If air from the syringe gets into the muscle. Intramuscular injection into the buttock: learning to do it yourself

What happens if air gets into a vein? This question often arises among those who have received an incorrect injection. And this is not without reason, because in many films and detective novels this method is often used by ruthless killers towards their victims. And watching how the negative character takes a large syringe, lifts the piston, pumps air into the vein and the hostage dies, the viewer’s memory involuntarily retains the information that such an injection is fatal.

What happens if air gets into a vein?

In medical practice, the process of air entering an artery, as well as the subsequent blocking of blood flow to the brain or heart, is called an air embolism. It is precisely this pathological condition that those who were accidentally injected with air into a vein are afraid of. It should be noted that this can indeed be a fatal situation, since a bubble that has entered a vein begins to gradually move along the artery, and then enters the system of the smallest vessels, which subsequently narrow to capillaries. In such a place, the air quickly stops the flow of blood entering any vital area of the body.

Danger of entering a vein

In some cases, the penetration of bubbles into the vessels is dangerous, as it leads to various serious complications.

If they penetrate in large quantities, and even into a large vessel (artery), then in this situation death can occur. Death usually results from cardiac embolism . The latter is due to the fact that a plug forms in a vein or artery, which clogs it. This pathology also provokes a heart attack.

If the bubble enters the cerebral vessels, a stroke or cerebral edema may occur. Pulmonary thromboembolism may also develop.

With timely help, the prognosis is usually favorable. In this case, the air lock quickly resolves, and negative consequences can be prevented.

Sometimes residual processes may develop. For example, when cerebral vessels are blocked, paresis develops.

Heart attack or stroke?

So what happens if air gets into a vein? According to doctors, the injured person can actually die from blocking the artery with air. In this case, we are talking about a cardiac embolism, which causes a rather life-threatening coronary air plug or so-called heart attack. Similarly, an embolism in the brain causes a stroke. However, it is worth noting that accidental entry of air into a vein does not cause death in 99% of cases. Why? You can find a comprehensive answer to this question below.

Preventive measures

In the medical literature, veins are classified as blood vessels that provide transport connections for blood flow from all vital organs to the myocardium. Their importance for the body cannot be overestimated. In order to prevent the dropper from damaging them and causing harm to the body by allowing air to enter the vessels, you must adhere to simple rules when performing any kind of injection into a vein:

Use only serviceable syringes and systems. High-quality devices will not allow air to enter the vessels without permission.
Identify and observe expiration dates on medical supplies. It is unacceptable to use an expired dropper or syringe.
Carefully remove air from the syringe. The drip needs to be checked no less scrupulously. Before the needle enters the vein, release some of the medicine. The liquid will displace the bubbles

The installation of IVs should only be entrusted to qualified professionals, ideally if the procedure is performed in a hospital setting. If this is not possible, follow the recommendations above and remove air from the medical devices before the catheter or needle is in the vein. This way you will protect blood vessels from damage, but also prevent negative consequences.

Rules for administering an injection

What happens if air gets into a vein? This question arises in people not only because of films and detective novels, but also due to the fact that before an injection, nurses try to carefully squeeze out all the bubbles that are there from the syringe or dropper. Such caution among clinic workers involuntarily prompts the patient to think that if air is introduced into a vein, something very terrible will certainly happen. However, it is not. It’s just that similar procedures are required for any type of injection. Firstly, if all the bubbles are not removed, it will be quite problematic to administer the drug quickly and painlessly. Secondly, if air does get in, then in the first minutes the patient will actually feel “local” discomfort, calling the injection “sick”. But as practice shows, such unpleasant symptoms disappear after some time.

It is for these reasons that nurses try to give intravenous, subcutaneous or intramuscular injections according to all the rules. After all, few people will like a “sick” injection, after which it cramps an arm, leg or other parts of the body.

Injections and droppers

During the injection process, there is a possibility of air bubbles entering the vein.

To avoid this, nurses shake out the contents of the syringe and release a little medicine before giving the injection. Thus, the accumulated air comes out along with the drug. This is done not only to avoid dangerous consequences, but also to reduce the pain of the injection itself. After all, when an air bubble penetrates a vein, it causes very unpleasant sensations in the patient, as well as the formation of a hematoma in the puncture area. When placing IVs, the likelihood that air will get into the vein is almost zero, since all bubbles are also released from the system.

A cube of air into a vein: fatal or not?

If you notice that during the injection small air bubbles entered your bloodstream, then you should not immediately panic - there will definitely not be a fatal outcome in such a situation. Moreover, it makes sense to worry about this only if the intravenous injection was done incorrectly, since the air that gets into the muscle tissue or under the skin almost immediately dissolves in the cells, leaving no consequences, except perhaps short-term discomfort at the injection site.

As for intravenous injection, it all depends on the size of the bubble itself. If you let air into a vein just a little, it will immediately dissolve in the cells of the body, as is the case with an intramuscular or subcutaneous injection. That is why the accidental entry of small bubbles into the body will not affect the patient’s health in any way.

Consequences of injecting the buttock incorrectly

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In muscle

Getting oxygen bubbles during an injection into the gluteal muscle is one of the common mistakes of beginners who try to give intramuscular injections without the help of others. You should know that this situation is not capable of causing harm to health and does not pose a danger to the patient’s life.

There are 2 options for air getting from a syringe when injected into the buttock, the consequences of which may vary. If air gets into the muscle, then the person will not feel any troubles or bad feelings.

Small gas bubbles will resolve themselves under the influence of the body's defenses.

When air enters the vessel, it becomes clogged. A blocked capillary in the muscle tissue will contribute to the formation of a bruise or bump. Then the small subcutaneous hematoma will resolve without the help of others.

into a vein

A lethal outcome in such a situation is unlikely.

If an injection was carried out with oxygen bubbles, then in the vessel ( Vessels are a tubular organ in animals and plants through which a liquid medium moves

) an air embolism develops.

The bad consequences depend on the amount of oxygen entering the vessel. Death can only occur if a huge amount of gas enters a large artery, where the blood flow may be blocked.

An embolism occurs when a moving obstruction appears in a blood vessel.

Its main symptoms, which most often appear during the development of decompression disease, are the occurrence of dizziness, numbness and tingling in those organs where the air bubble moves ( a mixture of gases mainly nitrogen and oxygen - 98-99% in total and depends on humidity (concentration water vapor), as well as argon, carbon dioxide, hydrogen, forming the earth’s atmosphere

). If a huge amount of gas enters the artery, paralysis may develop.

Symptoms of damage

The thickest, longest nerve runs from the lumbosacral area and is located along the entire length of the lower limb. Its diameter is about 1 cm, so damage to the sciatic nerve during an injection causes severe inflammation (sciatica).

The first sign of aggravation is the occurrence of pain of a sharp nature. The pain syndrome persists after the injection and spreads throughout the lower limb. Symptoms of sciatic nerve injury from an injection ( Injection is a method of introducing medications into the body using a syringe and a hollow needle

) can develop immediately or within 3 days:

tingling, numbness in the leg;
lameness;
sensitivity disorder;
pain when moving or trying to sit down;
spread of pain to the lumbar region;
lack of mobility of the heel tendon.

One of the symptoms is the inability to change the position of the foot or straighten the toes. The mobility of the pelvic and femoral bones decreases, abduction of the leg becomes difficult.

Is it possible to swim after an injection in the buttock?

The question of whether it is possible to wash your face after an injection so as not to increase the possibility of infection worries almost all patients. It all depends on the type of intramuscular product being injected.

These kinds of restrictions should be checked with the treating doctor; he will tell you whether you should swim after taking the medicine, limit yourself to taking a shower, or completely abstain from import procedures.

Preliminary activities

Before this, how to give an intramuscular injection to an adult ( a social being with intelligence and consciousness, as well as a subject of socio-historical activity and culture

) you need to take:

Soap, preferably bactericidal;
Unstained cotton towel or sterile cardboard wipes;
Cotton honey;
Antiseptic - alcohol or Chlorhexidine, hydrogen peroxide will not work;
Disposable medical gloves;
Additional needle (if it is necessary to dilute the lyophilisate in the bottle);
A plate scalded with boiling water for placing tools;
A sterile syringe, the capacity of which corresponds to the size of the ampoule of the medication;
Trash bag.

Selecting a location

The patient who needs to be given an injection must be placed on his tummy, so you need to choose a flat place, not very soft. A hard couch, an unfolded sofa, or, as a last option, a table covered with a clean cloth will do. You cannot lie on the floor, as there is a lot of bacteria and dust there.

A person giving an injection ( a method of introducing certain solutions (for example, drugs) into the body using a syringe and a hollow needle or injection under high pressure (no-needle injection)

), must have free access to the table where there is a plate with a syringe, needles, medication, etc. During the procedure, his hands must not come into contact with interior items. Only with the body of an unhealthy person and sterile instruments.

If you need to give an injection for yourself, then you should not lie down, but stand. In this case, it is better to sit in front of a mirror to see the back of the body and correct your actions.

Hand washing

Before each injection of an intramuscular solution, the person giving the injection must thoroughly wash their hands.

This is an essential hygienic procedure that prevents tiny pathogenic organisms from entering the patient’s skin or wound.

Also, washing your hands before touching another person's buttocks allows you to protect yourself from infection by bacteria, fungi and microbes, especially if he is suffering from an infectious disease.

Dilution of the lyophilisate

The medication can be supplied to pharmacies either in the form of a ready-made solution or in powder form.

In extreme cases ( one of several editions of a work (literary, musical, etc.) or an official document; modification of any part of the work (different readings of individual

), it must be diluted with sodium chloride 0.9%. This is done according to the following scheme:

Sodium chloride is drawn up with a syringe;
The protective cap of the jar is pierced with a needle and the solvent is poured in;
Without removing the needle, carefully shake the bottle until the lyophilisate is completely dissolved.

Afterwards, the medication is drawn into the syringe and the needle is replaced with a new one. You can’t use an old needle, because when you pierce the rubber cap, its end will become dull and it will be difficult to pierce the skin.

Determining the injection site

To avoid piercing a blood vessel or nerve of the sacral plexus, you need to choose the right place to insert the needle. To do this, the half of the butt is divided into 4 parts at the level of thoughts. The outer area at the top is the zone where it is permissible to inject.

The pharmaceutical solution can be injected into both the left and right buttock. If a patient undergoes long-term treatment with medication and needs frequent injections, then it is necessary to inject each time into a different gluteal muscle. For example, now the injection is given in the right half, tomorrow in the left, and the day after tomorrow again in the right.

Source: https://grudnoj.asustav.ru/lechenie/esli-nepravilno-sdelat-ukol-v-yagodiczu-posledstviya/

What dose of air during injection is life-threatening?

As mentioned above, during a regular injection, only a minimum of air bubbles can accidentally enter the body, which will not in any way affect the person’s well-being. As for the possible lethal outcome, you have to try very hard for this. After all, according to experts, an air embolism will only occur if at least 200 ml of bubbles are injected into a vein. Only in this case they will not be able to resolve properly, which may well cause a stroke or heart attack.

What to do in this case

The situation of an injection with air and its entry into the muscle during the injection cannot cause health problems. Most often, the bubbles resolve on their own.

If bruises or lumps appear under the skin, then experts recommend using absorbable ointments (Troxevasin, Indovasin, Heparin, etc.) or folk remedies (poultices with honey and cabbage).

Where is it especially dangerous to inject air?

Just above, we told you that the entry of air into the body during an intramuscular or subcutaneous injection does not threaten human life. Moreover, if a syringe with air was inserted into a vein, then this is also not fatal. And this has nothing to do with the number of bubbles. After all, death will not occur due to accidental entry of air into any of the small veins. In this regard, it is advisable for best-selling authors to write about the ruthless killing of victims using large syringes and injections into the main artery. After all, this is the only way the patient may soon have a stroke or heart attack.

Signs of air entering the circulatory system

If a mistake has been made, it cannot always be seen visually. If after the injection the following signs appear, it can be assumed with a high degree of probability that he got there:

Painful sensations in the chest area. Occurs when the myocardium experiences a lack of blood supply due to an obstruction in the circulatory system in the form of air
Bumps, bruises at the puncture site from the IV. The signs are indirect, but they quite often accompany airing
Weakness, faintness, clouding of consciousness. It happens when a vesicle blocks a vein that supplies the brain
A swollen vein, numbness in the extremities (usually the arms). This condition occurs if the bubble does not move towards the heart muscle, but is stuck at the entrance to a narrower bloodstream (the size of which is congenital or acquired)
Wheezing in the chest, shortness of breath, drop in blood pressure, increase in heart rate, arrhythmia. Symptoms may indicate that air, having passed through the circulatory system, has entered the myocardium

What traces remain?

Returning to detective novels, it should be noted that quite often the presented method of murder is chosen based on the fact that in the future forensic experts will not be able to identify the true cause of a person’s death. But this is the same myth as death from one small “air” injection. The fact is that any specialist is able to almost immediately identify a recent injection, especially if it was done only with air. After all, after a person’s death, the injection site becomes very dark, and a light halo appears around it. As for the usual incorrect injection, in this case patients may subsequently experience minor bruises, as well as bumps or pustules. As a rule, hematomas at the injection site resolve quite quickly on their own. But if for some reason this does not happen, and the person begins to feel pain, his temperature rises, etc., then he should immediately consult a doctor, since it is likely that a serious infection has entered the wound.

How to give injections

Stretch the skin at the injection site with two fingers to the sides and move the skin slightly to the side. After administering the drug, remove the needle and return the skin to its place. The result is the letter Z in the cut. The injection site will be covered with a cloth and the oil will not leak out of the puncture. There is no need to rub the injection site with a cotton swab and alcohol. Just press lightly. I injected myself many times. But one day the injection site became numb and the right buttock and thigh did not feel anything for about six months. For intramuscular injections into the gluteal muscle, 3 or 5 cc syringes are usually used.

Very skinny butt” in my understanding and in yours may be very different. I personally imagine some kind of anorexic... It’s definitely not worth giving the injection at an angle. In general, it is believed that 3-cc syringes should be used for injections in the buttock. But many people find it more convenient to give 5 cc injections. What and how you entered is another matter. Firstly, most likely the drug itself is difficult to inject, it is “painful”, and the drug may have been administered too quickly. Hello! For the 6th day, the health worker has been giving me injections of Medokalm and alternating Ketanol and Mesipol.

What is the reason for this and is it worth continuing treatment? And of course, follow all recommendations regarding the dosage of the drug. Hello! I gave an injection of diclofenac in the thigh. Huge bruise, numb skin in the area of the front of the thigh, closer to the knee. They said it was very painful, but I don’t have severe pain, and everything is fine at the injection site.

I advise everyone not to engage in nonsense and still contact specialists because... IM and IV injections must be administered correctly. 20-30 cubic meters of air. Your pathetic one-two-three, etc. Fortunately, this only happens with injections into a vein and only with very large volumes of air. Of course, it is advisable that a nurse gives the child the first injections and shows you all the details live.

There is an opinion that there is a simple way to kill. All you need is a syringe for this. What happens if air gets into a vein? The myth of death arose after detective novels gained popularity, because almost everyone has read at least one of them in their life.

However, this version of the murder has significant flaws, and it looks more like the author’s fiction. From the outside, everything looks plausible, and there is almost no trace of the injection left, and it is difficult to find the cause of death from the victim’s blood.

But not only in the literature can one find mention of this method. Currently, many teenagers are susceptible to various addictions, including drug addiction. Therefore, it is worth paying attention to the young man if he asks questions that relate to this topic.

What can happen, what will happen when air gets into a vein? Experts give the exact answer to this question. Theoretically, everything is correct, and the term “air embolism” is well known to doctors. This is the penetration of a fairly large amount of air into a human artery. What is important here is its quantity, and where it goes if it is introduced.

What will happen in a situation where air enters the artery? A blockage will occur, that is, the blood flow will not be able to move freely through the arteries and vessels. Wide arteries pass the bubble with difficulty, but then it enters smaller blood vessels, and it is there that the chance of stopping the blood flow increases significantly.

But the human body is accustomed to fighting, and it does not give up so easily. A person will die from such a procedure only if he is seriously ill, or has heart problems, or suffers from hypertension. In general, the percentage of deaths does not exceed 2%, so in real life this form of murder cannot be called effective.

The dose should be decent and sometimes repeated. Small portions will be safely absorbed throughout the body. It is also worth noting that small vessels will not react at all; you need to hit a large artery, and this is not easy. After such an intervention, there will definitely be a mark left (everyone could notice the bruises that remain after taking a blood test), and after death, there will be a dark spot surrounded by a light border. So this act will not go unnoticed.

How is air removed correctly?

The rules for administering an injection are the same for everyone. That is why absolutely every medical worker is obliged to remove air from the medical device before injection. Let’s look at how exactly this is done a little further.

From a syringe (for intramuscular, intravenous or subcutaneous injection). After drawing the medicine, the syringe is raised vertically with the needle up, and then the nurse makes light clicks on its body, thereby knocking all the bubbles together (into one air pocket). Then, by gently pressing the piston, the air is squeezed out. In this case, you should definitely release some of the drug, along with which all the remaining bubbles will go away.
From IVs. Before inserting the system into the patient, medical staff perform all the same actions as with a syringe before an injection. By the way, if the liquid in the dropper runs out before the nurse removes the needle from the patient’s vein, then the air will not enter the human body in any case, since there is simply not enough pressure in the system for this.
From complex medical devices. In such devices, where a sufficient amount of air can accumulate to cause death, there are special filters that automatically remove absolutely all existing bubbles.

Through an IV

While people take injections more calmly, the drip causes panic in some people, since the procedure is quite long and the medical worker can leave the patient alone. It is not surprising that the patient experiences anxiety because the solution in the dropper will run out before the doctor removes the needle from the vein.

According to doctors, the patients’ concerns are unfounded, since it is impossible to put air into a vein through a drip. Firstly, before inserting it, the doctor performs all the same manipulations to remove air as with a syringe. Secondly, if the medicine runs out, it will not get into the blood vessel, since the pressure in the dropper is not enough for this, while the blood pressure is quite high and it will not allow it to penetrate the vein.

As for even more complex medical equipment, special filtering devices are installed there, and bubbles are removed automatically.

In what other cases can an air embolism occur?

Quite often, divers encounter such a pathological condition that threatens human life. This happens in situations where a professional diver runs out of air at great depths and tries to quickly surface to the surface, while holding his breath. In this case, the air in the lungs begins to expand due to a decrease in pressure. As a result of this phenomenon, a rapid and rather strong filling of the internal respiratory organs with bubbles occurs, which can ultimately lead to the instant rupture of small sacs called alveoli. After this, air gradually enters all blood vessels, which ultimately leads to an air embolism, that is, a stroke or heart attack.

Dangerous situations

What happens if for some reason air does get into the artery? This causes a condition called air embolism. Its essence is that the blood flow is blocked. The air plug blocks the movement of blood along the vascular bed and, having created a bubble, wanders through the arteries. The air spreads in parts through small vessels, right up to the capillaries. Since the capillary network provides blood supply to all organs and systems, due to an air embolism, a vital part of the body may be isolated. The likely consequences are heart attack and stroke. Under what circumstances can such an amount of air enter a vein that is actually sufficient to cause death? This is possible with wounds and injuries to the neck or chest. These situations are dangerous because the neck is above the level of the heart, and in the thoracic region the pressure is lower than in the environment. In this case, air is quickly absorbed into the circulatory system and simply breaks it.

During childbirth, during contractions of the uterus, air can enter its vena cava. In this case, it will be absorbed very quickly.

A phenomenon called pulmonary barotrauma occurs in the following situation: a diver runs out of air, holds his breath in panic and quickly rushes to the surface. As you ascend, the pressure decreases and the air in your lungs expands. The lungs become overfilled and the alveoli may rupture as a result. In this case, air from the lungs will pass into the blood vessels and can provoke an air embolism.

Such cases are mostly fatal. But ordinary intravenous injection has nothing to do with them.

There is no point in being afraid of a tiny air bubble, but this does not mean that you can deliberately inject a full syringe of air into a vein. There is no consensus on what minimum amount of air can actually cause death.

Some believe that 10 cubes is enough, others call the figure 50 or even more. But nevertheless, you should not experiment and test experimentally what will happen if you inject air into a vein. If the ingress of a small amount of air happened accidentally, for example, when you injected yourself with medicine at home, then it is best not to panic, not to listen to the horror stories of relatives and friends, but to seek advice from a doctor who will calmly and reasonably explain everything to you.

How to do intravenous injections correctly

Collection for analysis from the ulnar vein is carried out after applying a tourniquet in the shoulder area. This is necessary for a short-term delay in blood flow. By pulling the syringe piston or by gravity, blood comes out of the needle, while the formation of a bubble is impossible due to the increased pressure inside the vessel. If air enters the subclavian vein during catheter installation, subcutaneous crepitus (crunching on palpation) is simultaneously observed.

Intravenous injections are prescribed in the complex treatment of diseases. The doctor writes in the referral how much is recommended for a particular patient.

Intravenous injection

Manipulation requires successive steps:

a tourniquet is applied above the intended injection site (for the elbow area it is necessary to clamp the shoulder, for injections into the hand - the forearm);
lightly pat the hand or massage from bottom to top until a clear picture of swollen superficial vessels appears;
insert a needle along the direction of blood flow;
after dark blood is released, the tourniquet is removed and the solution is slowly (some medications are very slow) injected.

You should draw the medicine into the syringe and remove the bubbles by pressing the piston before applying the tourniquet.

How to protect yourself and your relatives

To avoid introducing air into a vein, if necessity forces a person to resort to injections, one should trust only experienced specialists. Not all nurses and doctors are proficient in manipulation techniques or have sufficient practical experience. The best work in treatment rooms, surgical departments, intensive care and intensive care units.

Medical examination and examination of the child should not be neglected if a suspicion of congenital patent septum is detected. Surgery is not always recommended. The small hole heals with age, but parents need to be aware of the possible dangers of injections.

You can learn to give an injection into a muscle or subcutaneously with strict adherence to the rules and responsibility.

Injection into the muscle

Of particular concern are the numerous unlicensed offers from the network for withdrawal from binge drinking, urgent sobering up, and treatment at home. For this purpose, it is permissible to contact an official team from a drug treatment or general medical institution and draw up an agreement. You can't trust random people. Lack of experience and control leads to disaster.

It is possible to predict the consequences of a gas embolus entering the vessels taking into account the anatomical features of the human blood supply. A child with suspected heart disease should be examined and treated as early as possible. The severity of the consequences depends on the volume of the bubble. Any injections must be carried out according to strict indications.

How does it manifest itself?

An air bubble may appear in large vessels. With this phenomenon, there is no blood supply in a certain area, since the vascular lumen is blocked.

In some cases, the plug moves through the bloodstream and enters the capillaries.

When air is introduced into a blood vessel, the following symptoms may occur:

small seals in the puncture area;
bruises in the injection area;
general weakness;
joint pain;
dizziness;
headache;
a feeling of numbness in the area where the airlock is advancing;
clouding of consciousness;
fainting;
rashes on the skin;
dyspnea;
wheezing in the sternum;
increased heart rate;
a sharp drop in pressure;
swelling of veins;
pain in the chest.

For these symptoms, the person is listened to with a stethoscope to confirm the diagnosis. Diagnostic methods such as ultrasound, electrocardiography, mass spectrometry, and capnography are also used.

If you inject a large amount of air into a vein, the blood supply is disrupted. This can trigger a heart attack or stroke.

If small bubbles enter, this is almost always asymptomatic, since the air in this case usually resolves. When an injection is given intravenously, sometimes a few bubbles enter the vessel, resulting in a bruise or hematoma at the puncture site.

Causes of embolism

They are associated with pathological conditions and violations of the technique of intravenous manipulation. Some cases are caused by an attempt on human life.

The wall of the vessel is delimited from the surrounding tissues, so even if air appears in them, it will be impossible to let it into the vein. Another thing is conditions when a rupture of a large main vessel occurs (open fractures of the pelvis, femur, ribs). An entrance gate is formed through which air is sucked in. A severe infection - gas gangrene - contributes to the “corrosion” of the vascular wall, breaking its tightness.

Chest surgery

When performing operations on the thoracic and abdominal organs, the surgeon always takes into account the risk of damage to large vessels. Clamps are temporarily applied not only to prevent bleeding, but also to prevent air from entering large veins with serious consequences.

In hospitals, catheterization of the subclavian vein is used for long-term infusion therapy. The manipulation is carried out by anesthesiologists or surgeons. If the needle is directed incorrectly or the vessels are atypically positioned, they often end up in the artery. An experienced doctor will immediately notice the scarlet color of the blood and noticeable pulsation. If it is not possible to distinguish in time, a small bubble can enter the arterioles of the heart, lungs or brain.

When connecting an IV to a correctly installed catheter, the hole is open for a moment, and there is a danger of letting in a small volume of air. Doctors always cover the needle with a finger.

Criminal cases are difficult to prove. The expert is always alarmed by the presence of an injection mark, the absence of obvious signs of serious illness, and the suddenness of death.