The study of the corpses of persons who died in hospitals, is made according to general rules, but has certain features. In medical institutions, many diagnostic and therapeutic procedures are used, affecting the morphological manifestations of injuries and diseases.
Thus, in cases of death from mechanical injury as a result of surgical interventions, the original type of damage significantly changes (the edges of wounds are excised, damaged organs are removed, craniotomy is performed, etc.).
During resuscitation and intensive care, not only the tissues (ribs) can be injured, but also changes of a nontraumatic nature (morphological, changes in the rheology of the blood, etc.) can occur.
In these cases, the forensic expert needs not only to establish the original nature of the damage, but to distinguish the pathological changes resulting from the disease from the changes associated with treatment. A large role in solving these issues belongs to the medical documentation. In particularly difficult cases, it is necessary to resort to interrogations (through the investigator) of the attending physicians in order to clarify questions that are unclear and insufficiently reflected in medical documents regarding the initial type of injuries and the nature of the medical care provided.Go
In cases of detection of injuries as a result of resuscitation measures, the forensic expert has to decide not only the nature of these injuries, but also the time of their occurrence. Resuscitation is carried out not only in the premorbid period, but also at clinical death, and in some cases continues with the onset of biological death. Damage may occur during any of these periods.
In some cases, there is a need to give an expert assessment of the manifestations of trauma from which the victim entered the hospital, and, in addition, an assessment of the morphological manifestations of therapeutic measures and complications in diagnostic and therapeutic procedures, anesthesia, etc., as well as the effect of treatment on the course and outcome injuries. Since the solution of these issues presents significant difficulties, in a number of cases the expertise is carried out not by one but several experts, with the involvement of highly qualified doctors.
If defects in the diagnosis and treatment in the prehospital and hospital periods are detected during the examination, these cases are discussed at clinical and anatomical conferences.
Sudden death. A significant place in expert practice is occupied by forensic investigations of the corpses of persons who died suddenly, which accounts for 25-30% of all sectional cases.
Suddenly, a sudden, unexpected death for others is called a sudden death, which occurred against the background of apparent health from hidden diseases and acutely developed diseases.Go
Note. In the medical literature, especially foreign, the term "sudden death" is synonymous with "sudden death". In forensic medicine is used the term: "sudden death".
Sudden death is always non-violent death, because it comes from diseases (a healthy person does not die suddenly).
As can be seen from the definition itself, sudden death is characterized by the speed of its occurrence (from a few seconds to 1 day) and surprise to others (since the deceased seemed healthy before). It is these circumstances that make a sudden death suspicious, similar to a violent one, as a result of which the corpses of those who died suddenly become the object of forensic medical research.
As practice shows, the conditions and circumstances under which sudden death occurs can be very different. Sudden death can occur at work, on the street, in a vehicle, in a bath, during sleep, etc. If death occurs within a few hours, then symptoms may appear in the atonal period, resembling symptoms of poisoning.
The authorities of inquiry, directing the corpse of the suddenly deceased for a forensic medical examination, put the question of the cause of death before the expert, because in such cases the possibility of violent death cannot be ruled out without such examination of the corpse. Local doctors, if the deceased has not sought medical assistance for a long time, cannot issue a death certificate in these cases, since they do not know its cause. Consequently, the main task of the forensic expert in the study of the corpses of the sudden death is to establish the cause of death, the presence and nature of the diseases that led to death, exclude injury or poisoning. In expert practice it is rare, but there are cases when interested persons try to make it appear that a person died allegedly from a disease, and during the investigation it is established that the cause of death was an injury.