HEALTHCARE SIMULATION MIDDLE EAST reposted this
Hypostasis recognition for EMS - Trigger warning One of our recent projects has been the development of bodies with Post Mortem staining - which is a core skill now for all involved in EMS Once a person dies, their circulation comes to a halt, and the blood starts moving towards the lowest regions of the body due to gravity. This effect results in reddish-blue staining of those low-lying dependent regions of the body, known as the livor mortis, post mortem staining, post mortem lividity, or post mortem hypostasis. (Frustratingly it has many names!) During the initial phases, patches of discoloration start appearing in the dependent regions in 1 to 3 hours after death. These increase in size and spread all over the dependent regions in 4 to 6 hours and are fully developed within 6 to 8 hours. So, in case of the body of an individual lying on the floor of a room, the back of the individual will show postmortem staining. Any change in the position of the body causes blood to settle down in the newer dependent areas, referred to as ‘shifting of postmortem lividity.’ However, this shifting may not be possible after 6 to 8 hours of death, due to postmortem coagulation of blood accumulated in the dependent areas of the body. This phenomenon is termed as ‘fixation of postmortem staining.’ Whether or not lividity is fixed is determined by the blanching test. The pressure is applied to the livid area by the thumb of the observer for about a minute, then released. If the area underneath the thumb becomes pale on the removal of pressure, the lividity is said to be not fixed, while if the region stays stained even after removal of pressure, the lividity is said to be fixed. Importantly - The lividity does not appear on the parts of the body which are in contact with the floor/ bed/ slab, etc., or those compressed due to tight clothing, bands, etc., because of the obstruction and compression effect of surface in the underlying vessels. The absence of discoloration in these areas is called ‘contact flattening,’ ‘contact pallor,’ or ‘contact blanching.’ The appearance of postmortem staining depends on multiple factors, including, amount of blood at the time of death and the coagulability status, etc. Lividity is feeble/ less marked in deaths following blood loss/ those with anaemias, while it is more intense in cases of asphyxia deaths. Post mortem staining can be of a distinct colour in cases of poisoning. Cherry red staining presents in carbon monoxide poisoning, pink-colored staining is observable in cyanide poisoning, and brown coloured staining occurs in nitrate poisoning. We have started making manikins with post mortem staining at Lifecast Body Simulation Ltd Thanks to Steve Shackleton for his brilliant work on this. ( Baby victor was showcased at #IMSH2025 - Society for Simulation in Healthcare (SSH) ) ASPiH Simulation Samantha Mc Cormack MSc CSci FHEA MIScT ASPiH Accredited HealthySimulation.com HEALTHCARE SIMULATION MIDDLE EAST