Gastric mucosal tears and wall micro perforations after cardiopulmonary resuscitation in a drowning case

A fifty year-old woman died after drowning in a swimming-pool. Rescue and ambulance paramedic teams started resuscitation attempts followed by a medical care helicopter team. Acute haematemesis, mucosal tears and gastric micro perforations occurred, due to the cardiorespiratory resuscitation manoeuvres. Death occurred seven days later due to the cerebral anoxia and multiorgan failure. Forensic investigations excluded possible malpractice during external cardiac massage as responsible for the woman's death, while Judicial Authority considered the death as the consequence of the delayed intervention of the swimming-pool rescue team

Influence of passive leg elevation on the right ventricular function in anaesthetized coronary patients

INTRODUCTION: The aim of the present study was to evaluate the haemodynamic effects of passive leg elevation on the right ventricular function in two groups of patients, one with a normal right ventricular ejection fraction (RVEF) and one with a reduced RVEF. METHODS: Twenty coronary patients undergoing elective coronary artery bypass grafting surgery were studied by a RVEF pulmonary artery catheter. The haemodynamic data reported were collected before the induction of anaesthesia (time point 1), just before (time point 2) and 1 min (time point 3) after the legs were simultaneously raised at 60°, and 1 min after the legs were lowered (time point 4). The patients were divided into two groups: group A, with preinduction RVEF > 45%; and group B, with preinduction RVEF < 40%. RESULTS: In group A (n = 10), at time point 3 compared with time point 2, the heart rate significantly decreased (from 75 ± 10 to 66 ± 7 beats/min). The right ventricular end diastolic volume index (from 105 ± 17 to 133 ± 29 ml/m(2)), the right ventricular end systolic volume index (from 61 ± 13 to 77 ± 24 ml/m(2)), the systolic systemic arterial/right ventricular pressure gradient (from 93 ± 24 to 113 ± 22 mmHg) and the diastolic systemic arterial/right ventricular pressure gradient (from 58 ± 11 to 66 ± 12 mmHg) significantly increased. Also in group A, the cardiac index did not significantly increase (from 3.28 ± 0.6 to 3.62 ± 0.6 l/min/m(2)), the RVEF was unchanged, and the right ventricular end diastolic volume/pressure ratio (RVED V/P) did not significantly decrease (from 48 ± 26 to 37 ± 13 ml/mmHg). In group B (n = 6) at the same time, the heart rate (from 72 ± 15 to 66 ± 12 beats/min), the right ventricular end diastolic volume index (from 171 ± 50 to 142 ± 32 ml/m(2)) and the RVED V/P (from 71 ± 24 to 39 ± 7 ml/mmHg) significantly decreased. The cardiac index and the diastolic systemic arterial/right ventricular pressure gradient were unchanged in group B, while the RVEF and the systolic systemic arterial/right ventricular pressure gradient did not significantly increase, and the right ventricular end-systolic volume index did not significantly decrease. All results are expressed as mean ± standard deviation. CONCLUSIONS: We conclude that passive leg elevation caused a worse condition in the right ventricle of group B because, with stable values of cardiac index, of systolic systemic arterial/right ventricular pressure gradient and of diastolic systemic arterial/right ventricular pressure gradient (which supply oxygen), the RVED V/P (to which oxygen consumption is inversely related) markedly decreased. This is as opposed to group A, where the cardiac index, the systolic systemic arterial/right ventricular pressure gradient and the diastolic systemic arterial/right ventricular pressure gradient increased, and the RVED V/P slightly decreased. Passive leg elevation must therefore be performed cautiously in coronary patients with a reduced RVEF

Neck injury patterns resulting from the use of petrol and electric chainsaws in suicides. Report on two cases.

Suicides due to neck injuries caused by chainsaws are uncommon events. The cutting elements of petrol and electric chainsaws produce different features in lethal neck injuries. The accurate evaluation of the death scene, of the power and mechanical characteristics of the chainsaw and of wound morphology are all essential in distinguishing a case of suicide. \ua9 2014 Elsevier Ltd. All rights reserved

Fatalities resulting from falls from height in agricultural contexts

Agricultural work encompasses a variety of activities which carry with them different risks. One such activity is working at height, a frequent cause of fatal accidents. The aim of this work is to describe and discuss a typical case of a fall from height in order to understand the traumatic consequences of such accidents, to analyze the dynamics and lesions, and highlight the dangers of working at height. These falls, which may involve farm workers who are officially or unofficially employed, can produce injuries whose seriousness is not always strictly correlated to the height of the fal

Definition of a methodology for gradual and sustainable safety improvements on farms and its preliminary applications

In many productive sectors, ensuring a safe working environment is still an underestimated problem, and especially so in farming. A lack of attention to safety and poor risk awareness by operators represents a crucial problem, which results in numerous serious injuries and fatal accidents. The Demetra project, involving the collaboration of the Regional Directorate of INAIL (National Institute for Insurance against Accidents at Work), aims to devise operational solutions to evaluate the risk of accidents in agricultural work and analyze the dynamics of occupational accidents by using an observational method to help farmers ensure optimal safety levels. The challenge of the project is to support farmers with tools designed to encourage good safety management in the agricultural workplaces. \ua9 2018 by the authors. Licensee MDPI, Basel, Switzerland