The "exposed patient" Clamshell thoracotomy in prehospital trauma resuscitation

In order to recognize and correctly assess emergency measures a forensic pathologist should be familiar with new methods and advances in prehospital emergency medicine. When performing an external examination of a corpse it is necessary to have knowledge of the existing and latest guidelines for (invasive) emergency procedures in patients with traumatic cardiac arrest. This article presents a fatal case with complex self-inflicted injuries including blunt and penetrating trauma and a subsequent clamshell thoracotomy performed by an emergency physician. The case illustrates the potential for misdiagnosis and confusion that a rarely performed emergency procedure, such as the clamshell thoracotomy, might cause during a medicolegal inspection of the corpse if unknown to the police or other physicians. During a medicolegal autopsy a forensic pathologist has to assess such emergency measures with respect to the correct performance and the potential prospects of success. With the implementation of invasive emergency interventions in resuscitation guidelines, forensic pathologists will be confronted with extensive iatrogenic injuries more frequently in the future.