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Deficient Oxygenation
ASPHYXIA 1
Capillary Dilatation
Pooling of Blood
Due to Decreased O2 tension in bld & Increased reduced Hb Becomes apparent when at least 5 gm of red. Hb is present Blood is Purple / Dark in color.
2.
Increased Capillary Permeability Blood transudes into tissue spaces - Gelatinous Moistening of Organs.
3)
French Police Surgeon described them in 1866 Mechanism: Anoxia Blood Stasis - Increased Capillary Permeability
3)
Pronounced in areas where Intracapillary pressure Rises rapidly - Above the Level of Neck Constriction
Better appreciated in
But in these cases - Distribution is Generalized. Absence of Tardieu spots - Does NOT Exclude Asphyxia
If Dead Body is suspended for Long time - Gravitation of blood in dependant body parts Over distension - Rupture of Capillaries. Present on Hands & Legs
Features:
1. 2. 3.
Larger Less Circumscribed Does NOT appear on - Serous Surface of Heart & Lungs
Hanging
Strangulation
a. Ligature - Strangulation
b. Manual - Throttling
3. 4.
Suffocation
Drowning
Type of Violent Asphyxial Death in which body is suspended with Ligature around Neck resulting in Constriction of Air passages preventing Exchange of air between Lungs & Atmosphere
Based on Position of Knot 1. Typical Knot - At the Nape 2. Atypical Knot - At any site other than Nape Commonest site Angle of mandible or Mastoid Process
Complete Hanging Body is - Fully Suspended NO Body part touches the ground. Constricting force - Weight of body Incomplete / Partial Hanging Body is - NOT Fully suspended some Body part touches the ground. Some Body weight is transmitted to ground through the part touching the ground
Pressure on Carotid Artery Immediate Unconsciousness Failure of Resp. Center (reduced blood supply to brain)
Asphyxia alone
Apoplexy alone Cerebral ischemia (pressure over carotid & vertebral A Vagal shock: Inhibition of heart due to vagal stimulation. Injury to medulla (Fracture dislocation of C2-C3 Vertebrae)
External Findings
Face - Pale, Congested, Swollen, Pt. hm. Eyeballs - Prominent due to congestion. Tongue - Protrude due to Pressure at its base Exposed part of Tongue - Dark Brown / Black
PM staining
Circumferentially on dependant parts of Arms & Legs, Face & Neck above the ligature. Bluish discoloration of Hands, Nail Beds & Lips. Tardieu Spots on Forehead, Eyelids & Conjunctiva.
Situated - Above the level of thyroid cartilage & directed obliquely upwards along the line of mandible & Reaches Mastoid Process behind the ears. Non-continuous (Incomplete)
1.
3.
4.
Body Weight :
Heavy Body: Mark is Prominent.
5.
LM is Less Prominent.
4.
HANGING
Ligature Strangulation
Hyoid bone m/b fractured in persons > 40 yrs # Greater Cornua at Junction of Inner 2/3rd & outer 1/3rd
Ante-mortem or Post-Mortem ?
Ante-mortem Hanging
1. Dribbling of Saliva (Angle of Mouth) 2. Pt. Hm. & Ecchymosis underneath LM
Suicidal, Homicidal or Accidental Hanging - Most commonly Suicidal Partial hanging - Almost always Suicidal
Violent Asphyxial death caused by constriction of Neck by means other than body weight
Strangulation Throttling / Manual Strangulation Mugging Bansdola Ligature Hand
Cause of Death - Same as Hanging. Postmortem Appearance Asphyxia, Face - Congested & Cyanosed. Eye balls - Prominent. Tongue Protrudes, may be Bruised & Bitten. Tardieu Spots Abundant Sub Cunjunctival Hemorrhage.
Neck injuries L Mark - At or Below Thyroid level Horizontal, Encircles the Neck Completely.
Superior Horn of Thyroid Cartilage Commonly Fractured Hyoid Bone Fracture: Rare (Level of constriction is Below Hyoid) Hyoid Bone Fracture may be present if 1. Excessive force is used
Mouth Gagged; Limbs Tied Signs of Struggle Present In Females Signs of Sexual Assault Infanticide - by passing Umbilical Cord around the Neck.
Suicidal Rare Knot usually at Front
Accidental Rare
Neck tie / Scarf - Caught in moving machinery
PM Findings Signs of Asphyxia - Petechial Hemorrhages Asphyxial Signs are minimal in Cardiac inhibition due to Pressure on Carotid Sinus / Vagus N.
Neck - Scratch marks (Multiple, Crescent shaped) Internal Findings S/C Tissues underneath Bruises & Nail Marks Hemorrhage Superior Horns of Thyroid Cartilage Fracture - More common
Homicidal - Almost Always Accidental - Rare - Sudden holding of neck - Vagal Inhibition
Ante-mortem Throttling
1.
2.
3. 4.
5.
Mugging / Choke Hold Strangulation by Compressing Neck with Elbow / Knee Bent
Garroting
Bansdola Neck is Compressed between 2 bamboo sticks (one placed in front & other behind the neck).
Sticks are tied at one end & a rope is passed at the other
end to bring the sticks together
Neck can also be compressed with one stick against the ground.
Exchange of Air between Atm. & Lungs is prevented by means other than Neck Constriction & Drowning Types:
1. Smothering
3. Gagging
2. Choking
4. Burking
5. Traumatic asphyxia
Smothering
Accidental Smothering Abrasion, Contusion, Laceration around mouth & nose and Injury on inner side of Lips & Gums - May be present
Pornographic Literature, Exposed Private Parts, Wearing Dress of opposite sex Method used for Self Smothering
Suicidal Smothering
Pillow tied around Mouth & Nose Plastic Bag around Head Local effect of pressure but NO remarkable injuries.
Accidental (Most Common) Alcoholics / Epileptics Fall on Bed - Burry their Face in Bed - Fail to revert to favorable posture (Postural / Positional Asphyxia)
Accidental Smothering Child Birth - Placental Memb. adhere Mouth & Nose Overlaying - Mother rolls over the baby during sleep. Children - while playing with Plastic Bags.
Accidental Smothering Sexual perverts - Cover their head with plastic bags. Glue Sniffing (Solvent Abuse)
Trauma to Chest, Abdomen / Back - Prevent Resp. movement E.g House Collapse, Stampede, Run over by Vehicle, Fall of Earth on Trench workers
PM Findings
Signs of Asphyxia. Deep Cyanosis of face, Numerous petechiae
Demarcation Line b/w discolored Upper Body and Normal Lower Body. Chest CompressionBack pressure-Displace blood in opp. Direction (From SVC to Head & Neck Veins - No valves in SVC) Valves in Subclavian Veins Prevents blood to enter Veins of Upper Limbs.
Face & Neck deeply Cyanosed Eyes Blood Shot Petechiae Scalp, Face, Neck & Shoulders Heart & Lung Injured
Most Commonly Accidental Mothers Roll over a baby - Traumatic Asphyxia Can be Homicidal (Burking Phenomenon)
Lumen of Air Passage occluded by :Foreign Material / Pathology in Resp. Tract or Esophagus. Size of Object NOT Important Object smaller than lumen may cause spasm of Air passage
Cause of Death
Asphyxia, Vagal Inhibition, Laryngeal Spasm / Bronchospasm
PM Findings: Asphyxial signs. On Autopsy - Cause of Choking may be found. Chocking is most commonly Accidental May occur due to Foreign material in Air Passages
Inhalation of Vomitus due to Drunkenness, Anesthetic agent, Epilepsy or Coma. Regurgitation of Milk (Infants) Bleeding into Resp. Passages
GAGGING
Cloth is pressed inside the mouth Gag blocks the mouth Blocks passage of Air coming from Nostrils to pass through Back of Throat.
Gag become moist due to Saliva - Obstruct cloth Pores Leads to complete Obstruction of Air Passage. Autopsy findings: Lips, Soft palate & Pharynx - Abrasion, bruise & lacerations.
Medicolegal aspects:
Mostly Homicidal (in Infants / children) Adult - Gagged to prevent shouting (Death is Accidental)
Choking - Obstruction of larynx due to Food Bolus Occurs in Cafe / Restaurant Sudden Collapse mimics Coronary Heart Attack. common in suppressed Gag Reflex- (Intoxication, Sedation)
Cause of Death
Asphyxia or Reflex Cardiac Arrest (Stimulation of Laryngeal N.)
Food bolus impacted in Larynx. Death is Accidental (Relatives can claim Insurance benefits) Timely treatment can save the person. Blow on Back / Sternum or pressure on Abdomen
Combination of Smothering & Traumatic Asphyxia. Burke & Hare used to kill the Victims and sell their body to Edinburgh Medical School for dissection. Burke used to Sit on Chest of inebriated Victim and
Passage of Air between Atmosphere & Lungs is prevented by Submersion of Body in Water / Fluid. Types : - 1) Typical 2) Atypical.
Water moves from Lungs to Bld Vessels Hyper-volemia & Hemodilution. RBCs Burst & Hemolysis occurs - Liberation of K++ Decrease in Na++ & Cl -
Fatal Period:
4 - 5 mts (Five)
Very little or NO inhalation of water into Air passages. 1. Dry Drowning 20% cases of drowning are due to Dry Drowning. Water enters Larynx - Sustained Laryngeal Spasm.
3. Submersion of Unconscious Victim is Semiconscious / Unconscious during fall in water (Epilepsy, Drunk, Head Injury or Dizzy due to HT,) Typical findings drowning Absent
Lungs - Rigid, Stiff & heavy but are NOT edematous. Microscopically lungs show ARDS Death occurs after some hours or days.
Mechanism of Drowning
Non-Swimmer Falls in Water
Sinks due to
Rises to the Surface due to (1) Buoyancy of Body (2) Struggling Movements. Shouts for Help & Tries to Breath -
Water is Swallowed & Aspirated - cause Violent Coughing Air expels & its space is filled by water - Sp. Gravity of Body Increases Victim Sinks - Struggling Movements - Comes to Surface Again Sinks (due to inhalation of more water) This continues several times till he finally sinks
Sign / Symptoms
Auditory & Visual Hallucinations Return of Memory of Past Events.
Confusion
CAUSE OF DEATH: Asphyxia Vent. Fibrillation In Fresh water drowning.
Vagal inhibition Hypothermia, Sec. Drowning Syndrome, Injury to Head / other Vital organs during fall,
Cardiac failure,
Rupture of Cerebral Aneurysm.
Cause of Death can be (1) Drowning alone or (2) Combination of Drowning + Disease / Trauma
POSTMORTEM CHANGES:
External Changes Body & Clothes: Wet (if body is recently recovered from water) Skin - Wet, Cold & Pale (contraction of blood vessels)
Face - Cyanotic
Conjunctiva - Congested. PM Staining may be Absent (body constantly moving) When present it is confined to - Head & Neck, Front of Chest Rigor Mortis
Cuties Anserina / Goose skin Skin appears Granular & Puckered with
Skin of Hand & Feet - Wrinkled, Bleached & Sodden. Due to Immersion in Water. Not Diagnostic of Drowning Indicates that Body remained in Water for some time.
Emphysema Aquosum (Ballooning of Lungs) Lungs - Voluminous, Water Logged, Bulge out on Opening Chest Cavity. Impression of Ribs on its surface &
Microscopic, Unicellular Algae, Present in Natural water (single or in colonies). Size varies from 10-80
1. Deceased did NOT drink this water just before drowning 2. All the species present in Test sample are also present in Control sample. 3. Different Species of diatoms in Test sample & Control
Diatom test:
5-10 gm of Bone marrow kept in 10 ml conc. HNO3 + 0.5 ml conc. H2SO4 for 12 hrs Fluid is washed with DW and Centrifuged Repeatedly Final residue - Examined under Phase contrast Microscope
Signs of Ante mortem Drowning 1. Persistent, Copious, Fine Froth - from Mouth & Nose. 2. Fine froth in Air passages. 3. Diatom Test - Positive.
4. Edematous Lungs.
5. Cadaveric spasm - Hands Tightly Clenched containing material present under water
Suicidal Drowning Signs of Struggle Absent. common in Indian females (Dowry death).
Victim may tie her hands / legs & attach weight before jumping
She may take Poison, Cut her throat before drowning
Dead body may be injured by sea animals Injuries will be postmortem NO Vital Reaction.
Anoxic - Prevention of O2 from reaching Lungs Stagnant - Impaired Blood Flow resulting in Lack of oxygenated Bld transport to Tissues Anemic - Low Hb - Inability of Blood to carry O2 Histo-toxic Tissues Destruction Tissues cannot use O2
Slight Vagal Effect Slight Asphyxial Signs & Cyanosed face; Suffused Eyes Some Venous Constriction
Few petechiae Pronounced Venous & Well marked Asphyxial Signs Resp. obstruction Deeply Cyanosed face, Blood Shot Eyes, Bitten Tongue, many petechiae in Scalp, Slight Arterial Constriction Conjunctivae & Face.
Moderate Venous Moderate Asphyxial Signs Constriction Cyanosed Face, Bulging Eyes, & Conjunctival Ecchymosis & Some Resp. Obstruction
Two Limbs of Rope near Knot are Pulled upwards Inverted V shaped Mark At apex of V - Mark is Absent (Head tilts away from the knot)
Running noose:
End of Rope is passed through the loop (slip knot) Noose tightens in Horizontal plane LM - Horizontal. - additional Vertical mark (due to suspending ligature)
Gettler Test
In a living person Cl level of Bld. In Left & Right chambers of Heart - Equal According to Gettler In Fresh Water Drowning
In Salt Water Drowning Hemo-Concentration occurs on Left side First 30-40% increase in Cl level in Left Chambers of Heart