Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography
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Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography Carolin Edler 1 & Anke Klein 1 & Klaus Püschel 1 & Ann Sophie Schröder 1 Accepted: 26 January 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Vascular air embolism is caused by penetration of air into veins or arteries through a surgical wound or other connection between the external and internal aspects of the body. Vascular air embolism has various causes, and iatrogenic air embolisms are the most frequently described. We report a case of fatal air embolism in an 83-year-old woman who was admitted to hospital. At the time of the incident, she was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed. Autopsy and postmortem computed tomography (PMCT) findings are presented. The case illustrates the high diagnostic value of PMCT, which is an effective procedure for detecting the presence of air or gas. Keywords Air embolism . Postmortem computed tomography . Sudden death . Gas embolism . Postmortem gas detection
Case report A case of fatal air embolism in an 83-year-old woman who was admitted to hospital for treatment of pneumonia is reported. At the time of the incident, the woman was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed (Fig. 1). According to the hospital’s technical department, the flow rate of this compressed air connection was about 16 L/min. The patient was reportedly left unobserved for about 10 min. When she was found by a nurse, the patient was kneeling in front of the bed, lifeless, with her upper body and head on the mattress. The patient was pronounced dead immediately, and no resuscitation was initiated. A plug-in connection was present between the upper end of the intrave-
* Carolin Edler [email protected] 1
Institute of Legal Medicine, University of Hamburg-Eppendorf, Butenfeld 34, D-22529 Hamburg, Germany
nous antibiotic infusion system, near the drip chamber, and the inhalation tube system from which the mask had been removed (Fig. 2). An inspection showed that this plug-in connection was tightly sealed. The patient, who had remained independently mobile, was not a medical or care professional. She was due to be discharged from the hospital the following day, which she had been pleased about. She had not reported any suicidal thoughts or made any previous attempts at suicide. Because the inhalation and infusion systems had been connected by different people, and the infusion system had been prepared for use in another room, an error by the medical personnel was ruled out during an investigation into the patient’s death. A molecular genetic investigation
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