Search

Death from falls accounts for a significant number of injuries and fatalities globally, often linked to suicides, workplace accidents, or substance abuse, and rarely to homicidal causes. Injuries from falls vary based on height, impact point, and surface struck, with severe trauma often seen, including visceral ruptures, organ lacerations, and complex fractures. Even minimal external injuries can mask severe internal damage, such as multiple organ ruptures, organ tears, and large vessel lacerations. Blunt cardiac injuries, which occur in 5% to 50% of falls, are significant, especially in falls over 6 m. In 70% of the cases, cardiac rupture is observed at the level of the posterior wall of the heart and occurs due to a contusive action on the heart during the diastolic filling phase. We report a case of a 29-year-old man (weight 95 kg) who died from an 11-meter fall. He had a history of cardiac surgery for the transposition of the great vessels, and an autopsy revealed extensive cardiac rupture, likely worsened by fibrotic adhesions anchoring the heart to the pericardium. Toxicological investigations on peripheral blood showed BAC > 2.58 g/L. Heart scars, macro- and microscopically as a deposit of fibrous tissue, due to previous surgery, may have contributed to the extent of the lesion, suggesting the need for further study on post-operative tissue changes and their effects on trauma from falls.

Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.

Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.