Use of modern forensic methods for post-mortem diagnosis of blood loss

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

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Safety of anesthesia in acute blood loss moderate hypovolemia

Reviews on Clinical Pharmacology and Drug Therapy ◽

10.17816/rcf19179-86 ◽

2021 ◽

Vol 19 (1) ◽

pp. 79-86

Author(s):

Aleksei G. Klimov ◽

Yaroslav A. Stepanov ◽

Leonid P. Erdniyev ◽

Igor V. Mokshanov ◽

Alexandr Yu. Mikshta ◽

...

Keyword(s):

Blood Loss ◽

Cause Of Death ◽

Opioid Receptors ◽

Brain Injuries ◽

Armed Conflicts ◽

Acute Blood Loss ◽

North Caucasus ◽

Circulating Blood Volume ◽

The North ◽

White Rats

Acute blood loss is the most common cause of death in armed conflicts. During the great Patriotic war, 37.2% of the wounded died on the battlefield from acute blood loss and its consequences. According to statistics of military surgeons in local wars, the percentage of deaths from bleeding on the battlefield has remained quite high in recent decades: in Afghanistan, 43% due to untimely first aid for gunshot and mine-explosive wounds, of which 27% died from acute blood loss. During counter-terrorism operations in the North Caucasus, acute blood loss was the cause of death in 26.6% of cases. Analysis of recent armed conflicts shows that the main causes of death on the battlefield are the consequences of penetrating wounds, in particular blood loss with combined traumatic brain injuries of various origins. The issue of analgesia for a lack of circulating blood volume, as well as for continuing bleeding, is complex due to the need to prevent the development of shock conditions against the background of possible side effects of anesthesia. The paper presents pharmacometric and toxicometric characteristics of a model agonist of opioid receptors in acute blood loss of moderate hypovolemia in an experiment. It was shown that the sensitivity of white rats and rabbits to intravenous anesthesia according to the criteria of deep anesthesia increased by 7.3 and 7.5 times, respectively; there were no changes in the mortality criterion for acute blood loss of moderate hypovolemia. A decrease in the speed of action and an increase in the duration of the effect of deep anesthesia in hypovolemia after intravenous administration of a model opioid receptor agonist at doses of 1 ED50 was revealed. An assessment of the breadth of therapeutic action of the model agonist of opioid receptors was made, according to the results of which an increase in this indicator was revealed. It is shown that it is necessary to clarify the anaesthetic manual for more severe variations of polytrauma with blood loss.

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Prevention of massive intraoperative bleedings associated with heparin with the systemic use of fibrin monomer in the experiment

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2019.04.48-55 ◽

2019 ◽

pp. 48-55

Author(s):

А.П. Момот ◽

В.М. Вдовин ◽

Д.А. Орехов ◽

Н.А. Лычёва ◽

И.Г. Толстокоров ◽

...

Keyword(s):

Liver Injury ◽

Blood Loss ◽

Unfractionated Heparin ◽

Loss Rate ◽

Antithrombin Iii ◽

Fibrinogen Level ◽

Circulating Blood Volume ◽

Intraoperative Bleeding ◽

Fibrin Monomer ◽

Antithrombin Iii Activity

Цель исследования - изучение способности фибрин-мономера предупреждать тяжелую интраоперационную кровопотерю, ассоциированную с введением нефракционированного гепарина, при дозированной травме печени. Методика. На кроликах «Шиншилла» индуцировали гипокоагуляцию нефракционированным гепарином (150 ед/кг). Профилактику интраоперационных кровотечений осуществляли внутривенным введением фибрин-мономера (0,25 мг/кг) за 1 ч до травмы или протамина сульфата (1,5 мг/кг) за 10 мин до травмы. После нанесения стандартной травмы печени оценивали объем (в % ОЦК) и темп (мг/с) кровопотери. Анализировали число тромбоцитов, активированное парциальное тромбопластиновое время, протромбиновое и тромбиновое время свертывания, уровень фибриногена и активность антитромбина III, параметры ротационной тромбоэластометрии крови. Результаты. Объем кровопотери в группах животных после в/в введения фибрин-мономера и протамина сульфата на фоне гепаринизации был, соответственно, в 5,1 и 4,0 раза меньше по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем, фибрин-мономер не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение протамина сульфата в качестве антидота гепарина сопровождалось нормализацией данных тромбоэластометрии и коррекцией гипокоагуляционного сдвига по активированному парциальному тромбопластиновому времени, протромбиновому и тромбиновому времени. Заключение. Установлено, что фибрин-мономер (0,25 мг/кг) снижает посттравматическое кровотечение в условиях блокады свертывания крови гепарином без видимых признаков восстановления гемостатического равновесия. The research objective was to study the ability of fibrin monomer to prevent severe intraoperative blood loss associated with administration of unfractionated heparin in controlled liver injury. Methods. Hypocoagulation was induced in chinchilla rabbits with unfractionated heparin (150 U/kg). Intraoperative bleeding was prevented by administration of fibrin monomer (FM, 0.25 mg/kg, i.v.) one hour prior to the injury and of protamine sulfate (PS, 1.5 mg/kg, i.v.) 10 min prior to the injury. Following the liver injury, blood loss was assessed as percentage of circulating blood volume and the blood loss rate (mg/s). Platelet counts, aPTT, PT, TT, fibrinogen level, antithrombin III activity, and parameters of blood rotation thromboelastometry were analyzed. Results. The volume of blood loss was 5.1 times and 4.0 times less, respectively, after the FM and PS administration during heparinization compared to the placebo group treated with the same anticoagulant. However, FM affected neither coagulogram indexes (no visible hemostasiological effect) nor thromboelastogram while the use of PS as an antidote for heparin was associated with normalization of thromboelastometric data and correction of hypercoagulative changes in aPTT, PT, TT. Conclusion. FM at a dose of 0.25 mg/kg reduced severity of posttraumatic bleeding induced by heparin inhibition of coagulation with no visible signs of hemostatic balance recovery.

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CORRECTION OF METABOLIC INDICATORS OF ERYTHROCYTES AND THE STRUCTURE MYOCARDIUM AFTER ACUTE BLOOD LOSS USING AN OZONIZED ERYTHROCYTAL MASS

Tsitologiya ◽

10.31116/tsitol.2018.02.03 ◽

2018 ◽

Vol 60 (2) ◽

pp. 89-95 ◽

Cited By ~ 1

Author(s):

A. V. Deryugina ◽

◽

G. A. Boyarinov ◽

I. S. Simutis ◽

V. O. Nikolskiy ◽

...

Keyword(s):

Blood Loss ◽

Acute Blood Loss

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Some aspects of the development of blood donation in domestic health care

Vrač skoroj pomoŝi (Emergency Doctor) ◽

10.33920/med-02-2001-08 ◽

2020 ◽

pp. 61-68

Author(s):

M. Sharavina

Keyword(s):

Health Care ◽

Blood Loss ◽

Blood Donation ◽

Regulatory Framework ◽

Blood Transfusions ◽

Acute Blood Loss ◽

Donated Blood

The first successful blood transfusions were aimed at saving lives of patients with acute blood loss, application of donated blood is much wider today. Expansion of informational work with donors, including development of understanding in a donor concerning importance of the donor program in patient’s life, as well as creation of the Blood Service, which is responsible for promotion, collection of blood and its components, their storage and transportation, contributes to the development of regular and ongoing donation. The author reviewed the regulatory framework for blood donation.

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Violencia en la formación médica

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.2.07 ◽

2020 ◽

Vol 63 (2) ◽

pp. 46-55

Author(s):

Héctor García Hernández ◽

Guadalupe Alvear Galindo

Keyword(s):

Medical Practice ◽

Medical Training ◽

Structural Violence ◽

Medical Model ◽

Medical Personnel ◽

Medical Culture ◽

Cultural Violence ◽

Direct Violence ◽

Health Institutions ◽

And Function

The purpose of this work is to provide elements to understand, in a broad way, the violence within medical training, since most of the work on the subject focuses on its consequences: for example, the physical and psychological conditions of violent acts in the medical training. The article begins with the concept of violence proposed by Galtung, that points out direct violence, structural violence and cultural violence. Then, it describes the hegemonic medical model as a sculptor of medical culture and its effect on medical practice and medical education. Afterwards, it describes the medical habitus and the hidden curriculum, two elements of the medical culture. The first one refers to how the medical personnel justifies the use of violence, the second one refers to what is taught about the structure, organization and function of the health institutions. Then, the article reviews the characteristics of the health institutions as spaces where an organized medical practice is crystallized in a rigid, hierarchical and vertical manner. We then focus on the worker/student conflict. These conditions are necessary for the appearance of direct violence in the medical training. Key words: Cultural violence; structural violence; direct violence; medical training; hegemonic medical model.

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