The Role of Autopsy and Post-Mortem Investigations in Falling Traumas in the Hospital Environment.

Falls in a hospital setting are a global public health problem. Despite the production of sensors and various preventive tools to reduce the risk, falls remain a dangerous event with a significant impact on the morbidity and mortality of patients. Despite numerous prevention strategies, falling in the hospital are not always investigated and the autopsy is not always performed in these cases, so it is often not known whether the death is related to the fall or to other causes, inevitably affecting the assessment of any profiles of medical liability for health personnel or for the hospital in the accident. We describe three cases of falls that occurred in different hospitals, in which the autopsy allowed to diagnose with certainty the extent of the trauma and to reconstruct its dynamics. Along with the circumstantial and documentary analyses, deficiencies both in the trauma diagnostics and in the application of the safety measures on the patients were showed. Together with the description of our cases, we propose the post-mortem investigations of these events, both for judicial and risk management purposes.

The Role of Forensic Investigation in an Unusual Case of Patricide by a Schizophrenic Woman Involving Dismemberment of a Decomposed Body.

Dismemberment is characterized by the fragmentation of the body into anatomical sections. It can occur because of a murder, suicide, or accident. In the literature, there are no cases of patricide perpetrated by a daughter in which the offender performed the dismemberment. However, in this paper, we reported a case of patricide by a schizophrenic daughter that was not treated with antipsychotic therapy. Post-mortem Computed Tomography (PMCT), autopsy, and histological examinations were performed. The soft tissues were removed through maceration techniques and chemical treatment. An analysis was performed to study the bone margins and clarify the weapon and manner of death. This investigation, which used radiological and histological studies, helped to assess the vitality of the injuries. The purpose of the study is to discover the weapon used, the cause, and the manner of death, with particular interest in this case due to the dismemberment. Moreover, we emphasize the correlation between patricide, dismemberment, and a lack of antipsychotic treatment in patients with schizophrenia.

Hospital Restraints: Safe or Dangerous? A Case of Hospital Death Due to Asphyxia from the Use of Mechanical Restraints.

Asphyxia can be defined as an impediment to the influx of air into the respiratory tract, leading to tissue hypoxia. By restraint, we mean the use of physical, pharmacological and/or environmental means to limit the subject's ability to move. Fall prevention is the main reason restraint is used. Unfortunately, restraint can sometimes be fatal. There are few studies in the literature on this subject. We report the case of a man with Down syndrome in a psychiatric clinic found dead between the bed and the floor of the room where he was hospitalized. The analysis of the scene showed the presence of a means of a restraint, located around the man's chest and neck, which kept him tied to the bed and applied a constricting mechanical action. There was doubt as to the cause of death. For this reason, an inspection of the scene and an autopsy were carried out. Upon opening the chest, blood infiltration of the left intercostal muscles that was topographically compatible with external cutaneous excoriation (sign of restraint) became evident. In view of the danger of using restraint, it is necessary to evaluate the means of restraint as an extraordinary and not an ordinary procedure in patient management. Each patient undergoing restraint measures must be carefully monitored by specialized personnel. Greater surveillance of the nurse/patient ratio is necessary to reduce the use of restraints. In this case report, we highlight the lack of surveillance of patients subjected to restraint.