Asphyxial Death

Professor Gopal Krishnan Reddy M.D.

Head Of Department
Department of forensic medicine
Kathmandu medical college

Asphyxia

A condition, where supply of oxygen to

the tissues has been reduced appreciably
below normal working level, due to
interference with the process of
respiration.

Gordon in 1944, defines asphyxia as,

where death is due to mechanical
obstruction in the process of respiration.

Features of asphyxia
Cyanosis
Persistent

fluidity of blood
Visceral congestion
Petechial haemorrhages
Capillary dilatation
Capillary stasis
Pulmonary oedema
Pulmonary haemorrhages

Classification:
Lack

of oxygen in surrounding air:suffocation

Obstruction in the external orifices:smoothering , overlaying
Obstruction in internal airway:- gagging ,
choking
Obstruction at the leval of neck hanging,
strangulation, mugging

 Occupation

of airway by any fluid:-

drowning
Pressure in the chest:- traumatic asphyxia

Suffocation
It

is a violent form of asphyxial death,

where respiration is obstructed distantly
out from natural air orifices.

eg:-

plastic bag ariund the face and neck

and lack of oxygen in immediate
atmosphere.

Medicolegal importance(MLI)
It

is commonly accidental and rarely

suicidal and homicidal.

Postmortem features:
Externally

no definite signs in the body.

Plastic bag or some other objects around
the place.
General features of asphyxia present.
Grossly congested internal viscera.

Smoothering
It

is a mode of violent asphyxial death,

where air entry to lungs is prevented by
obstruction of the external airway like
mouth and nostrils.
MLI: Homicidal smoothering: very common
Suicidal smoothering: very rare
Accidental smoothering: drunk people and
epileptics

Postmortem features:
Externally

fingertip bruises and finger nail

abrasions over face.
Contusions or lacerations in inner lips.
Congested face.
Internally bruising under external marks
and grossly congested internal organs.

Overlaying
Something

overlays and closes mouth and

nostrils.
Infant during nights by mothers breast
while feeding.
Small children by adults body parts
during sleep.
Unconscious persons.
[ It is always accidental. ]

Gagging
some

objects pushed deep into oral

cavity(gag).
MLI:
It is almost always homicidal sometimes
may be accidental.
Newborn babies and elderly people are
killed by this way.

Postmortem features:
Minimal

injuries like abrasions and

contusions in and around the mouth.
Presence of gag inside oral cavity.

Choking
Air

entry in lungs is prevented by some

foreign body at the level of laryngeal
opening and downward.
MLI: Always accidental.
Postmortem features:
Externally general signs of asphyxia.
Vomitus mass and food bolus present
internally.

Cafe

coronary is the best example and

common situation.
- Cafe coronary is a condition in which a
healthy but grossly intoxicated
person(resturant person), who begins a
meal suddenly turns blue, coughs
violently, then collapses and dies, without
much fuss. Death appears due to suuden
heart attack.

Hanging
It

is a mode of violent asphyxial death,

caused by suspension of the body by a
ligature that encircles the neck, the
constricting force being the weight of the
body.
The constricting force is full (complete
hanging) or part of body weight (partial
hanging).

 MLI:

All hanging deaths are taken as suicidal

unless proved otherwise.

Medicolegal

Suicidal
Accidental
Homicidal
Judicial

aspects:

Mechanism of death:
Asphyxia
Cerebral

hypoxia
Cerebral anoxia
Vagal inhibition of heart
Combination of above mechanisms
Fracture dislocation of cervical vertebra
judicial hanging.
2 kg of pressure is enough to occlude the
jugular vein.

Points which are favour of suicidal

hanging:Closed room from inside
Suicidal note
Point of suspension is accesible to victim
No injuries or poisioning to incapacitate
the victim
Minimal or no disturbances at scene
No other causes of death

Postmortem findings:
External

findings:

-Neck: may be stretched in prolong

suspension
-Face: plae and flaccid, may be congested
-Eye: opened eyelids, conjunctiva congested,
pupils dilated, protruded eyeball
-Finger nails: cyanosed
-Tongue: protruded
-Frothy mucous collection in mouth & nose

-Dribbling of saliva from lower angle of

mouth(surest sign of antemortem
hanging)
-Relaxation of sphincters may cause
involuntary discharge of faeces, urine,
semen.
-Hypostasis: above ligature, lower
limbs,hands
-Rigor mortis: slow onset
-Ligature mark on neck

Internal

Findings:

-Muscles: Platysma & sternocleidomastoid

may be ruptured.
-Thyroid cartilage: may be injured
-Carotid artery: inner coat may be
lacerated/rupture
-Cervical vertebra: fractured & dislocated,
commonly C2 & others are C1,C3,C4
-Epiglottis: congested
-Trachea & larynx: mucosa congested

Contd..
-Lungs: congested,exude dark coloured
frothy blood on section, sub-pleural air
vesicles are ruptured, producing
subpleural emphysema.
-Heart: Rt.side full of dark fluid
blood.Pulmonary artery & venacava
engorged.

Thank you