Forensic medical aspects of sudden cardiac death caused by commotio cordis due to the impact of a tear gas bomb during manifestations in Venezuela in 2017

Purpose: The objective of the study was to visualize the sudden cardiac death generated by the Commotio Cordis phenomenon, due to the impact of a tear-gas bomb direct to the precordial area of a protester's thorax, fired by law enforcement officers, in street protest manifestations for economic political and social claims in Venezuela in 2017. Likewise, it seeks to know the legal regulations and the forensic approach that derives from this, as well as the legal consequences that face the public order agents; we analyzed the legal medical responsibility of the forensic pathologist in the autopsy report necessary to exercise the criminal legal actions that are perceived under the charges of homicide with treachery or for futile or ignoble motives.Materials and methods: We report the case of a young adult who died due to the impact of a tear gas bomb in the thoracic precordial area, triggered by law enforcement officers during the social political manifestations that took place in the city of Caracas-Venezuela in the year 2017. He underwent forensic evaluations (autopsy) by the National Service of Medicine and Forensic Sciences (SENAMECF).Case description. A 20-year-old young adult impacted by a tear gas bomb that was fired directly by law enforcement officers on the thorax at the level of the precordial area, which caused sudden cardiac death also known as commotio cordis.Results: We analyzed the result transcribed in the death certificate issued by the forensic pathologist of the prosecution and the National Service of Medicine and Forensic Sciences (SENAMECF) attached to the Criminal Scientific and Criminal Investigation Body (CICPC), who performed a forensic autopsy; the following postmortem diagnosis was concluded: closed thoracic trauma in the left chest region that caused cardiogenic shock and cardiac contusion.Discussion: It is necessary to know the physiopathological mechanism that causes the sudden cardiac death product of the commotio cordis and the revision of the current regulations of security and control of the manifestations by the national and international public order agents; we analyzed the problems of legal medical forensic significance due to the diverse implications related mainly to criminal and / or civil law, in which the figures of homicide (fraudulent or negligent) and professional responsibility arise.Conclusions: Sudden cardiac death by commotio cordis due to the impact of a tear gas bomb on the precordial area is an uncommon but very devastating event, which is why it must be distinguished as a crime against humanity due to the violation of human rights of the victims, which is typified in the Rome Statute in international criminal law.Key words: Sudden cardiac death, commotio cordis, ventricular fibrillation, tear gas, impact, thorax, precordial, medical, forensic, manifestation.