Zeitschrift für Rechtsmedizin. Journal of legal medicine
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The purpose of this paper is to define the criteria for the differential diagnosis of trauma following resuscitation and road accidents. To this end, 311 cases of thoracic and epigastric trauma were selected from the 2893 medico-legal autopsies carried out between 1979 and 1982 at the Institute of Forensic Medicine of the University of Heidelberg. Cardiopulmonary resuscitation had to be considered as the cause of trauma in 140 of these, but 45 of this group were excluded from further evaluation as they had been the victims of blunt trauma and no clear-cut distinction was possible between trauma resulting from an accident and trauma resulting from resuscitation. ⋯ Rib fractures, predominantly on the left side, were established in half the cases resuscitated, sternal fractures also being found in one-third of these victims. Bleeding at various sites, including hemato-thorax, was rare, with an incidence of 15%, thus making it highly unlikely that serious traumas caused by resuscitation were a major factor in the cause of death. This paper encompasses an extensive discussion on serious injuries, such as aortic and gastric ruptures, in this connection.
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The importance is demonstrated of anastomoses between the pulmonary artery and the bronchial artery as well as of the arteriovenous anastomoses that arise from these in microembolism. In cases of air embolism, microembolism in the lungs is seldom. ⋯ The pressure in the bronchial artery must decrease. Under these conditions, blood is shunted from the pulmonary artery to the bronchial artery and little air bubbles can pass via the above-mentioned anastomoses into the pulmonary vein.