ASPHYXIA

"Asphyxia" is a term derived from

Greek that literally translates as
"stopping of the pulse."
Strangulation should not be used as a synonym for hanging. Strangulation is
defined as asphyxia by closure of the blood vessels and/ or air passages of the
neck as a result of external pressure on the neck. It is subdivided into three
main categories: hanging, ligature strangulation and manual strangulation. The
distinction between these three entities is attributed to the cause of the external
pressure on the neck — either a constricting band tightened by the gravitational
weight of the body or part of the body (hanging); a constricting band tightened
by a force other than the body weight (ligature strangulation); or an external
pressure by hands, forearms or other limbs (manual strangulation).
Hanging with a fall from height is not a typical form of hanging
and is not a subtype of strangulation. [2] Indeed, hangings after
jumping or being pushed from height (including judicial
hanging) are very different in nature from typical hangings.
Death in these cases is related to fracture-dislocation of the
upper cervical vertebrae rather than by asphyxia.
 CLASSIFICATION OF ASPHYXIA
MECHANICAL ASPHYXIA

Airway is blocked in an unnatural way either

from inside or outside.
 POST MORTEM FINDINGS
EXTERNAL
• No external findings are observed (if
soft material is applied)
• Signs of violence in form of scratches,
nail marks, bruises, and occasionally
laceration on the face, predominantly
on/around nose, cheeks, mouth, and
chin and also on arms.
• Inner side of lips, gums, and tongue
may show signs of injury.

INTERNAL
• Edema of lungs
AUTOPSY FINDINGS
• Petechial hemorrhages
There may be pale area around the
• congestion
mouth and nose due to pressure of
the object
 MEDICOLEGAL ASPECT
SUICIDAL HOMICIDAL ACCIDENTAL

Possible when the • Infants burning

victim become helpless face into the
Rare reported in by:
mental patients  Age bed clothes or
and prisoners (face  Ill health soft pillows or
buried in mattress  Incapacitate by mattress.
drink • Circumstances
or clothes) One of the commonest are suggestive.
way of child killing
 CIRCUMSTANCES
• Seen in cases of robbery with
violence.
• Keep the person silence by
having a scarf or other fabric
tied around his face.

AUTOPSY FINDINGS
• Petechial hemorrhages on face
• Cyanosis and congestion present
• Circumstances are suggestive
CAUSES • Lesion of the
a. Foreign bodies glottis or larynx
b. Dentures • Edema of acute
• False teeth hypersensitivity
• Extracted large (insect stings)
tooth • Irritant vapors,
• Blood clots inhalation of
c. Acute obstructive hot gases,
lesion infection
diphtheria
a. Food Material
• Food drawn
into the larynx
during act of
swallowing
• Regurgitated
from the
stomach
 VICTIMS MECHANISM OF DEATH

• Children below 3 • Hypoxia: Occlusion of airway

years old • Neurogenic Cardiac Arrest
• Old persons (Vaso-Vagal Shock)
• Alcoholics • Stimulation of Laryngeal mucosa
ILLUSTRATION
HANGING COMPLETE INCOMPLETE

• Some part of the body is

• It is when feet do not touching the ground.
It is a form of • Only head weight suspended.
violent asphyxia touch the ground and • Patient will die from Venous
as a result of the weight of the whole Congestion
suspension of body acts as
body by a constricting force. MATERIAL USED
ligature round • Trachea is always
the neck, the Rope, Wires, String,
compressed. Waistband, Pajama, Belt,
constricting force
being the weight
• Person will die from Cords,
Stockings,
Neck
Torn
Tie,
Bed
of the body. Asphyxia. Sheets.
 MECHANISM OF DEATH
• Obstruction of laryngeal passage
ANOXIC ANOXIA • The base of tongue is drawn upward against posterior pharyngeal
wall and folds the epiglottis over laryngeal opening

• Jugular veins are blocked by the ligature which results in stoppage

VENOUS
of cerebral circulation.
CONGESTION
• Occurs if ligature is made up of broad and soft material.

• Due to obstruction of carotids.

CEREBRAL ISCHEMIA
• It occurs when ligature is made of thin chords.
 REFLEX VAGAL
INHIBITION Leading to sudden cardiac arrest.

INJURY TO SPINAL
CORD FRACTURE
It is seen in judicial hanging (C2, C3, C4)

COMBINED ASPHYXIA
AND VENOUS Commonest cause
CONGESTION
 AUTOPSY FINDINGS
EXTERNAL GENERAL (BODY)
• Lividity marked on the skin
of dependent parts
depending upon the
positioned of the body
remained after death.
• Head inclined to opposite
side of the knot.
• If death is asphyxia, face
and head above ligature
may be congested.
• If death is instantaneous or
arteries occluded, face may
be pale.
• Tongue protruding out with
saliva dribbling out.
LIGATURE MARKS
I. APPERANCE: Depressed grooved area showing pattern of the
material used (imprint abrasion).
II. LOCATION: Upper part of neck above the level of thyroid
cartilage.
III. COLOR: EARLY – Pale, then later will become dry, hard, yellowish
brown.
IV. NUMBER: Single
INTERNAL
FINDINGS
• Injury (Bruising, rupture,
laceration of neck’s soft
structure.
• Transverse intimal tear of
carotid with extravasations
of blood in the surrounding
tissue.
• Congestion and
hemorrhages in lymph
nodes above and below
ligature marks.
• Posterior horn of thyroid
may be fractured due to
pressure exerted on
thyroid ligament
• Hyoid bone rarely
fractured but, when
fractured, it is fractured
at greater horn at the
junction of outer 1/3 with
inner 2/3.
 It is a violent asphyxia death caused by constriction /
STRANGULATION compression of neck by some means, where the constricting
force being other than the weight of the body.

GARROTING
• Victim is
AUTOPSY FINDINGS LOCUS EXTERNAL (NECK)
EXTERNAL I. LIGATURE MARK
attacked from • Appearance – Groove or
• Congestion of face above ligature
back without furrow around the neck.
well marked
warning. • Location/Level – at or below
• Grasping • Petechiae in skin face, eyelids,
the the level of thyroid cartilage.
and conjunctive well-marked.
throat by ligature • Colour – Pale, then later
• Cyanosis may be observed
and tightened it becomes Yellowish brown,
• Face swollen, eyeballs bulging,
quickly. dry, hard, and parchment like.
• Rapid loss of and tongue protruded.
• Bleeding from nose and ears also
consciousness.
seen.
• CHARACTER: Soft Ligature Material – No
mark or very light
Rough Strong Material – Patterned mark
with severely abraded skin and
hemorrhages.
• DIRECTION – Mark is horizontally placed
encircling the neck completely. More
prominent on the front and sides than back or
due to interposing hair, clothes.
• NUMBER – May be single or more than one.
Multiple turns may cause multiple marks.
• Fracture of thyroid cartilage at both
superior horn seen
MEDICO-LEGAL ASPECTS
Strangulation whether Ante or Post Mortem
• Ante mortem evidence of violence
– Injuries having vital reaction
(inflammation, bruises, ecchymosed
hyperemia zones)
– Signs of struggle or resistance

INTERNAL FINDINGS
• Bruising of the neck muscle
• Severe engorgement with the hemorrhages
into tissue and above the area compressed
• Hyoid bone is not fracture
METHODS FOR HOMICIDAL STRANGULATION OTHER THAN LIGATURE

MUGGING BANSDOLA

Holding neck of the victim Neck is compressed between

two bamboo sticks or any
in the bend of elbow goof other hard object, one placed
and knee anterior and other posterior
TOXIC ASPHYXIA This form of asphyxia results from poisonous substances.

When a person smokes, snorts or injects an opioid, the substance

enters the bloodstream, then the brain. Once the drug binds to those
opioid receptors and activates them, it sets off a cascade of
psychological and physical actions; it produces euphoric effects, but it
also produces respiratory-depressing effects. As a result, victims of a
OPIUM fatal overdose usually die from respiratory depression—literally
POISONING choking to death because they cannot get enough oxygen to feed the
demands of the brain and other organ systems. When the drug binds
to the mu-opioid receptors it can have a sedating effect, which
suppresses brain activity that controls breathing rate. It also hampers
signals to the diaphragm, which otherwise moves to expand or
contract the lungs. Opioids additionally depress the brain’s ability to
monitor and respond to carbon dioxide when it builds up to
dangerous levels in the blood. It’s just the most diabolical way to die,
because all the reflexes you have to rescue yourself have been
suppressed by the opioid.
 Carbon monoxide is harmful when breathed because it
displaces oxygen in the blood and deprives the heart,
CARBON brain and other vital organs of oxygen. Large amounts
MONOXIDE of CO can overcome you in minutes without warning —
causing you to lose consciousness and suffocate.

The effects of cyanide ingestion are very similar to the effects of suffocation.
The mechanism of toxicity occurs because cyanide stops the cells of the body
from being able to use oxygen, which all cells need to survive.
CYANIDE Cyanide leads to histotoxic hypoxia by poisoning the systems that utilize
oxygen to create energy and preventing them from using the oxygen. Even
though there is plenty of oxygen there, the cells experience a lack of oxygen
and are affected as if there was too little/no oxygen available.
 ENVIRONMENTAL Insufficient oxygen in inspired air or breathing in
ASPHYXIA vitiated atmosphere

HAPE (High-altitude
HIGH ALTITUDE pulmonary edema): HAPE
produces excess fluid on
The human body can adapt to the lungs, causing
high altitude through both breathlessness, even when
immediate and long-term resting. You feel very
acclimatization. At high altitude, fatigued and weak and may
in the short term, the lack of feel like you're suffocating.
oxygen is sensed by the carotid HACE (High-altitude
bodies, which causes an cerebral edema): HACE
involves excess fluid on the
increase in the breathing depth
brain, causing brain
and rate (hyperpnea).
swelling.
 TRAUMATIC
ASPHYXIA

Is a form of Asphyxia
resulting from trauma to
the chest, or pressure on
the chest and back,
which prevents
respiratory movements.
 Cervical Nerve Functions

•C1, C2, and C3 (the first three cervical nerves) help

control the head and neck, including movements
forward, backward, and to the sides. ...

•C4 helps control upward shoulder movements.

Carotid sinus reflex death is a

potential etiology of sudden death •Cerebral ischemia is a condition in which a blockage
in which manual stimulation of the
in an artery restricts the delivery of oxygen-rich blood
carotid sinus allegedly causes
to the brain, resulting in damage
strong glossopharyngeal nerve
to brain tissue. Cerebral ischemia is sometimes
(Vagus nerve is for aortic arch
called brain ischemia or cerebrovascular ischemia.
baroreceptors) impulses leading to
terminal cardiac arrest.