ASPHYXIA

Interference with oxygenation any where

from environment down to cellular level

Greek meaning is “ Pulse Less”

Mechanism of Death
Oxygen deprivation
CO2 accumulation
Reduced blood flow to and from the brain.
Vagal stimulation resulting in cardiac inhibition
Complex.

Arterial blood oxygen saturation.

Normal 90-100 mm/Hg
Drop to 60 mm/Hg in mild hypoxia
Between 40-20 mm/Hg in severe fatal hypoxia
Pathological changes
GENERAL
Cyanosis, congestion, Engorgement right side of heart,
Fluidity of blood ( Fibrinolysin, Capillary endothelium
under stress secretes Fibrinolycin)
Petechial hemorrhage ( Tardieu spots)

SPECIFIC
Injuries to the larynx, hyoid bone, thyroid cartilage,
carotid arteries and vagus nerve.
Patho-physiology of Asphyxia
ASPHYXIA

O2 tension Oxygenation
in the lungs

Pulmonary Flow Capillary Dilatation

Venous return Engorgement

Stasis of Blood
 ANOXIA
Absence of O2
TYPES, four
1. Anoxic Anoxia,
 Due to mechanical asphyxia leading to defective oxygenation
in lungs e.g. Hanging, Strangulation, Suffocation etc.
2. Anemic Anoxia
 Due to reduced O2 caring capacity of blood e.g. CO poisoning
3. Histo-toxic Anoxia
 Due to depression of tissue oxidation e.g. Cyanide poisoning
4. Stagnant Anoxia
 Due to in efficient circulation of blood e.g. C.C.F and
traumatic Shock
 Tardieu Spots
Or Petechial hemorrhages
Are usually round, dark, well defined and
about the size of pin head
(up to 2mm).

Found in those parts where capillaries

are least supported e.g. Face,
Conjunctiva, Epiglottis, Serous Surface of
heart and lungs etc.
Petechial hemorrhages
 Signs of Asphyxia
Are due to pathological changes resulting from anoxia.
The effect of Anoxia on tissue in mainly two fold.
1. Non Specific
2. Specific.

Non Specific effects:

 Body tissue under go parenchymatous degeneration.
Specific Effects:
 As a result of specific effects following systemic changes are seen.
 Generalized Cyanosis, Vascular Congestion, Edema of tissue and
viscera, Petechial hemorrhage in skin and viscera, fluidity of blood.
 These Signs develop when mechanical obstruction to breathing
is maintained for about 30 seconds.
 How Much Weight is Required to Occlude the,

Jugular vein …. 4.4 pounds.

Carotid Artery by.. 11 pounds.

Trachea by … 33 pounds.
 Autopsy Procedure in Case of
Death from Asphyxia
V Shaped incision.
Dissection of neck layer by layer is essential.
Eviscerate cranial, Thoracic and Abdominal viscera
so that body is drained of blood which provides a
clean field for study of neck organs and prevents any
artifectual seepage of blood in soft tissues of neck.
Some times when sufficient asphyxia features are
not found, the cause of death is expressed as
“CONSISTENT WITH ASPHYXIA”.
 Classification of asphyxia
1. Mechanical asphyxia ;
obstruction of air passages either from within or by exerting
pressure from the out side.
2. Pathological asphyxia ;
Transfer of oxygen to lungs is prevented due to blockage caused
by a disease of respiratory tree.

3 .Toxic asphyxia ;
[Industrial hazards ] uptake of o2 is prevented in lungs due to
presence of poisonous gases ,co ..
 4. Environmental asphyxia .
 Insufficiency of o2 in inspired
air [deep wells or closed spaces ]

5. Iatrogenic asphyxia;
 Associated with anesthesia
and surgery.
 6. TRAUMATIC ASPHYXIA.
 LEVELS OF OBSTRUCTION TO TYPES OF
MECHANICAL ASPHYXIA
TYPES OF ASPHYXIA
LEVEL
 Suffocation (Smothering and  Nose and Mouth
gagging)
 Hanging  Glottis

 Strangulation and  Larynx and upper Trachea

 Throttling

 Choking  Trachea and main bronchus

 Traumatic Asphyxia  Muscles of Respiration

 HANGING
It is a form of violent asphyxia
Hanging is the suspension of a person by a
noose or ligature around the neck

Hanging can take place with victim standing,

semi-reclining or sitting position provided
pressure on neck is such that it is sufficient to
occlude blood vessels.
TYPES
 1 COMPLETE:
 Body is suspended with feet off the ground

 2 INCOMPLETE:
 With the feet touching the ground

 a. Typical Hanging,
 Knot is at occipital region
 b. Atypical Hanging,
 Knot is mostly at the side of the face.
 MECHANISM OF DEATH
 1. Vagal Inhibition by pressure over carotid sinus or
in Vagus nerve
 2. Cerebral Anoxia by compression of jugular veins
or carotid arteries.
 3. Asphyxia by lifting of glottis and tongue into
pharynx and obstructing airway.
 4. Fracture Dislocation and separation of upper
cervical segment of spinal cord (Judicial Hanging)
 5. Combination of any of the above.
 FATAL PERIOD
In Judicial hanging

death may be instantaneous from a fracture

of cervical vertebrae and associated injury
to spinal cord.
If no injury to spinal cord and blockage of
air passage is not complete then 5-8 minutes
is common fatal period.
 AUTOPSY FINDING
 Depends on mode of death.
 In Asphyxial death appearance will be:
 External Appearance:
 Head is stretched and is always inclined to the side opposite
the Knot due to gravitational force.
 Face is pale
 Eye ball is prominent (Congestion)
 Tongue may protrude (due to pressure by ligature at its base and
dark brown) (Drying)
 Saliva: Dribbling from the corner of the mouth opposite to the
side of Knot (Pressure on Salivary glands)
 P.M Lividity: on the skin of dependent arms and legs on skin
and face above ligature.
 LIGATURE MARK
 It is a pressure mark which is not continuous
and absent at the place of Knot. Appears as
groove. Direction of mark is oblique towards
the Knot, situated at the upper part of the neck
above thyroid Cartilage.
 CHARACTERISTICS depends upon type of
material used. It is well defined groove with hard
material like rope, wire or belt and definition is
diffused with soft ligature material like cloth.
 Depth:
 Is deepest at a point opposite to Knot and
gradually becoming shallower towards it.
 Abrasion and bruises of skin at the site of Knot
and bed of groove- along the edges areas of
hyperemia and a few ecchymosis.

 Ligature and Knot may be a fixed noose (Rope

Knotted) or running noose (Loop)
 It should be photographed and Knot is
preserved by cutting body noose.
 NOTE:
 Ligature mark due to hanging resist putrefaction
( due to avascularity which retards access of
bacteria and may be seen in bodies exhumed 6
days after death)
 INTERNAL APPEARANCE
 Dissection of neck layer by layer.
 In Judicial hanging much local injury: muscle
fibers may torn and posterior horn of thyroid
cartilage fractured.

 Hyoid bone may be fractured but over 40 years

(increase calcification and brittleness).
broken fragments displaced outwards
 Periostial tear only on inner side of the
bone.
 M/L SIGNIFICANCE
 Whether it is A/M or otherwise

 1. Presence of vital reaction in skin and deeper tissues

in relation to ligature mark will point to A/M hanging.
 2. Area of hyperemia and ecchymosis along the
edges of groove is a definite A/M sign and is confirmed
histologically.
 3. Autopsy should be complete to exclude other causes of
death specially poisoning.
 4. May be suicidal, homicidal or accidental.
 IN ANTEMORTEM HANGING
 1. Hyperemia of trachea and epiglottis.
 2. Lymph nodes above and below ligature mark
shows congestion and hemorrhage.
 3. Intimal tears of carotid arteries with
subintimal hemorrhage.
 4. Under ligature mark: compressed and dry
white bands of subcutaneous tissues with
petechial hemorrhage and ecchymosis.
 These findings are never seen in P-M hanging.
These findings may be slight or absent if death is
sudden due to vagal inhibition.
 JUDICIAL HANGING
Allow a drop of 5-7 feet or more to cause
fracture dislocation of cervical column. C2
and C3 or C3 and C4.
Spinal Cord is torn.
Pons and medulla injured.
Instantaneous death due to damage of
spinal cord and brain stem. Though heart
may continue to beat for 15 to 20 minutes.
 ACCIDENTAL HANGING

 May occur in sexually deviant individuals during

masochistic examination condition known as Sexual
Asphyxia or

 Autoerotic hanging
 Totally confined to men usually between puberty and
middle age. Sexual pleasure can be enhanced by partial
production of blood supply to brain achieved by some form
of hypoxia or pressure on neck.
 Once sexual gratification is achieved person come back to
normality by release of restricting apparatus but
occasionally the device malfunctions and death ensues.
Hypoxia may be induced by masks pads on the
face or envelopment in plastic but self suspension
or semi strangulation is most common mode.
May take a form of noose around the neck
( padded to avoid mark) which is attached to the
neck.
Associated with the signs of sexual activity,
transvestism, Pornography- semi nakedness etc.
Toxicological analysis may reveal recreational
drugs like Alcohol, Cocaine etc.
 LYNCHING
 Also known as lynch law
 CHARLES LYNCH [JURIST ]

 DEFINITION;
 To put to death [as by hanging ] by mob action with out
legal sanction.
 To murder [an accused person ]by mob action n without
lawful trial , as by hanging.