Blunt cardiac rupture due to physical assault: An autopsy-based case series.

Background: The literature reports cases of ventricular rupture in blunt chest trauma following motor vehicle accidents. It rarely describes cardiac tamponade due to rupture of the heart following blunt thoracic trauma in a physical assault. There are rare cases where fatal cardiac tamponade results from a ruptured ventricle without externally visible injuries to the chest. It is also rare for the cardiac rupture to occur on the posterior side. In our case series, the first case involved a direct blow to the left side of the chest by a projectile (brick), causing rupture of the left ventricle's base with intact pericardium. In the second case, a direct blow to the left side of the chest led to rupture of the right ventricle's posterior wall. Case presentation: Here, we report two autopsy-based case series of isolated right and left ventricular rupture with cardiac tamponade in blunt thoracic trauma with a specific history and background information of assault. The first case is a 35-year-old male assaulted with a brick thrown at his chest in a moving bus; he was declared dead on arrival after a one-hour journey. The second case is a 55-year-old male assaulted with double punches in his chest and declared dead on arrival at the hospital after 30 minutes. A medicolegal autopsy and thorough investigation, in both cases, revealed cardiac tamponade due to ventricular rupture with no underlying pathology. Conclusion: This case series underlines the importance of systematic and complete cardiac examination in all death cases following blunt chest trauma even with minimal or no evidence of a visible injury to the chest. Rarely cardiac rupture is noticed on the posterior surface or apex of the heart. The case series illustrates a rare occurrence of cardiac rupture that requires apt investigation and certification of medicolegal causes of death to determine how the death was caused.

Doctrine of Novus Actus Interveniens Not Always a Defense: Analysis of a Case.

Doctrine of novus actus interveniens (NAI) sometimes plays an important role as a tool of defense in medical negligence suits. It is a Latin phrase which means breakage of the causal chain at some point, relieving the initial wrongdoer. In medical negligence suits, the appearance of an external factor or event in the causal chain and the outcome is not directly related to the negligence of the doctor, but for the novel agent; the doctrine of NAI can be applied and the initial wrongdoer, i.e., the treating physician can be exempted. Autopsy of a similar type of case was performed in a tertiary care hospital in the State of Chhattisgarh. The autopsy findings identified a new factor in the form of dereliction in duty by another physician causing breakage of the chain in the current case described. How to cite this article: Dheeraj AB, Giri SK, Sarma B. Doctrine of Novus Actus Interveniens Not Always a Defense: Analysis of a Case. Indian J Crit Care Med 2020;24(10):983-985.