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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="research-article" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Russian Journal of Forensic Medicine</journal-id><journal-title-group><journal-title xml:lang="en">Russian Journal of Forensic Medicine</journal-title><trans-title-group xml:lang="ru"><trans-title>Судебная медицина</trans-title></trans-title-group></journal-title-group><issn publication-format="print">2411-8729</issn><issn publication-format="electronic">2409-4161</issn><publisher><publisher-name xml:lang="en">Eco-Vector</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">16299</article-id><article-id pub-id-type="doi">10.17816/fm16299</article-id><article-id pub-id-type="edn">QFQRPJ</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Case reports</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Экспертная практика</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="zh"><subject>临床病例报告</subject></subj-group><subj-group subj-group-type="article-type"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title xml:lang="en">Suspected fatal drug intoxication during resuscitation after submersion asphyxia: a case report</article-title><trans-title-group xml:lang="ru"><trans-title>Подозрение на смертельное медикаментозное отравление при реанимационных мероприятиях по поводу гидрогенной асфиксии: описание случая</trans-title></trans-title-group><trans-title-group xml:lang="zh"><trans-title>在水源性窒息复苏过程中疑似致死性药物中毒：病例报告</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3132-8522</contrib-id><contrib-id contrib-id-type="spin">5122-0242</contrib-id><name-alternatives><name xml:lang="en"><surname>Kuznetsov</surname><given-names>Semyon V.</given-names></name><name xml:lang="ru"><surname>Кузнецов</surname><given-names>Семён Валерьевич</given-names></name><name xml:lang="zh"><surname>Kuznetsov</surname><given-names>Semyon V.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Cand. Sci. (Medicine), Assistant Professor</p></bio><bio xml:lang="ru"><p>канд. мед. наук, доцент</p></bio><bio xml:lang="zh"><p>MD, Cand. Sci. (Medicine), Assistant Professor</p></bio><email>Nachsml@mail.ru</email><xref ref-type="aff" rid="aff1"/><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4343-4656</contrib-id><contrib-id contrib-id-type="spin">7439-0540</contrib-id><name-alternatives><name xml:lang="en"><surname>Molin</surname><given-names>Yuri A.</given-names></name><name xml:lang="ru"><surname>Молин</surname><given-names>Юрий Александрович</given-names></name><name xml:lang="zh"><surname>Molin</surname><given-names>Yuri A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine), Professor</p></bio><bio xml:lang="ru"><p>д-р мед. наук, профессор</p></bio><bio xml:lang="zh"><p>MD, Dr. Sci. (Medicine), Professor</p></bio><email>juri.molin@yandex.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4472-6546</contrib-id><contrib-id contrib-id-type="spin">5828-0337</contrib-id><name-alternatives><name xml:lang="en"><surname>Reiniuk</surname><given-names>Vladimir L.</given-names></name><name xml:lang="ru"><surname>Рейнюк</surname><given-names>Владимир Леонидович</given-names></name><name xml:lang="zh"><surname>Reiniuk</surname><given-names>Vladimir L.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine), Assistant Professor</p></bio><bio xml:lang="ru"><p>д-р мед. наук, доцент</p></bio><bio xml:lang="zh"><p>MD, Dr. Sci. (Medicine), Assistant Professor</p></bio><email>institute@toxicology.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8672-2906</contrib-id><contrib-id contrib-id-type="spin">4886-8890</contrib-id><name-alternatives><name xml:lang="en"><surname>Lodiagin</surname><given-names>Aleksei N.</given-names></name><name xml:lang="ru"><surname>Лодягин</surname><given-names>Алексей Николаевич</given-names></name><name xml:lang="zh"><surname>Lodiagin</surname><given-names>Aleksei N.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine), Assistant Professor</p></bio><bio xml:lang="ru"><p>д-р мед. наук, доцент</p></bio><bio xml:lang="zh"><p>MD, Dr. Sci. (Medicine), Assistant Professor</p></bio><email>alodyagin@mail.ru</email><xref ref-type="aff" rid="aff4"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2693-6283</contrib-id><contrib-id contrib-id-type="spin">9446-5175</contrib-id><name-alternatives><name xml:lang="en"><surname>Batotsyrenov</surname><given-names>Chimit B.</given-names></name><name xml:lang="ru"><surname>Батоцыренов</surname><given-names>Чимит Баирович</given-names></name><name xml:lang="zh"><surname>Batotsyrenov</surname><given-names>Chimit B.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="zh"><p>MD</p></bio><email>steelfire282@gmail.com</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6673-8230</contrib-id><contrib-id contrib-id-type="spin">7016-7086</contrib-id><name-alternatives><name xml:lang="en"><surname>Davydova</surname><given-names>Zlata V.</given-names></name><name xml:lang="ru"><surname>Давыдова</surname><given-names>Злата Вячеславовна</given-names></name><name xml:lang="zh"><surname>Davydova</surname><given-names>Zlata V.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Cand. Sci. (Medicine), Assistant Professor</p></bio><bio xml:lang="ru"><p>канд. мед. наук, доцент</p></bio><bio xml:lang="zh"><p>MD, Cand. Sci. (Medicine), Assistant Professor</p></bio><email>zlata.davydova@rambler.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6368-680X</contrib-id><contrib-id contrib-id-type="spin">5101-9477</contrib-id><name-alternatives><name xml:lang="en"><surname>Lukovnikova</surname><given-names>Lubov V.</given-names></name><name xml:lang="ru"><surname>Луковникова</surname><given-names>Любовь Владимировна</given-names></name><name xml:lang="zh"><surname>Lukovnikova</surname><given-names>Lubov V.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine), Professor</p></bio><bio xml:lang="ru"><p>д-р мед. наук, профессор</p></bio><bio xml:lang="zh"><p>MD, Dr. Sci. (Medicine), Professor</p></bio><email>lukovnikova.l.v@toxicology.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6788-3050</contrib-id><contrib-id contrib-id-type="spin">1958-4902</contrib-id><name-alternatives><name xml:lang="en"><surname>Narzikulov</surname><given-names>Rustam A.</given-names></name><name xml:lang="ru"><surname>Нарзикулов</surname><given-names>Рустам Абдухалимович</given-names></name><name xml:lang="zh"><surname>Narzikulov</surname><given-names>Rustam A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Dr. Sci. (Medicine)</p></bio><bio xml:lang="ru"><p>д-р мед. наук</p></bio><bio xml:lang="zh"><p>MD, Dr. Sci. (Medicine)</p></bio><email>rnarzikulov@yandex.ru</email><xref ref-type="aff" rid="aff4"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-5368-7493</contrib-id><contrib-id contrib-id-type="spin">6017-5632</contrib-id><name-alternatives><name xml:lang="en"><surname>Martinson</surname><given-names>Tatiana G.</given-names></name><name xml:lang="ru"><surname>Мартинсон</surname><given-names>Татьяна Гербертовна</given-names></name><name xml:lang="zh"><surname>Martinson</surname><given-names>Tatiana G.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, Cand. Sci. (Medicine)</p></bio><bio xml:lang="ru"><p>канд. мед. наук</p></bio><bio xml:lang="zh"><p>MD, Cand. Sci. (Medicine)</p></bio><email>martinson.t@mail.ru</email><xref ref-type="aff" rid="aff4"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-0820-8471</contrib-id><contrib-id contrib-id-type="spin">1618-1510</contrib-id><name-alternatives><name xml:lang="en"><surname>Demidova</surname><given-names>Ekaterina O.</given-names></name><name xml:lang="ru"><surname>Демидова</surname><given-names>Екатерина Олеговна</given-names></name><name xml:lang="zh"><surname>Demidova</surname><given-names>Ekaterina O.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="zh"><p>MD</p></bio><email>bedskaya.667@yandex.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0002-0981-9701</contrib-id><name-alternatives><name xml:lang="en"><surname>Sukhonos</surname><given-names>Sofia Yu.</given-names></name><name xml:lang="ru"><surname>Сухонос</surname><given-names>София Юрьевна</given-names></name><name xml:lang="zh"><surname>Sukhonos</surname><given-names>Sofia Yu.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>ssuhonos0103@mail.ru</email><xref ref-type="aff" rid="aff5"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-4360-0836</contrib-id><name-alternatives><name xml:lang="en"><surname>Kirsanova</surname><given-names>Darya A.</given-names></name><name xml:lang="ru"><surname>Кирсанова</surname><given-names>Дарья Андреевна</given-names></name><name xml:lang="zh"><surname>Kirsanova</surname><given-names>Darya A.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>dashakirsanova2510@gmail.com</email><xref ref-type="aff" rid="aff6"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Institution Golikov Research Clinical Center of Toxicology</institution></aff><aff><institution xml:lang="ru">Научно-клинический центр токсикологии имени С.Н. Голикова</institution></aff><aff><institution xml:lang="zh">Institution Golikov Research Clinical Center of Toxicology</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Saint-Petersburg State Pediatric Medical University</institution></aff><aff><institution xml:lang="ru">Санкт-Петербургский государственный педиатрический медицинский университет</institution></aff><aff><institution xml:lang="zh">Saint-Petersburg State Pediatric Medical University</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="en">North-Western State Medical University named after I.I. Mechnikov</institution></aff><aff><institution xml:lang="ru">Северо-Западный государственный медицинский университет имени И.И. Мечникова</institution></aff><aff><institution xml:lang="zh">North-Western State Medical University named after I.I. Mechnikov</institution></aff></aff-alternatives><aff-alternatives id="aff4"><aff><institution xml:lang="en">Saint-Petersburg Institute of Emergency Care named after I.I. Dzhanelidze</institution></aff><aff><institution xml:lang="ru">Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе</institution></aff><aff><institution xml:lang="zh">Saint-Petersburg Institute of Emergency Care named after I.I. Dzhanelidze</institution></aff></aff-alternatives><aff-alternatives id="aff5"><aff><institution xml:lang="en">Medical College No. 2, Saint Petersburg</institution></aff><aff><institution xml:lang="ru">Медицинский колледж № 2, Санкт-Петербург</institution></aff><aff><institution xml:lang="zh">Medical College No. 2, Saint Petersburg</institution></aff></aff-alternatives><aff-alternatives id="aff6"><aff><institution xml:lang="en">Kirov Military Medical Academy</institution></aff><aff><institution xml:lang="ru">Военно-медицинская академия имени С.М. Кирова</institution></aff><aff><institution xml:lang="zh">Kirov Military Medical Academy</institution></aff></aff-alternatives><pub-date date-type="preprint" iso-8601-date="2025-10-22" publication-format="electronic"><day>22</day><month>10</month><year>2025</year></pub-date><pub-date date-type="pub" iso-8601-date="2025-11-24" publication-format="electronic"><day>24</day><month>11</month><year>2025</year></pub-date><volume>11</volume><issue>3</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><issue-title xml:lang="zh"/><fpage>289</fpage><lpage>303</lpage><history><date date-type="received" iso-8601-date="2025-05-28"><day>28</day><month>05</month><year>2025</year></date><date date-type="accepted" iso-8601-date="2025-08-03"><day>03</day><month>08</month><year>2025</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2025, Eco-Vector</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2025, Эко-Вектор</copyright-statement><copyright-statement xml:lang="zh">Copyright ©; 2025, Eco-Vector</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="en">Eco-Vector</copyright-holder><copyright-holder xml:lang="ru">Эко-Вектор</copyright-holder><copyright-holder xml:lang="zh">Eco-Vector</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/" start_date="2027-11-24"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by-nc-nd/4.0/</ali:license_ref></license></permissions><self-uri xlink:href="https://for-medex.ru/jour/article/view/16299">https://for-medex.ru/jour/article/view/16299</self-uri><abstract xml:lang="en"><p>Circumstances of deaths in water are diverse, encompassing both relatively typical drowning cases and rarer causes such as injury from electrogenic aquatic animals. It is not uncommon for medical assistance rendered during or immediately after a water-related incident to contain errors that may result in an unfavorable outcome.</p> <p>The article presents a detailed analysis of a representative case of asphyxia in a child in a swimming pool, which resulted in death 16 days later in a hospital setting. The sequence of medical interventions—from prehospital to specialized care—is described. Special attention is given to the interaction with investigative authorities in distinguishing between possible circumstances of death: drowning versus inadequate resuscitative measures. The necessity of interpreting potential iatrogenic complications strictly within the context of the initial cause of medical intervention is emphasized. The importance of strict adherence to water safety rules is also highlighted.</p> <p>The article identifies contentious aspects of legal qualification in such cases and underscores the lack of a unified methodology for their forensic evaluation. Shortcomings commonly observed in forensic medical examinations of similar situations are noted, emphasizing the inadmissibility of a formal approach. Directions for improving expert practice and eliminating identified disadvantages are proposed.</p></abstract><trans-abstract xml:lang="ru"><p>Ситуации наступления смерти в воде многообразны: они охватывают как относительно типичные случаи утопления, так и более редкие причины, например поражение электрогенными животными. Нередки случаи, когда непосредственно в процессе или после происшествия на воде пострадавшему оказывают медицинскую помощь с дефектами, которые могут влиять на возникновение неблагоприятного исхода.</p> <p>В статье продемонстрирован детальный разбор показательного случая развития асфиктического состояния у ребёнка в бассейне, завершившегося летальным исходом через 16 сут в условиях лечебного учреждения. Описаны последовательные этапы оказания медицинской помощи: от доврачебной до специализированной. Особое внимание уделено вопросам взаимодействия с органами предварительного следствия при разграничении возможных обстоятельств наступления смерти: утопления или ненадлежащего проведения реанимационных мероприятий. Обоснована необходимость рассматривать вероятные ятрогенные осложнения исключительно в контексте первоначального повода оказания медицинской помощи. Подчёркнута значимость строгого соблюдения правил безопасности при нахождении на воде.</p> <p>Выявлены дискуссионные аспекты юридической квалификации подобных ситуаций и акцентировано внимание на отсутствие единой методологии в их экспертной оценке. Отмечены недостатки, допускаемые при проведении судебно-медицинских экспертиз в аналогичных случаях, подчёркнута недопустимость формального подхода к их выполнению. Предложены направления совершенствования экспертной практики и устранения выявленных недостатков.</p></trans-abstract><trans-abstract xml:lang="zh"><p>水中死亡的情形复杂多样，既包括相对典型的溺水案例，也涵盖较为罕见的原因，如放电动物造成的损伤等。在水上事故发生时或之后，受害者常常会接受存在缺陷的医疗处置，而这些不足之处可能成为不良结局的重要影响因素。</p> <p>本文展示了一例具有代表性的病例的详细分析：一名儿童在游泳池中发生窒息性状态，最终于住院第16天出现致死结局。文中介绍了从院前急救到专科治疗的各个环节。重点探讨了法医专家与调查机关在区分死亡原因为溺水或复苏措施不当时的协作问题。阐明了应仅在医疗干预初衷背景下评估所有可能的医源性并发症的必要性。同时强调严格遵守水上安全规范的重要性。</p> <p>文章分析了此类案件在司法定性方面的争议点，指出目前尚缺乏统一的法医学评估方法。文中总结了类似案件司法鉴定中常见的问题，强调在鉴定过程中不得采用形式化、片面化的结论方式。提出了改进司法鉴定实践和消除已发现缺陷的方向。</p></trans-abstract><kwd-group xml:lang="en"><kwd>drowning</kwd><kwd>submersion asphyxia</kwd><kwd>forensic medical examination</kwd><kwd>acute drug poisoning</kwd><kwd>lidocaine</kwd><kwd>toxicology</kwd><kwd>chemical toxicological analysis</kwd><kwd>postresuscitation disease</kwd><kwd>case report</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>утопление</kwd><kwd>гидрогенная асфиксия</kwd><kwd>судебно-медицинская экспертиза</kwd><kwd>острые отравления лекарствами</kwd><kwd>лидокаин</kwd><kwd>токсикология</kwd><kwd>химико-токсикологическое исследование</kwd><kwd>постреанимационная болезнь</kwd><kwd>клинический случай</kwd></kwd-group><kwd-group xml:lang="zh"><kwd>溺水</kwd><kwd>水源性窒息</kwd><kwd>法医学鉴定</kwd><kwd>急性药物中毒</kwd><kwd>利多卡因</kwd><kwd>毒理学</kwd><kwd>化学毒理学检测</kwd><kwd>复苏后综合征</kwd><kwd>临床病例</kwd></kwd-group><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Kuznetsov SV. 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