[Death after explosion of an "empty" acetone barrel]. / Tod nach Explosion eines "leeren" Acetonfasses.

Inappropriate disposal of (hazardous) waste material led to an explosion of an acetone-air mixture in a metal barrel. The lid was blown off and caused blunt traumatization with fatal exsanguination. The case furnishes information relevant for the practical teaching of forensic knowledge and the indicated consultation of medico-legal experts already at scene.

Progression of chronic subdural haematomas in an infant boy after abusive head trauma.

Abusive head trauma is a serious form of child abuse that can lead to severe neuropsychological sequelae or death in infants. In questionable cases, without a confession from the caregivers and ambiguous clinical information, evidence for the diagnosis of abusive head trauma is often based on typical patterns that have been observed in neuro-imaging. This study shows the progressive evolution of multifocal chronic subdural haematomas, including re-bleedings, in a case of abusive head trauma in an infant boy who was documented with repeated magnetic resonance imaging. The chronic subdural haematomas occurred during closely monitored in-patient rehabilitative care, and repeated maltreatment did not appear to be likely. Due to excessive growth, neurosurgical intervention with endoscopic craniotomy, evacuation of the subdural haematomas and temporal external cerebrospinal fluid drainage was performed with a favourable recovery. This study discusses the current pathophysiological knowledge concerning the development and clinical course of chronic subdural haematomas and draws relevant conclusions for the clinical practice and psychosocial management of caring for victims of abusive head trauma.

Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity.

UNLABELLED: Survival after in-hospital pulseless electrical activity (PEA) cardiac arrest is poor and has not changed during the last 10 years. Effective chest compressions may improve survival after PEA. We investigated whether a mechanical device (LUCAS™-CPR) can ensure chest compressions during cardiac arrest according to guidelines and without interruption during transport, diagnostic procedures and in the catheter laboratory. METHODS: We studied mechanical chest compression in 28 patients with PEA (pulmonary embolism (PE) n=14; cardiogenic shock/acute myocardial infarction; n=9; severe hyperkalemia; n=2; sustained ventricular arrhythmias/electrical storm; n=3) in a university hospital setting. RESULTS: During or immediately after CPR, 21 patients underwent coronary angiography and or pulmonary angiography. Successful return of a spontaneous circulation (ROSC) was achieved in 27 out of the 28 patients. Ten patients died within the first hour and three patients died within 24h after CPR. A total of 14 patients survived and were discharged from hospital (13 without significant neurological deficit). Interestingly, six patients with PE did not have thrombolytic therapy due to contraindications. CT-angiography findings in these patients showed fragmentation of the thrombus suggesting thrombus breakdown as an additional effect of mechanical chest compressions. No patients exhibited any life-threatening device-related complications. CONCLUSION: Continuous chest compression with an automatic mechanical device is feasible, safe, and might improve outcomes after in-hospital-resuscitation of PEA. Patients with PE may benefit from effective continuous chest compression, probably due to thrombus fragmentation and increased pulmonary artery blood flow.

Automated continuous chest compression for in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity: a report of five cases.

Of patients with in-hospital cardiac arrest, those with pulseless electrical activity (PEA) have the worst outcome. Especially in these patients effective chest compressions according to the guidelines may be the key strategy to improve survival. Recently, a novel automatic mechanical chest compression device (LUCAS-CPR) has been shown to ensure effective continuous compressions without interruption during transport, diagnostic procedures and in the catheter laboratory, and may thus significantly improve outcome after resuscitation of in-hospital cardiac arrest. We report here on the first five well documented cases of in-hospital resuscitation of PEA using the LUCAS-CPR compression device.

Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death.

The discussion surrounding shaken baby syndrome (SBS) arose from the lack of evidence implicating diffuse axonal injury (DAI) as a cause of death. It was assumed instead that injury to the cervical cord, medulla, and nerve roots played a causal role. The present pathomorphological study examines 18 selected infants (<1-year-old) whose deaths were highly suspicious for SBS, exhibiting the classical SBS triad of acute subdural hemorrhage (SDH), retinal bleeding, and encephalopathy. Gross autopsy and microscopic findings of these infants were compared with those of 19 victims of sudden infant death syndrome (SIDS; control group 1) and of 14 infants who died of disease or injuries/violence not involving the head, neck or eyes (control group 2). Symptoms of mechanical impact to the head were evident in seven of the SBS infants, but in none of the control infants. DAI was not detected in either the SBS or control cases. Localized axonal injury (AI) was regularly present in the brains of the SBS infants surviving longer than 1.5-3.0 h, but only occasionally in the craniocervical junction and within the nerve roots of the upper cervical cord; it was never present in the medulla. Epidural hemorrhage of the cervical cord was seen in four of the ten examined SBS cases, but in none of the control cases. Based on the absence of DAI in the brain and of signs of generalized cervical cord or nerve root injuries, we conclude that the cause of death in the SBS victims was a global cerebral ischemia secondary to SDH, focal vasospasm, trauma-induced transitory respiratory and/or circulatory failure.