence of disease through air borne vectors or toxic fumes was uncommon among passengers and crew. However, it is claimed that modern day jet airliners generally carry the threat of disease through the ventilator systems of these aircraft which are designed for optimum efficiency, leaving them exposed to lapses in the recycling of clean air and blocking fumes from engine exhausts of the jets from entering the inhabited parts of the aircraft. It has been claimed that aerotoxic fumes are most common in the cockpit, and that the technical crew are the most susceptible to the aerotoxic syndrome.     

Forensic aspects of 'crack' abuse.

Two cases of paranoid psychoses resulting from 'Crack' abuse are described. In each case the content of the delusions led to violence. These cases were referred to forensic psychiatric services for assessment, without prior contact with services for drug abusers. The importance of eliciting a full drug history in assessment of violent offenders is emphasized.     

生存链在心肺复苏中的作用

本文通过回顾心肺复苏(CPR)生存链概念的建立,结合2010年美国心脏病协会CPR及心血管急救指南,重点论述五环生存链的作用,包括:(1)立即识别心脏停搏并启动急救系统;(2)尽早进行心肺复苏,着重于胸外按压;(3)快速除颤;(4)有效的高级生命支持;(5)综合的心脏停搏后治疗.阐述了优化和持续改进生存链各环节对于提高...     

Forensic web watch--medicolegal aspects of paediatric pathology

The trials over the deaths of Matthew Eappen and Victoria Climbie have highlighted the importance of forensic evidence in cases of suspected child abuse. The debate as to whether bruises, fractures or head injuries have been sustained as a result of previous trauma or non-accidental injury is central to these, and other, cases. A variety of subjects are encountered in forensic paediatric pathology, including Shaken Baby Syndrome, non-accidental injury, retinal haemorrhage, skeletal injury, Sudden Infant Death, sexual abuse and Munchausen Syndrome by Proxy. The coverage of these areas on the internet was assessed using two search engines (Google and the meta-search engine Mamma) and revealed patchy coverage. The majority of sites uncovered were, unsurprisingly, aimed at the layperson concerned by such issues; however, several sites containing useful information for the professional are available.     

CT demonstration of massive cerebral air embolism from pulmonary barotrauma due to cardiopulmonary resuscitation

A 77-year-old man with loss of consciousness, circulatory collapse, and apnea caused by myocardial infarction underwent cardiopulmonary resuscitation with intratracheal intubation and manual bag ventilation. Computed tomography of the head demonstrated massive air embolism in the entire cerebral circulation. The patient was diagnosed as brain dead the next day. Demonstration of massive cerebral air embolism on head CT is presented.     

Retroperitoneal fluid resulting from rapid intravascular resuscitation in trauma: CT mimic of retroperitoneal injury

Objective: We postulate that retroperitoneal fluid density (RFD) observed on computed tomography (CT) following blunt abdominal trauma can result from aggressive intravascular volume resuscitation. The purpose of this study was to determine associated CT findings useful in distinguishing RFD related to rapid intravascular volume expansion from primary retroperitoneal injuries that produce a similar CT appearance. Subjects and Methods: All admission CT scans performed for blunt abdominal trauma over a 13-month period demonstrating RFD were reviewed. If CT findings, as determined by consensus of the authors, clearly indicated a primary retroperitoneal injury to account for the RFD, such as duodenal or pancreatic injury, the study was excluded from further analysis. There were 11 patients with RFD whose CT scans showed no primary retroperitoneal injury. The admission and any follow-up CT studies of these 11 patients were assessed for CT signs of intravascular volume expansion. Medical records were reviewed to determine the quantity and rate of intravenous (IV) fluid administration, serum amylase level(s), and operative findings if performed. Results: All 11 patients had CT signs of intravascular volume expansion including periportal low density in the liver (11 patients), distention of the inferior vena cava (11 patients), and diffuse edema of the small bowel (7 patients). Identification of RFD as edema was confirmed directly at celiotomy in 3 patients and by rapid resolution of RFD on follow-up CT in 8. No follow-up CT showed evidence of delayed retroperitoneal hemorrhage or signs of primary retroperitoneal injuries. Postadmission IV fluids were administered at 210 to 2400 ml/hr (mean 840 ml/hr) at the time of CT with total volume resuscitation from 4.7 to 57.0 L (mean, 11.6 L) given over a 24-hour period postadmission. Serial serum amylase levels did not show a rising trend to suggest pancreatic injury. paConclusion: The CT demonstration of RFD after blunt trauma suggests primary retroperitoneal injury, including the bowel, pancreas, kidneys, and cisterna chyli, and could prompt exploratory laparotomy. However, if this CT finding is accompanied by periportal low density, vena caval distention, or diffuse bowel edema, it suggests that RFD results from interstitial edema related to aggressive IV resuscitation. If no other clinical or CT evidence of primary retroperitoneal injury is identified, these patients should be managed conservatively.