Asphyxia

By Dr. Naveen
 1. Definition:
 It is a pathological changes caused
by lack of oxygen in respired air,
resulting in hypoxia and
hypercapnia.
Death is said to have occurred
due to asphyxia when, respiratory
function ceases first and initiates
the process of failure of the other
two vital systems.
 In asphyxia, there is
prevention of exchange of
air between the atmosphere
and to the lungs alveoli and
there is lack of oxygen
supply to the tissues.
 Asphyxia may be
mechanical, toxic,
traumatic or
pathological.
1). Mechanical

 (1). Constriction
around or pressure
over the neck, as in
cases of hanging,
strangulation by
ligature ,throttling.
(2). Closure of the


external
respiratory
orifices, as in case
of smothering.
 (3). Occlusion of the
respiratory passage
from inside, as in cases
of drowning, choking
and gagging.
 (4). Restriction of the
respiratory movement
caused due to
compression over the
chest, as in cases of
traumatic asphyxia and
overlying.
2).Toxic
 (1). Poisons which
depress the respiratory
centers, like –
opium,barbiturate,
CO2, H2S,chloroform,
bromides etc.
 (2). Respiratory tract
irritants, like – irritant
volatile poisons or irritant
vapors, e.g., chlorine gas,
SO2, vapors of HNO3, HCL,
ammonia gas etc.
 (3). Poisons which
affect the pick-
up,carriage, and
diffusion of oxygen at
the tissue level, like,
phosgene, CO,
(4). Lack of


oxygen in the
inhaled air.
 (5). Poisons which
causes paralysis of the
respiratory muscle like,
muscle relaxants,
cobra snake venom.
3).Traumatic
 (1). Injury to both
lungs.
 (2). Pulmonary

embolism – Fat and air

emboli may be of
traumatic origin.
4).Pathological
causes
 Infective conditions
and new growth of the
lungs or in the
respiratory tract.
2. Stages of
asphyxia
 1). State of dyspnoea .
Initially, increased CO2 level in
the blood causes respiratory
stimulation and the rate and
depth of the respiration is
increased. There is
breathlessness, feeling of
oppression in the chest and
raised blood pressure. Mild
degree cyanosis may be noticed.
 2). State of convulsion:
The level of CO2 in the blood is
further increased. The pulse rate
and the blood pressure are still
high. The neck veins are
engorged. There is marked
cyanosis. Expiratory effort is more
prominent. There is convulsion.
 3). Stage of respiratory
exhaustion:
The respiratory center is
depressed. There is gasping
respiration, the rate is much
diminished. Muscles are
relaxed, reflexes are lost or
very sluggish.

There are deep cyanosis,
widely dilated pupils. There
is fall of blood pressure,
pulse is feeble and slow.
Involuntary passage of
stool and urine may occur.
There is failure of the vital
centers and death.
3. Pathogenesis
 In acute cases, the process
of asphyxia progresses
very rapidly. The increased
CO2 tension in the blood
causes capillary dilatation
and loss of tonicity of the
vascular wall. This leads to
stasis of blood.
 On one hand, the organs
are congested and on the
other, increased
permeability of the
capillary wall due to
asphyxia causes oedema
of the organs.
 The sum effect of capillary
dilatation, stasis and
congestion is low venous
return. This further
aggravates the lack of
oxygen and increase of CO2
on the blood which in turn
exerts its effects as
 Hence, the progress
towards the final
stage is very rapid,
if the primary cause
of the asphyxia
continues.
 Stasis of blood and
distension of capillaries
cause their rupture and
leakage of blood in the
tissue. High CO2 tension
also increases the
capillary permeability
and leakage of whole
 Thus, minute
haemorrhagic spots
appear in the tissue
spaces which are
known as petechial
haemorrhagic spots or
Tardieu’s spots.
 These are pinhead size
or slightly larger
haemorrhagic spots,
more conspicuous at
the under surface of
pleura, pericardium
and epidermis.
 3. Postmortem
features
 1). External features:
(1). The postmortem
staining is bluish and
prominent.
 (2). Cyanosis is
evident at the
fingertips, nail-beds,
ear lobules and lips.
 (3). Face may be
congested.
 (4).There will be
presence of Tardieu’s
spots over the
forehead, eyelids and
conjunctiva in some
cases of violent

(5).In some cases,
depending on the mode
and process of
asphyxiation, there may
be protrusion of the
eyeballs and the tongue
and in some cases, there
is seminal discharge.

Evidence of
(6).
mode of
asphyxiation may be
present in some
cases.
 a. Presence of ligature
marks in strangulation
and hanging.
 b. Dribbling of saliva in

hanging.
 c. Abrasions and
bruises around the
mouth and nose in
case of smothering.
 d. Abrasions and
bruises on the neck in
case of throttling.
2). Internal findings
 (1). The organs are in
general congested.
Congestion is more
marked in deaths due to
asphyxia.
 (2). The lungs are
congested, oedmatous
with presence of
Tardieu’s spots at the
undersurfaces of lobes.
 (3). Tardieu’s spots are
also present at the
undersurfaces of the
pericardium and in the
brain and meninges.
 (4). Vessels contain
dark fluid blood.
 (5). According to the
specific causes of asphyxia,
there will be presence of
specific signs in different
organs like lungs, trachea
and larynx as in cases of
death due to drowning and
strangulations.
 (6). Similarly, there will be
additional findings in the
structures of the neck,
inside the mouth cavity and
the chest wall, in cases of
compression of neck,
smothering and traumatic
asphyxia respectively.