Postmortem diagnosis of shock conditions

Aim. Develop a method for postmortem diagnosis of shock conditions.

Methods. Brood serum obtained from 72 dead bodies of people who died from different causes such as anaphylaxis, toxic shock, cardiovascular diseases, traumatic injury and thermal burns was examined. The level of fibrinogen fraction was performed by sulfite-alkaline method. Plasma soluble fibrin monomer complexes were identified by paracoagulation tests (ethanol and protamine sulfate tests).

Results. The method of shock conditions postmortem diagnosis was determined, regardless of shock etiology. The lowest levels of fibrinogen fraction in cases of anaphylactic and toxic shock were 19.3 and 11.9 g/l, respectively, which is significantly higher compared to other groups. In cases of death due to acute burn, fibrinogen level was almost tenfold higher (p <0.01) compared to patients with burn disease, indicating the presence of a shock at the time of death. In acute burn injury (burn shock), the lowest level of fibrinogen fraction was 10.1 g/l, while in burn disease the maximal content of fibrinogen fraction was 9.6 g/l. Disseminated intravascular coagulation syndrome was diagnosed in 5 (62.5%) of 8 cases of road traffic injury and in 20 (57.1%) of 35 cases of sudden death, indicating the traumatic and cardiogenic shock before the death. Paracoagulation tests were positive result in 6 (8.3%) of 72 cases. Ethanol test was positive in traumatic injury and cardiovascular diseases, protamine sulfate test was positive in acute burns and anaphylactic shock.

Conclusion. The postmortem diagnosis of shock conditions regardless of etiologic factor leading to death might be performed by detecting the signs of disseminated intravascular coagulation. The level of fibrinogen is significantly elevated at anaphylaxis, toxic shock and other types of shock. Positive results of paracoagulation tests indicate the stage of the process.