Thursday, August 18, 2011

Emedinews: Insights on Medicolegal issues - Resuscitation injuries in postmortem report

It is essential to consider the entire history along with autopsy findings during a death investigation by the forensic doctor and legal agency.

• Soft tissues injuries nail marks, contusions ribs fracture are common in both adults and children who have undergone cardiopulmonary resuscitation; however, potentially life-threatening injuries are very rare.
• The doctors performing the resuscitation go through a very exhaustive cycle of CPR and generally forget to put a note after resuscitation particularly if resuscitation is followed by death. Hence a format of resuscitation details should be kept attached to clinical sheet by the doctors.
• The pre-arrest history in a resuscitated adult often assists the doctor conducting the autopsy to interpret findings related with resuscitation.
• In infants or children, there may not be a reliable history. In this situation, it may be difficult if not impossible to distinguish resuscitation injuries from pre-existing accidental or inflicted trauma.
• It has been seen in some cases that there were significant autopsy-documented injuries initially attributed to abuse like contusions and nail marks produced during resuscitation. The State filed murder charges against the caretaker in each case. However, further history and review of the medical records suggested that resuscitation rather than pre-arrest trauma caused almost all of the injuries. The State dismissed the charges in the first case. A western jury returned a "not guilty" verdict in the second.
• The Honorable Delhi high court recently has also given an acquittal on the benefit of doubt in a case of alleged murder by strangulation where CPR has been given.

(Contributed by Dr Sudhir Gupta)

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