Fatal gas embolism in hospital: accident or suicide?
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Fatal gas embolism in hospital: accident or suicide? Lucia Tattoli 1
&
Hannah Gauselmann 2 & Lars Oesterhelweg 2
Accepted: 13 January 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Fatal gas embolism in hospital is usually an iatrogenic complication of invasive diagnostic and therapeutic procedures. Air or gas enters the venous circulation, leading to cardiovascular failure or migrating to the systemic arterial circulation. A 73-year-old man died suddenly in hospital. An allergic reaction was initially suspected because of the presence of soft tissue swelling, but it was noticed that his oxygen tube was attached to the indwelling catheter inserted in the patient’s right median cubital vein. Wholebody post-mortem multi-slice computed tomography (pm-MSCT) revealed abundant gas in the subcutaneous fatty tissue, in the heart chambers, in the mediastinum, pericardium, thoracic wall and peritoneum. The external examination revealed massive subcutaneous emphysema with marked palpable cutaneous tension and crepitation on palpation of the entire body’s surface. Autopsy found gas bubbles in the heart and throughout the vascular system. Death was attributed to cardiac gas embolism. Keywords Gas embolism . Iatrogenic cause . Air embolism . Postmortem computed tomography . Hospital
Case report A 73-year-old man was admitted to hospital with pneumonia; he suffered from lung cancer, chronic bronchitis, chronic kidney failure, cardiac arrhythmia, and diabetes. He had been taking several medications such as analgesics, anticoagulant, and antihypertensive. During hospitalization, he received oxygen therapy through a nasal cannula connected to an extension tube for chronic respiratory failure. An indwelling catheter was inserted in his right median cubital vein. At 2:15 A.M. on the day he died, an alert in the patient’s room rang and a duty nurse found the patient alive and approachable. After few seconds, she noticed his body was swelling; after that a
* Lucia Tattoli [email protected] Hannah Gauselmann [email protected] Lars Oesterhelweg [email protected] 1
S.C. Medicina Legale U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126 Torino, Italy
2
Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charité, University of Berlin, Turmstr. 21, Building N, 10559 Berlin, Germany
cardiopulmonary arrest occurred. An allergic reaction was initially suspected because of the presence of soft tissue swelling. Cardiopulmonary resuscitation was performed for 45 min, but the patient was pronounced dead. The nurse noticed that the patients oxygen tube was connected to the vascular indwelling catheter. A police investigation found that nobody was witnessed entering the patient’s room before the incident and no suspect was found to have had a role in the incorrect tube connection. Error by the medical personnel was also ruled out during the investigation. The manner of the death (accident or suicide) rem
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