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Traumatic Cardiac Arrest
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Bisman Jeet Kaur, Nidhi Bhatia
There are certain indications for withholding resuscitation in patients of TCA:Injuries that are incompatible with life, like decapitation or hemicorporectomyNo signs of life in the preceding 15 minutesSigns of prolonged cardiac arrest (dependent lividity, rigor mortis)
Life and death as biological and legal constructs
Published in Peter Hutton, Ravi Mahajan, Allan Kellehear, Death, Religion and Law, 2019
Peter Hutton, Ravi Mahajan, Allan Kellehear
Somatic criteria are those that can be applied by simple external inspection of the corpse without any need to undertake a detailed clinical examination. They include such things as decapitation, rigor mortis and decomposition. Examples are given below. massive cranial and cerebral destructionhemicorporectomymassive truncal injury incompatible with life including decapitationdecomposition/putrefaction (where tissue damage indicates that the patient has been dead for some hours)incineration (the presence of full-thickness burns with charring of > 95% of the body surface)hypostasis (the pooling of blood in congested vessels in the dependent part of the body in the position in which it lies after death)rigor mortis (the stiffness occurring after death from the post-mortem breakdown of enzymes in the muscle fibres).
Hemicorporectomy – the ultimate solution of terminal pelvic sepsis
Published in Acta Chirurgica Belgica, 2021
Patrik Richtr, Jiří Hoch, Karolína Svobodová, Jiří Kříž, Veronika Hyšperská, Jan Štulík, Babjuk Marek, Petr Přikryl
The patient reported in the case report had extensive pressure sores in the area of sacrum and both trochanters, and pelvic skeleton osteomyelitis, and he was in a chronic sepsis with acute exacerbations [18–23]. Possibilities of conservative treatment were used-up, the condition was unsustainable in the long term, and he was in the terminal phase of the disease [24–26]. The only curative option remained pelvic and lower limbs amputation – hemicorporectomy [27–29]. The health status, prognosis, treatment options, surgery and its consequences were repeatedly explained to the patient and his family, and a psychologist was involved [30,31]. As hemicorporectomy is a multidisciplinary operation, plastic surgeons, anaesthesiologists, a urologist, spondylosurgeons, rehabilitation specialists, a psychologist, and vascular surgeons were invited to the team [32,33]. We carefully planned the operation in the team and, based on experience in literature, we decided to carry it out in two times. The foundation of stomas in the first instance shortened the total time of surgery and allowed the patient to recover in the meantime [34,35]. Another major decision was to perform hemicorporectomy by a ‘back-to-front’ approach. It means to start the operation in the abdominal position and after a partial interruption of the spine from the patient’s back access, turn him to the back and complete the surgery from the front. The decision led us to use an ‘anterior-to-posterior’ approach to first ligate and disrupt the lower hollow vein, leading to a significant increase in pressure in the remaining venous bed and blood congestion of the venous epidural plexus (plexus venosus vertebralis), which may be a source of non-manageable blood loss of up to 12 L, as described in literature [36]. As compared with this, if we use the posterior approach, this plexus treats coagulation as the first, and later blood loss is not so remarkable. This was confirmed in our case, when total blood loss during the whole 16-h operation was 5.5 L. We interrupted the vertebral column and dural sac at vertebra level L4/5, at the site of bifurcation of the aorta and the lower hollow vein. As enclosure to caudal part of the remaining body, we used soft tissue from the rest of the lower limbs after removing thigh bones, called fillet flap method [37–39]. First, we covered the bowels by the muscle tissue, the second layer was the skin cover. Thus was created an interlayer and bottom of the body between the newly formed cavity for the bowels and the skin cover, which served to prevent direct threat to the bowels in the event of dehiscence of the skin cover.