Journal of forensic and legal medicine
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Hypoxic ischemic brain injury (HIBI) is the most decisive factor in determining the outcome following a cardiac arrest. After an arrest, neuronal death may be early or delayed. The aim of our study is to determine the prevalence and predictors of HIBI on autopsy following an in hospital cardiac arrest. ⋯ On univariate analysis, predictors of HIBI were prolonged hospital stay, prolonged survival time following an arrest and a slight increased trend following multiple resuscitative events. On multivariate analysis, prolonged survival time was the only significant predictor of HIBI. Similar to other prognostication cardiac arrest studies, there were minimal predictors of early neuronal injury even on autopsy.
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Myocardial infarctions caused by coronary artery injury after blunt chest trauma is a fatal, but rare occurrence. In the case reported on here, a fatally injured 69-year-old male driver sustained such trauma in a frontal car collision. ⋯ Using triphenyl tetrasolium chloride and hematoxillin-eosin stains, an acute myocardial ischaemia of the anterior left ventricle wall and the septum was diagnosed as the cause of death. Since coronary injuries affecting more than one vessel in blunt chest trauma are extremely rare, only a few papers have yet to refer to this type of coronary injury in addition to the case presented here.
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In the UK tramadol is a frequently prescribed opioid analgesic which is becoming increasingly popular as a drug of misuse. Its use varies worldwide and in the last decade it has been upgraded to a controlled substance in several countries, due to an increased number of deaths associated with its use. A review of all deaths associated with tramadol in Northern Ireland was performed and this highlighted 127 cases from 1996 to the end of 2012. ⋯ In just over half of the deaths tramadol had not been prescribed by a medical practitioner (53%). Depression, addiction and seizures were recognised risk factors. An increase in awareness of tramadol toxicity is needed amongst the public and doctors.