The role of blood loss in the structure of thanatogenesis factors in explosive injury during peacetime

Abstract

Currently, explosive trauma is rare in peacetime injury surgery, but is of great importance in the work of surgeons. This is due to damage of a large number of anatomical areas, various damaging factors of the explosion and the simultaneous entering of several victims. The results of forensic medical examinations of 24 corpses of people who died as a result of terrorist acts in the subway of Minsk on 11/04/2011 and St. Petersburg on 03/04/2017 were analyzed. Incompatible with life injuries as the immediate cause of death were found only in 33,3% of cases. Profuse blood loss was the immediate cause of death in 66,7% of those killed. The most common (in 87,5% cases) cause of profuse blood loss was internal bleeding: in 7 (50%) cases - due to damage to organs and large vessels of the chest, in 6 (42,9%) cases - due to combined damage to the anatomical structures of the chest and abdomen, in 1 (7,1%) case - due to damage to the parenchymal organs of the abdominal cavity and retroperitoneal space. The leading role in thanatogenesis during the considered explosive peacetime injuries was occupied by blood loss, its specific gravity was 66,7%. Profuse blood loss in 87,5% of cases was due to damage to the organs of the chest and abdomen. Potentially salvable were 7 (29,2%) dead who received damage to the main vessels of the limbs, damage to internal organs without injuring the heart and large blood vessels. Thus, the development of new ways to stop intracavitary bleeding at the advanced stages of medical care for victims with explosive injuries and injuries is a priority aim.

Keywords

explosive trauma / injured / forensic examination / thanatogenesis / life-incompatible injuries / bleeding / blood loss / complications / potentially salvable

References

[1] Быков, И.Ю. Военно-полевая хирургия: национальное руководство / Под ред. И.Ю. Быкова, Н.А. Ефименко, Е.К. Гуманенко. – М.: ГЭОТАР-Медиа, 2009. – 816 с.

[2] Гуманенко, Е.К. Военно-полевая хирургия локальных войн и вооруженных конфликтов: руководство для врачей / Под ред. Е.К. Гуманенко, И.М. Самохвалова. – M.: ГЭОТАРМедиа, 2011. – 672 с.

[3] Йовенко, И.А. Интенсивная терапия кровопотери, коагулопатии и гиповолемического шока при политравме / И.А. Йовенко [и др.] // Медицина неотложных состояний. – 2016. – № 4. – С. 64–75.

[4] Клевно, В.А. Судебно-медицинская экспертиза: теоретические, процессуальные, организационные и методические основы / В.А. Клевно. – М.: ГЭОТАР-Медиа, 2012. – 368 с.

[5] Крюков, В.Н. Руководство по судебной медицине / Под ред. В.Н. Крюкова, И.В. Буромского. – М.: ИНФРА-М, 2014. – 656 с.

[6] Лапшин, В. Н. Экстренная помощь при шокогенной травме и острой кровопотере на догоспитальном этапе / В.Н. Лапшин, Ю.М. Михайлов. – СПб.: Русский Ювелир, 2017. – 96 с.

[7] Нечаев, Э.А. Взрывные поражения: руководство для врачей и студентов / Под ред. Э.А. Нечаева. – СПб.: Фолиант, 2002. – 656 с.

[8] Пиголкин, Ю.И. Судебная медицина: лекции [учеб. пособие] / Ю.И. Пиголкин [и др.] – М.: Практ. медицина, 2014. – 133 с.

[9] Попов, В.Л. Судебная медицина: учебник / В.Л. Попов [и др.]. – СПб.: Юридический центр, 2016. – 512 с.

[10] Самохвалов, И.М. «Потенциально спасаемые» раненые – резерв снижения догоспитальной летальности при ранениях и травмах / И.М. Самохвалов [и др.] // Скорая медицинская помощь. – 2019. – № 3. – С. 10–16.

[11] Eastridge, B.J. Death on the battlefield (2001–2011): implications for the future of combat casualty care / B.J. Eastridge [et al.] // Journal of Trauma and Acute Care Surgery. – 2012. – Vol. 73, № 6. – P. 431–437.

RIGHTS & PERMISSIONS

Trukhan A.P., Samokhvalov I.M., Tolmachev I.A., Isakov B.D., Golovko K.P., Skakunova T.Y., Ryadnov A.A.