The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Mar 1990
Case ReportsAnterior thoracic wall trauma in elderly homicide victims. The "CPR defense".
During the course of medicolegal postmortem examinations, forensic pathologists often encounter the sequelae of cardiopulmonary resuscitation (CPR) that was administered by medical and paramedical personnel. A wide variety of CPR-related injuries have been described since the institution nearly 30 years ago of this now common-place emergency technique. The forensic pathologist must be aware of both typical and unusual CPR-related trauma patterns in order to differentiate between injury produced during emergency therapy procedures and injury sustained through other mechanisms (for example, during an assault or an accident). ⋯ In each instance, bony injuries of the anterior thoracic wall structures were identified during the autopsy. Defense attorneys in each case attempted to use these injuries as proof that their accused clients had performed external cardiac massage on their victims, thus indicating that the homicides had not been intentional, and that the perpetrators showed remorse. These cases are presented, with a discussion of the typical features of CPR-related thoracic wall trauma as compared with willfully inflicted injury.
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We report two cases of suicide by multiple gunshots to the head. The first victim (of two shots) fired the first shot, which was observed, into his mouth, leading to damage to the left optic nerve and frontal lobe. The man still was able to drive his car home, where he shot himself in his right temple. ⋯ Finally, he shot himself in his left temple, resulting in destruction of the pons. In the first case, an amateurishly modified 8-mm blank revolver firing 6.35-mm- (.25)-caliber ammunition was used; in the second case, a rifle firing 5.6-mm (.22)-caliber ammunition with a reduced charge was used. In both cases, low-energy transfer to brain tissue by the initial bullets was due to low bullet energy or due to the bullets' missing the brain or vital centers.
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Nine cases of multiple-shot suicides (suicides involving more than two gunshot wounds) examined in the last 6 years at the Office of the Chief Medical Examiner. State of Maryland, are reported. All victims, with the exception of one, were white: three were women and six were men, with ages ranging from 22 to 81 years. ⋯ The most common site for the gunshot wounds of entrance was the precordial region, followed by the left chest, the head, and the abdomen. Gunshot wounds were rarely localized exclusively to the head, whereas gunshot wounds scattered on different classic suicide body sites or all confined to the precordial region and the left chest were common. A distinction between instantaneously lethal targets, rapidly lethal targets, and targets of secondary importance is provided, and the guidelines for the proper determination of a multiple-shot suicide are presented.
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The case described is that of a 50-year-old housewife, a State Registered Nurse, who was kicked to death. Death was caused by penetration of the left ventricle by two fractured ribs, a relatively rare form of fatal injury.