Asphyxia

(ASPHYXIA)


Hypoxia means (low oxygen) while anoxia
means (without oxygen)

Types of anoxia:
(1) Anoxic anoxia:
- Ambient.
- Central.
- Paralytic.
- Mechanical (violent asphyxia)
- Obstruction of the blood flow to the lungs.
(2) Anemic anoxia:
- Chemically combined hemoglobin.
- Hemolysis.
- Hemorrhage.
(3) Stagnant anoxia.
(4) Histotoxic anoxia.

Stages of mechanical anoxia or violent

asphyxia:
Three stages:
(1) Stage of forced respiration:
- It is due to stimulation of the respiratory center.
- Clinical picture: DYSPNEA

(2) Stage of convulsions:

- It is due to cerebral irritation.
- Clinical picture: CONVULSIONS, CYANOSIS, HYPERTENSION, LOSS OF
CONSCIOUSNESS, CONSTRICTED PUPILS.
(3) Stage of paralysis:
- Clinical picture: LOSS OF CONSCIOUSNESS, FLACCID MUSCLES & LOST
REFLEXES, DEEP CYANOSIS, DILATED PUPILS, IRREGULAR BREATHING (CheyneStokes respiration).
**Death occurs in about 5 minutes..

General postmortem picture of

mechanical anoxia:
- Deep cyanosis.
- Proptosis of the eye balls.
- Bloody froth from the nose and mouth.
- Congested face with petechial hemorrhage all
over.
- Dark violet or blue extensive hypostasis.
** All these are external signs
N.B: Blood is dark and fluid in consistancy due to
increased CO2 and fibrinolysis respectively.


(Congestion)
(Cyanosis)
(Peticiae) (Fluidity of blood)
** **

5 %

(Fibrinolysis)


1. SUFFOCATION
2. STRANGULATION
3. CHEMICAL ASPHYXIA

1. SUFFOCATION


1.1 Entrapment or environmental suffocation

1.2 Smothering

1.3 Choking

1.4 Mechanical asphyxia

1.5 Mechanical asphyxia combined with smothering

1.6 Suffocating gas

1.1 Entrapment or environmental suffocation

Homicidal, suicidal or accidental

20.9%
5%

1.2 Smothering

Smothering
Definition:
It is the mechanical anoxic death caused by occlusion of the external
respiratory openings by the hand or soft objects.

Causes of death:
Mechanical anoxia

Postmortem picture of smothering:

(1) General
(2) Special features
- Multiple contusions and fingernail abrasions.
- Contusions in the buccal mucosa.
- Ventral hypostasis in cot death.

** Homicidal, suicidal or accidental

Postmortem picture of smothering:

(1) General
(2) Special features
- Multiple contusions and fingernail abrasions.
- Contusions in the buccal mucosa.
- Ventral hypostasis in cot death.

** Homicidal, suicidal or accidental

1.3 Choking
Causes of death:
- Reflex cardiac inhibition
- Mechanical anoxia

Types:
- Pathological
- Non-pathological

**Homicidal, suicidal or accidental

CAF CORONARY

1.4 Mechanical asphyxia

Postmortem picture
(1) General
(2) Special features
- Contusions and abrasions of the chest and abdomen.
- Fracture ribs.
- Rupture of internal organs.
- Line of demarcation between the discolored upper part of
the body and the lower part.

** Homicidal, suicidal or accidental

1.5 Mechanical asphyxia combined with smothering

Burking

1.6 Suffocating gas

( )

2 - 3

2. STRANGULATION

2
(carotid arteries)
(vertibral arteries)

jugular vein
vertibral vein

2. STRANGULATION

jugular vein

2
carotid arteries

5
vertebral arteries

30
vertebral vein



5

2. STRANGULATION





(hemorrhage) (petichia)




10
10-12

2. STRANGULATION
2.1 (hanging)
2.2 (ligature strangulation)
2.3 (manual strangulation)

2.1 (hanging)





(
)

( )

Post-mortem picture:
(1) General
(2) Special features
- Protrusion of the tongue.
- Dribbling of saliva.
- Hypostasis of the lower half of the body.
- Neck signs:
.Elongated and the head is tilted to the opposite side of
suspension point.
.Ligature marks (HIGH UP in the neck, OBLIQUE,
INCOMPLETE, has an IMPRINT of the ligature).
** Homicidal, suicidal or accidental

Types of hanging
Point of comparison

COMPLETE HANGING

INCOMPLETE HANGING

Other name

High point hanging

Low point hanging

Touching the ground

Negative

Positive

Circumstances

Presence of a near-by table or

chair

Negative

Main cause of death

Cerebral ischemia

Asphyxia

Face

Less congested, sometimes

pale

Markedly congested

Hypostasis

Lower half of the body

According to the part touching

the ground

Type of knot

Fixed knot or running noose

Always running noose

Rope marks

-Incomplete with fixed knot

-Above thyroid cartilage
-Oblique
-Deep and fades gradually
towards suspension point

-Complete
-Below thyroid cartilage
-Transverse
-Deep all through

Dribbling of saliva

Positive

Negative

Tear in carotid intima

Positive

Negative

Hyoid bone

If fractured: outwards

If fractured: inwards

2.2 (ligature strangulation)

20%
42%

Strangulation
Definition:
It is the mechanical anoxic death caused by
constriction of the neck by a ligature occluding the
air passages from outside.

Causes of death:
- Mechanical anoxia.
- Reflex cardiac inhibition.
- Delayed edema of the glottis and choking.

Postmortem picture of strangulation:

(1) General
(2) Special features
All are neck signs:
- Ligature marks:
. Low in the neck below the thyroid cartilage.
. Transverse.
. Complete.
. Deep all through.
. Abrasions and contusions taking the shape of the ligating material.
- Inward fracture of the hyoid bone and the thyroid cartilage may be
fractured.
- Contusions and lacerations of the neck muscles.

**Homicidal, suicidal or accidental

2.3 (manual strangulation)

90%

Postmortem picture:
(1) General
(2) Special features
All are neck signs
- Multiple contusions and fingernail abrasions.
- Inward fracture of the hyoid bone (it is the most common
cause of hyoid bone fracture) and fracture of the thyroid
cartilage.
- Contusions of the deep tissues of the neck.

** Homicidal, suicidal or accidental

3.
(chemical asphyxia)



3.1 (carbon monoxide CO)
3.2 (cyanide)
3.3 (hydrogen sulfide H2S)

3.1 (carbon monoxide CO)

CO 300
CO


CO 5 ppm
CO 5%
5 - 6%
13%


3.1 (carbon monoxide CO)
CO
0.02-0.03%
23-30%
5-6

0.04-0.06%
36-44%
4-5


0.07-0.10%
47-55%
3-4
0.11-0.15%

0.15-0.20%
0.21-0.30%
0.30-0.50%
0.50-1.0%

55-60%

61-64%
64-68%
68-73%
73-76%

1.5-3

1-1.5
30-45
20-30
2-15

3.1 (carbon monoxide CO)

CO
CO

CO 4%
CO

CO
toxicity ?

 CO 60%
CO 8%

3.2 (cyanide)
HCN,KCN,NaCN



HCN 75-100
KCN,NaCN 200 1/20

(
)
11
CO
bitter almond

3.3 (hydrogen sulfide H2S)

H2S 0.015%
H2S 0.1 - 0.2%
H2S


0.9 - 3.8 1


(sexual asphyxia)

Drowning

Definition of drowning

respiratory distress

Pathophysiology
Drowning 3
-> CO2
->

respiratory distress

Type of Drowning
Typical drowning
Wet drowning

Atypical drowning
Dry drowning
Secondary drowning/Near drowning
it refers to death at a later stage, after removal from water.
Complications of submersion may be, pulmonary or cerebral
edema, Metabolic acidosis, infection from water

Immersion syndrome
vagus nerve

Typical drowning
it is also known as " wet drowning
obstruction of the air passage and the lung
by inhalation of fluid
Different pathophysiological changes occur when
fresh or salt water is inhaled
typical signs of drowning are present in autopsy

Type of Drowning
Typical drowning
Wet drowning

Atypical drowning
Dry drowning
Secondary drowning/Near drowning
it refers to death at a later stage, after removal from water.
Complications of submersion may be, pulmonary or cerebral
edema, Metabolic acidosis, infection from water

Immersion syndrome
vagus nerve

Dry drowning

vagus nerve laryngeal spasm

asphyxial stigmatas

Finding in drowning
External finding
Internal finding

External finding
Body - cloths may be wet.
Forth White, fine, leathery, abundant forth
from nose & mouth Hypostasis

 Cadaveric spasm, the last act of life is surest

sign of antemortem drowning ( aquatic plants,
sand etc may be hold in the grip.)
Washer womans hands & feets.

 Follicular muscle rigidity -> cutis anserina or

goose skin

Post mortem injuries due to aquatic animals

(bite) may be seen In stagnant water, P.M. lividity
may be seen on, head, face & anterior part of
chest P.M. lividity may not be seen in running
water

Internal finding
Respiratory passage contains, sand, water, forth,
algae etc
Lungs are enlarged due to water
During P.M. examination, on cutting the ribs &
sternum, lungs bulge out of the chest cavity i.e.
ballooning of lungs

 Large patches of hemorrhages may be seen on lungs,

due to rupture of alveolar walls
Presence of water in esophagus, stomach & intestine
Water is also present in the middle ear

 Presence of Diatoms in remote body parts like

, brain, bone marrow, liver, etc
Sure signs of drowning, Could still be
identified in putrefied bodies, Could give an
evidence of the site of drowning (fresh or salt
water species).

Thank you for your attentions.