Issues of electric shock in forensic medical practice.

The authors summarize the current state of knowledge of electric shock as a minority group of injuries in forensic practice. Initially, they deal with electric current as a physical quantity and its effect on the human body, how it enters and moves in the body, which tissues due to their electrical activity and properties are the best conductors and which, on the contrary, due to their high resistance, practically do not conduct current. Subsequently, different pathways of current passage through the body are mentioned, leading to different types of damage, the most serious of which appears to be damage to the cardiovascular system, which can lead to immediate death due to disturbed heart rhythm with subsequent arrest, but is also likely to leave permanent effects leading to late health complications. The effect of electric current at the cellular level is demonstrated in experimental animal models exposed to both low- and high-voltage electric current, with damage described not only at the site of entry but also by microscopic examination in organs distant from the site of direct electric current. Since the effect of electric current on the organism is not fully understood and experimental studies have produced results indicating damage mainly to the cardiovascular system, this opens up certain possibilities for improving not only the diagnosis of deaths due to electric shock but also the follow-up care of patients who survive these injuries.

CPR-related injuries after non-traumatic out-of-hospital cardiac arrest: Survivors versus non-survivors.

AIM: There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors. METHOD: This retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU. RESULTS: A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity. CONCLUSION: CPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.

[Double homicide with a damning bite mark on the offender´s body - case report]. / Dvojnásobná vrazda s usvedcujícím kousnutím na tele pachatele - kazuistika.

The authors deal with a case of a double homicide, the parental murder made by their older son, which was committed by a combination of stabbing and cutting wounds. The perpetra-tor tried to hide the bodies, so he doused them with gasoline and set fire to them on a lonely forest road. Then he ran over the remains by his car. The cause of death was in both cases open wound of the neck - autopsy findings of the woman´s body testified for a blood aspi-ration, on the man´s body it was not clear for a partial charring, so the possibilities were blood aspiration, air embolism or external bleeding with haemorrhagic shock. There were also many other injuries on the bodies, especially of the post-mortem origin. During the combat, one of the victims - the mother - bit the assailant´s left forearm. So a few days after creation the injury on murderer´s left upper extremity, the police technicians took photos and during the forensic autopsies of both bodies, authors created the impressions of the teeth. The utilities were loaned from Department of Stomatology of University Hospital Královské Vinohrady in Prague and they were designed for the general adult population. The work was more difficult for the state of mortal remains, which were damaged by combination of fire and blunt violence. However finally the impressions of each arch were made, and they were given to the experts from Institute of Criminalistic Prague, who compared them with pictures of the bite mark. The results of this analysis were used in a court as evidence against the perpetrator.

A concise history of forensic medicine in Czech Republic.

This paper presents the most important historical facts about all forensic medicine workplaces in the Czech Republic since the beginning till present day, including a perspective on how to establish a new one. Each of the University Forensic Medicine Institutes or district Departments is covered by at least one author. The oldest institute is in Prague and in Brno, the youngest is in Pardubice.