ASPHYXIA

Dr. (Mrs) BUDDHIKA WERASUNDERA Faculty of Medicine 2005

LEARNING OUTCOMES
At the end of the lecture the student should be able to, Define Asphyxia Describe different types of Asphyxia, general features of Asphyxia. Analyse and Interpret postmortem technique and findings. Perform a medico legal investigation of a body found hanging.

ASPHYXIA
Stoppage of the pulse Suspended animation owing to any cause interfering with respiration

HYPOXIA
Reduction of O2 in the cells

ANOXIA
Lack of O2 in the cells/ tissues

ANOXIA - Types
ANOXIC ANOXIA - mechanical obstruction/ suffocation ANAEMIC ANOXIA- O2 in lungs but cannot reach tissues (Hb is altered- CO poisoning) STAGNANT ANOXIA O2 in blood. Cant reach tissues.(Heart failure) HISTOTOXIC ANOXIA O2 in blood. Reaches tissues but cannot be used. (Inactivation of enzyme CN poisoning)

MODES OF ASPHYXIA
LEVEL OF NOSE/ MOUTH Smothering, Gagging, Overlying LEVEL OF AIR PASSAGES Choking, Drowning LEVEL OF NECK Manual strangulation, Ligature strangulation, Hanging, Mugging, Garrotting OTHERS Traumatic, Postural, Burking, Sexual

CLINICAL FEATURES OF ASPHYXIA

STAGE 1 Increase respiration, pulse, BP,Cyanosis and congestion of face

STAGE 2 Decrease respiration, pulse, BP, confusion, inco-ordination, Congestion and cyanosis deepens
STAGE 3 Irregular respiration, pulse, LOC, vomiting, fits

PATHOPHYSIOLOGY
(Anoxia/ Hypercarbia) Hypercarbia Increased secretion of fibrinolysin by vascular endothelium Anoxia Capillary dilatation, increased blood in tissues, congestion Anoxia Increase capillary permeability, oedema

PATHOPHYSIOLOGYcont.
Loss of fluid, haemoconcentration, stasis of blood, Increased intra capillary pressure, rupture, peticheal haemorrhage
Anoxia Disruption of capillary endothelium, further peticheal haemorrhages Anoxia dysfunction of organs and cessation of activity of organs, death

POST MORTEM FINDINGS

DUE TO ANOXIA Cyanosis, congestion, oedema, peticheal haemorrhages

DUE TO AGENT Ligature mark, finger nail mark, foreign bodies, abdominal/ thoracic trauma
DUE TO CIRCUMSTANCES Assault, sex. Offence, struggle, convulsions.

SMOTHERING
Mechanical obstruction by closure of nose and mouth Mechanism Asphyxia Circumstances Homicidal, Accidental, Suicidal Autopsy V + Facial Findings Features of Asphyxia + Agent

GAGGING
Mechanical obstruction by a gag of cloth or paper stuffed into the mouth Mechanism Asphyxia Circumstances Homicidal Autopsy facial Findings Features of asphyxia, + Agent + Other injuries

OVERLYING
Mechanical obstruction to respiration when part of another body obstructs the nose and mouth Mechanism Asphyxia Circumstances Accidental Autopsy Facial Findings Asphyxia + Agent

CHOKING
Mechanical obstruction to respiration with a solid foreign body obstructing the larynx or trachea Mechanism Asphyxia, Vagal inhibition Circumstances Accidental Findings Features of asphyxia +/+ Agent

MUGGING
Mechanical obstruction by compression of the neck at bend of elbow Mechanism Asphyxia, Vagal inhibition Circumstances Homicidal, Accidental Autopsy V Findings Features of asphyxia +/Agent, assault

TRAUMATIC ASPHYXIA
Respiration is prevented by external pressure on the chest and abdomen Mechanism asphyxia Circumstances Accidental, Homicidal Findings Features of asphyxia, agent, Circumstantial

BURKING
Respiration is prevented by sitting on the chest and closing the nose and mouth with both hands. Mechanism asphyxia Circumstances homicidal Findings Traumatic asphyxia and palmar strangulation

GARROTTING
Tightening of a noose around the neck by twisting a rod within the ligature, a form of judicial execution once employed in Spain

SEXUAL ASPHYXIA
Partial cerebral ischaemia produces erotic sexual fantasies. Men are usually involved Ishaemia attained by pressure on the neck, plastic bag, galvanic stimulation Secluded place, body nude, bonding + /- Pornography

POSTURAL ASPHYXIA
Occurs when the head and upper half of body is at a lower level than the rest of the body Mechanism Shifting of abdominal contents up, Asphyxia Circumstances Accidental (Alcoholics, Suspension in custody)

MEDICO LEGAL INVESTIGATION OF ASPHYXIAL DEATH

History Visit to the scene Identification Preliminaries Photo, Xray, trace material Clothing External Examination General, specific Internal Examination Lab Ix Documentation

MANUAL STRANGULATION (Throttling)

MANUAL STRANGULATION
Circumstances Homicidal Mechanism Asphyxia, Vagal inhibition Autopsy Xray neck, V dissection Findings Features of Asphyxia+/Agent External,Internal Circumstantial Struggle, Sexual assault, Assault. Lab Ix Nail scrapings, trace material, Toxicology, Histology.

STRANGULATION BY LIGATURE
Mechanical obstruction to respiration by constriction of the neck using a ligature Mechanism Asphyxia, Vagal inhibition Circumstances Homicidal, Accidental, suicidal Autopsy V dissection

STRANGULATION BY LIGATURE cont.

Findings Features of asphyxia Agent : External (Ligature,Ligature mark, asphyxial features marked above ligature) Internal (Contusions, fractures, dislocations, haemorrhages, corresponding to ext. injuries) Circumstantial injuries Lab Ix Trace material, Tox, Histo.

HANGING
Mechanical obstruction to respiration is brought about by constriction of the neck by a ligature where the constricting force is either the entire weight or part of the weight of the body. Complete/Full, Partial Typical/Atypical

CIRCUMSTANCES
SUICIDAL ACCIDENTAL HOMICIDES JUDICIAL POSTMORTEM

MECHANISM OF DEATH
VAGAL INHIBITION CEREBRAL ISCHAEMIA CEREBRAL VENOUS CONGESTION ASPHYXIA SPINAL CORD INJURY

AUTOPSY
V Dissection
FINDINGS Depending on mechanism (Vagal inhibition, cerebral ischaemia, venous congestion, asphyxia, spinal cord injury)

AGENT Ligature, Knot,Turns of ligature, Ligature mark, Shape of ligature mark, Above the ligature

AUTOPSY cont.
INTERNAL No injuries or minimal injuries Underlying ligature and the markcontusions, haemorrhages, ligament tears, fractures, dislocations, intimal tears in blood vessels, spinal cord injury Circumstantial Hypostasis on legs, engorged penis, injuries in convulsions and others.

AUTOPSY cont.
LAB INVESTIGATIONS Trace material (Fibre) Drugs/ Alcohol Histopathology of ligature mark.

MEDICO LEGAL INVESTIGATION OF A BODY FOUND HANGING

HISTORY

VISIT TO THE SCENE (Place, Total/ Partial,Point of suspension,support used to reach, distances, Position of head, Hypostasis, Cooling of body, Suicide note, Disturbance of scene, Evidence of sexual asphyxia

MEDICO LEGAL INVESTIGATION OF

A BODY FOUND HANGING cont IDENTIFICATION OF THE BODY PRELIMINARIES Photo, Xrays, Trace material CLOTHING - Naked, female attire, Disturbed GENARAL EXTERNAL EXAMINATION

MEDICO LEGAL INVESTIGATION OF A BODY FOUND HANGING cont.

SPECIFIC EXTERNAL EX Ligature, length of ligature around neck, other ligature measurements, number of ligatures, number and type of knots, ligature mark, other injuries, features of asphyxia. INTERNAL Ex V look for any injuries Lab Ix COD and opinion

DROWNING
Death following immersion or submersion in a fluid medium which is usually water. The entire body need not go under water CIRCUMSTANCES Accidental, Suicidal,Homicidal, Postmortem disposal.

MECHANISMS OF DEATH
NON ASPHYXIAL Vagal inhibition, hypothermia ASPHYXIAL Laryngeal spasm, Oedema aquosum, Emphysema aquosum, Others (Haemodilution, Haemoconcentration)

AUTOPSY FINDINGS
Depends on, MECHANISM OF DEATH VI Negative. Signs of immersion+ LS Asphyxia+. Signs of immersion+. No. fluid in respiratory passages OED. AQ Asphyxia+, Signs of immersion+, Fluid in respiratory passage, Pul oedema+, Little froth.

AUTOPSY FINDINGS cont

EMP. AQ Asphyxia+, Signs of immersion+,Froth in res. passage, Over distended pale lungs with rib indentations.

+
Medium(Fresh, polluted, stagnant) Objects in water Fauna Period of immersion. (Washerwomans hands)

LABORATORY INVESTIGATIONS
Toxicology Comparison of foreign matter (Res/medium) Chemical analysis of water (Res/medium) Histopathology Diatom studies (microscopic algae with a silicon exoskeleton. Resists digestion. Deposited in end organs) Problems?

MEDICO LEGAL INVESTIGATION OF A BODY RECOVERED FROM WATER

2 Questions: Was the person DEAD when entering water? Signs of immersion+, Natural or Un natural COD Was the person alive when entering water?Cadaveric spasm, Features of drowning, presence of foreign matter beyond bronchiole, + diatom studies, signs of immersion.

OTHER COD IN WATER

Natural diseases Injuries Hypothermia Electrocution domestic bath Neurogenic shock hot water bath Vagal inhibition alcoholic intoxication

WHAT PLACE IN THE WATER MEDIUM DID HE DIE?

Eye witness accounts Recovery of clothes and personal effects Diatom studies Foreign material in respiratory passage Chemical nature of water Nature of animal attacks

CIRCUMSTANCES
ACCIDENTAL SUICIDE HOMICIDE POSTMORTEM DISPOSAL OTHERS Cremation, Disposal when death in deep sea.

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