Asphyxia

Define Asphyxia.

Pulselessness due to mechanical interference with the process of respiration

How/why does Asphyxia lead to increased capillary permeability?

Low Oxygen -> anoxia -> vasodilation -> statis of blood -> damage to adhesion molecules b/w
endothelial cells -> fluid breaks free

Another name for petechiae haemorrhages.

Tardieu spots

What are Petechiae spots?

Tiny, purple-red spots, within dermal or submucosal layers. Size ranges from pinhead to pinpoint.

Why are Petechiae spots formed?

Anoxia, statis, increased capillary pressure and permeability

What are the conditions in which Petechiae spots are found?

Purpura, Posioning, Electrical shock, Coronory thrombosis, haemrrhage, Haemophilia, Scurvy

Which are the two kinds of Asphyxial deaths in which Petechiae spots are not found?

Drowning, Hanging (if carotid obstruction is complete)

How do post mortem petechiae spots form?

Death body suspended for a long time, blood gravitates to the dependent arts - capillary rupture ->
PM petechial hemorrhages

Where are post mortem Petechiae hemorrhages located?

Skin of hands and neck, no serous surfaces involved

Where are Tardie spots (classical finding in Asphyxial deaths) found?

Serous surfaces - of lungs and heart

What are four major findings of Asphyxial death?

1. Petechiae spots
2. Intense venous congestion, cyanosis and pronounced lividity
3. Postmortem fluidity of blood
4. Cardiac dilation
What are the three stages of Asphyxia?

1. Obstruction - Decrease O2, cyanosis, accumulation of CO2, stimulation of the respiratory centres.
No change in pulse rate and BP

2. Respiratory Dyspnea - Difficulty breathing, deepened cyanosis, neck vein engorged, congestion of
face&organs, unconsciousness and confusion

3. Exhaustion: unconsciousness -> coma. Shallow, irregular breathing, respiratory rate low, heart
beat present, pupils dilated

How many minutes of Asphyxia leads to unconsciousness?

2-3 minutes

How many minutes of Asphyxia leads to death?

4-5 minutes

What is the internal appearance of the heart in an Asphyxial death?

Right side is distended with blood. Left side is empty with subserous petechiae

What is meant by suffocation?

A death by any mechanical form of asphyxia apart from neck constriction and drowning

What is the term used to describe obstruction to respiration by restricting the respiratory
movement of the chest and abdomen?

Traumatic asphyxia

What do you call the obstruction of the airway passage from the inside?

Choking

The action of obstructing air passages outside by blocking the nose and mouth is an act known as?

Smothering

What does hanging, strangulation and throttling have in common?

Occlusion of air passage by applying pressure to the necl

If a person suffers an Asphyxial death due to lack of oxygen in the atmosphere or inhaling a gas
they can not exhale out (irrespirable gas) what is this called?

Suffocation

If a death has occurred due to ligature of neck but there is no suspension of the body..?

Strangulation
What is meant by garrotting and it classified as which type of mechanical asphyxia?

the action of ligature of neck by using a rope, wire, scarf etc from the back, when the victim is not
suspecting it. it is classified as strangling (because there's no suspension of the body). *execution
style in Turkey and Spain

What is the location of the ligature marks on the neck if the death has occurred due to
Strangulation?

Horizontally below the thyroid cartilage

A child with a short neck died due to Asphyxia caused by the tight collar of his shirt. His death will
be termed as?

Pseudostrangulation

What are the internal postmortem appearances of Strangulation?

Laceration of muscle tissues, subcutaneous areolar tissue under the ligature mark is ecchymosed,
inward fracture of hyoid bone, laryngeal cartilages, thyroid fracture, congested organs

Extreme injury to internal cervical structures is indicative of which type of strangulation?

bandsdola

Ligature mark of strangling appears as a ...?

Groove or depression

What color order does the skin in strangulation by ligature?

Light yellow -> brown -> dark brown -> dry, parchment like

Strangulation by foot with a boot on will display which external post mortem appearance?

Irregular wide spread bruising, local injuries to the neck (depending on the force applied)
Boot causes abrasions and lacerations

Strangulation by bare foot produces?

Contusions

A bruise in front of the neck (in the centre) shows how many sticks were used to strangulate?

one

Two brusies, one in front of the neck and one on the nape is indicative of how many sticks used?

two

Throttling is?

Strangulation by hands
Mugging is?

Strangulation by forearm/elbow

Examples of accidental strangulation include?

1. Children strangulated in swings

2. Infant strangulated in umbilical cord during birth
3. Scarf/dupatta/necktie gets in machinery and gets pulled
4. Masochistic accidental strangulation

Define hanging?

Asphyxial death caused by the suspension of the body by a ligature around the neck. The
constricting force is the weight of the body or the head itself.

Difference b/w Complete and Partial hanging?

Complete hanging - feet don't touch the ground and the weight of the victim's body acts as a
constricting force
Partial hanging - The weight of the head alone acts as a constricting force

What are the characteristics of a Typical hanging?

The point of suspension is over the centre of occiput - maximum possibility of occlusion of arteries.
Ligature is situated in the middle of the neck - above the thyroid cartilage
Ligature runs from both sides of the neck symmetrically upwards towards the occipital
There's greatest liability to arterial occlusion

What are the characteristics of judiciary hanging?

Fracture of C2-C4 vertebrae. laceration of upper cervical cord and spinal medulla.
The intima of the carotid arteries show tears because of the extravasation of blood. Instantaneous
death

Auto-erotic hanging

Accidental. Sexual asphyxia

When a mob gets together and hangs a person to the tree/pole etc with a rope

Lynching

What are the symptoms associated with hanging?

Flashes of light
Ringing noises
Loss of muscle power
Mental confusion
Complete cessation of respiration
Heart beat continues for a few minute
Livid face
Prominent eyes

Are the causes of death by hanging?

Asphyxia - air passage is blocked by the root of the tongue pressed against the pharnyx
Apoplexy - Compression of jugular veins (cerebral congestion)
Syncope (coma) - due to cerebral anoxia
Shock -vagal inhibition from the pressure on the vagus nerves or the carotid sinus
Spinal cord injury

What is the fatal period of Asphyxia in the case of hanging?

2-3 minutes

What is the fatal period of Apoplexy in the case of hanging?

30 minutes

How long will it take a person suffering from partial hanging and a slow asphyxia and apoplexy?

5-8 minutes

How long it takes for a person of judicial hanging to die?

Instantaneous

What is the direction of ligature in suicide hanging?

Oblique

True or false: women commit more suicide hanging than men in Pakistan.

True

What are the confirming findings of death due to hanging?

Ligature has ecchymosis or petechiae hemorrhages inside or around it

Marks of dribbling saliva
Torn intima in carotid arteries
Congestion and hemorrhage of lymh nodes above and below/around the ligature
Fracture and dislocation off cervical ertebrae
Absence of other fatal injuries and poisoning

What are the conditions in which the death is due to hanging but there are no ligature marks?

Soft ligature used

Ligature removed right after hanging
The body was no suspended for a long time

What are the features of homicidal hangings?

The knot is at the back
Injuries which can not be self inflicted
Signs of gagging and struggle, clothing torn
Presence of stupefying drugs in the system

What are the three instances in which accidental hanging can occur?

1. Children playing with cords or window blinds

2. Athletes playing gymnastics
3. Sexual perverts practicing masochism = sexual asphyxia

What is the external appearance of the neck due to hanging?

It is pulled - due to the upward stretch of the ligature

The head is always inclined opposite to the side of the knot

What is the external appearance of the face in hanging regarding the compression of the veins and
arteries of the neck?

1. If both veins and arteries are compressed together, the face is pale and there is less protrusion of
the tongue.
2. If the veins are compressed before the arteries, the face is blue, swollen and the protusion of the
tongue is apparent

What does the dribbling of saliva tell us about the hanging?

Dribbling of saliva proves that the body was alive at the time of the hanging because the ligature
caused the salivary glands to produce saliva

What is a special feature regarding rigor mortis in a person hanged?

There is a delay onset of rigor mortis of a hanged body. The fists are clenched

Describe postmortem lividity in a hanged body.

On extremities, above the constriction of the neck, in breasts, penis and testicles.

What is the position of the ligature in Complete hanging?

In the upper part of the neck, above the level of the thyroid cartilage

What is the position of the ligature in Partial hanging?

In the lower part of the neck, below the level of the thyroid cartilage

What kind of noose leaves a horizontal ligature mark and why?

Running noose - the rope is passed through the loop. The ligature mark is horizontal because the
weight of the body as the noose tightens.

What kind of noose leaves a V-shaped ligature mark?

Loose noose - the rope is knotted (granny knot or reef knot). Two limbs of the noose near the knot
will be pulled upwards.

One ligature mark points to suicide or homicide?

Suicide (two = homicide)

What would be found on dissection of a ligature mark of a hanging body?

Dry, glistening white band of subcutaneous areolar tissue with very few ecchymosis and petechial
haemorrhages

Is the Hyoid bone fractured in hanging?

rarely

What is the internal appearance of the lungs given the hanging occured during an inhalation?

They're pale

What is the internal appearance of the lungs given the hanging occurred during an exhalation?

They're congested and edematous

A ligature mark is incomplete at the back is indicative of a strangulation or hanging?

Hanging - that incomplete part is where the knot was. Thge ligature is also oblique.

A complete ligature mark horizontally encircling the neck and below the thyroid cartilage is
indicative of strangulation or hanging?

Strangulation

Are injuries to carotid arteries common in hangings?

No, they're only seen in long drops. However, injuries to carotid arteries are common in
strangulations

Emphysematous patches on the lungs are common to which of the following? hanging,
strangulation?

Strangulation

Who are the common victims of murder by throttling?

Women, children and infacts

How does accidental throttling occurs?

Sudden grasping, seizing and releasing of the throat with both hands can set of a vagal inhibition
which can result in throttling

One of the distinguishing internal characteristics of throttling are?

Laryngeal and hyoid bone fracture occurs commonly in person above the age of 40

"Burking" includes which two types of asphyxial methods?

Smothering and Traumatic asphyxia

What are the external signs of smothering?

Bruises or abrasions on the mouth and nose, bruising of gums and teeth and the side of the lips.
Splits in delicate tissues around the mouth

What kind of fluid is air passage of smothering victims full of?

Eosinophilic fluid with RBCs and desquamate respiratory epithelium

Overlaying infanticide?

Accidentally smothering an infant by rolling on top of it while sleeping

An alcoholic comes home drunk and stuffs his face in the pillow and dies. What is the cause of
death?

accidental smothering

How does glue-sniffing result in accidental smothering?

Pieces of glue stick ti the skin and block nsala airway passage

How does choking (occlusion of airway passage) result in death?

Asphyxia, vagal inhibition, laryngeal spasm

What is gagging and how does it cause choking?

Gagging is causing choking my blocking mouth or nose (entry of air) by a tightly packed filling or
material, obstructing breathing. This results in accumulation of saliva, mucus, edema fluid which
causes the choking.

How can cut throat injury cause choking?

Occlusion of airway passage with blood

What is meant by cafe coronary?

Bolus of food gets stuck in the larynx -> completely obstructs larynx -> stimulate laryngeal nerves ->
reflex cardiac arrest -> victim slumps over the dining table

Why is autopsy carried out of people who die in a manner similar to cafe coronary?

To carry out toxicological examination of alcohol and sedatives to make sure it isn't homicide

What is caul birth and why is it considered accidental choking?

When a new born baby dies from suffocation because it's head and face is still covered with
amniotic fluid

Why does a victim of Traumatic asphyxia present with a deeply cyanosed face?

Traumatic asphyxia has trauma to the chest.

Compression of chest -> displacement of blood from superior vena cava and subclavian vein to
smaller veins of the head and neck. The pressure increases and they burst resulting in deep cyanosis
of face.