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ASPHYXIA
A
HYPOXIA
Failure
- Hypoxic, hypoxia
Failure of O2 to enter blood circulation
- Anemic hypoxia
Insufficient of adequate O2 by blood for tissue
metabolism
- Stagnant hypoxia
Circulation failure
- Histotoxic hipoxia
Oxygen in erythrocyte can not be used in the
tissue
Histotoxic Hipoxia
A. Extracellular
Respiratory tissue enzyme poisoned (CO
intoxication)
B. Pericelullar
Dicrease of cell membrane permeability which
cause O2 cannot enter the cell (ether imtoxication)
C. Substrate
Insufficient nutrient for efficient metabolism.
(Hypoglicaemia)
D. Metabolic
End product from cellular metabolism cannot be
eliminated and inhibit the next metabolism
(Uremia, CO2 poisoning)
Mechanical Asphyxia
1.
2.
3.
4.
5.
Squeeze
a. Hanging
b. Strangulation
c. Throttling
Smothering
Choking
Drowning
Compression
D R O W N I NG
Dr. GUNAWAN ARSYADI, SpF, SpPA
(K)
Drowning
Type of suffocation where respiratory
tract is blocked by water/ fluid air /
fluid is sucked into respiratory tract &
alveoly
DROWNING DEFINITION
Drowning is the effect of sinked body
partially or totally. Death is cause by
fluid in the lung, generally water,
which cause difficulty in breathing
and cause death by the effect of
asphyxia
INTRODUCTION
Mechanism of death in drowning generally
cause by asphyxia, vagal inhibition and
larynx spasm. Death of asphyxia by
electrolite exchange in blood in fresh water
drowning and salt water drowning.
Drowning is especially happened by
accidentally, rather than murder and suicide
MECHANISM OF DROWNING
Victim is sinked cause by gravitation
specific gravity of body is smaller
than specific gravity of fluid, victim
would floating early reaction,
victim try to breath, fluid inhaled
specific gravity of victim > specific
gravity of water drowning.
Autopsy Examination
Outer Examination :
a. No diagnostic available
b. Several invention can enlighten
drowning diagnosis
spasm
Middle ear bleeding
Watery particle (grass, mud, etc.) at
respiratory tract
Paltauf rash
Net weight of right heart is different
than net weight of left heart
Diatome (+) in lung/ bone marrow
especially focused to
respiratory system.
Particle (Corpus Alienum), bubble in
trachea is seen either by
macroscopic & microscopic.
Pleura can be reddish and contain
petechia.
Large bleeding rash (diameter 3 -5
cm) is called paltauf rash .
at larynx is an essential
finding, lungs usually too expanded.
Edema and lung congestion (700
-1000 g)
Emphysema Aquosum or
Emphysema Hydroaerique.
Middle ear bleeding.
2.
a.
a.
3.
b.
c.
b.
c.
d.
Special examination
Destruction Test
Procedure:
Peripheral lung tissue is destruct with
H2SO4, then put with HNO3
sentrifuge sediment is put on glass
object seen under microscope to
detect diatome.
2.
must be fresh
Part which would be exammed must
at right part of peripher
Type of diatome that found must be
same with diatome at that water
surrounding
Total of diatome at lungs 5/ HFP
Bone marrow 1/ HFP
Drowning in salt
water
Hemoconcentration
Lungs
edema
Dead in 5 10 minutes
Lungs
* Wet appereance/ heavy
* Big
* Lot of fluid, lack of bubble
Blood net weight : 1.0595 1.060,
difference of 0.005 is exceptional