Electrical injury of the neck and cardiac air embolism: a novel mechanism of death

Abstract

We report a case of air embolism in an industrial worker complicating a deep electrical injury in the neck. He was found dead in an upright position while his chest and head were resting on top of a live transformer. At autopsy, there were multiple electrical burns involving the face, neck, chest, and arms. There was a deep electrical burn associated with hemorrhage in the neck involving the skin, underlying subcutaneous tissue, strap muscles, and the thyroid gland. The internal examination showed a prominently bulging right atrium, which was filled with air and not blood. At autopsy, when the pericardium was filled with water and the right atrium opened, a large number of bubbles emerged. We concluded that death was due to air embolism complicating electrical damage to the neck veins. This case illustrates that acute complications of electrical burns rather than electrocution-related cardiac arrhythmia can be the mechanism of death in rare electricity-related deaths. It also reveals the difficulties encountered by the pathologist in determining the exact mechanism of death when there are competing mechanisms.

Suicide by air embolism introduced by means of a bicycle pump

“…Gas embolisms are more frequently described in connection to medical procedures like the use of rapid infusion systems, invasive vascular procedures and neurosurgical procedures [17] as with, for example, cuts or stab wounds [18,19], gunshot wounds to the head [20,21] or open craniocerebral injuries [22][23][24]; however, gas embolism is not inevitable in these cases [25,26]. Furthermore, gas embolism can occur in connection with medical malpractice [4][5][6][7][8].…”

A Pilot Study on the Diagnosis of Fatal Electrocution by the Detection of Myocardial Microhemorrhages

“…Fourth is lethal blunt trauma resulting from the person being launched into the air after exposure to an electric current . In addition, there are the rarely reported acute complications of electrical burns, such as the development of gas embolism during electrocution , electrocution during anesthesia , electrocution with thrombosis of arterial blood vessels , and electrocution during hemodialysis . In all these cases, there are significant difficulties in interpreting the exact reason for death.…”

Child Deaths

“…But when it travels through the head and the neck, death would develop as a result of paralysis in the respiratory and circulatory center in the brain stem (Eke & Soysal 1999). There are cases reported with death due to air embolism resulting from electrical injury of neck veins (Kitulwatte & Pollanen 2009). External examination may not indicate any finding in death cases due to electric shock but may as well present with a carbonated body.…”