Asphyxial Death

Asphyxial Death

Professor Gopal Krishnan Reddy M.D.Head Of DepartmentDepartment of forensic medicineKathmandu medical college

Asphyxia A condition, where supply of oxygen to the tissues has been reduced appreciably below normal working level, due to interference with the process of respiration.

Gordon in 1944, defines asphyxia as, where death is due to mechanical obstruction in the process of respiration. Features of asphyxiaCyanosisPersistent fluidity of bloodVisceral congestionPetechial haemorrhagesCapillary dilatationCapillary stasisPulmonary oedema Pulmonary haemorrhages

Classification:

Lack of oxygen in surrounding air:-suffocationObstruction in the external orifices:- smoothering , overlayingObstruction in internal airway:- gagging , chokingObstruction at the leval of neck hanging, strangulation, muggingOccupation of airway by any fluid:- drowningPressure in the chest:- traumatic asphyxia Suffocation It is a violent form of asphyxial death, where respiration is obstructed distantly out from natural air orifices.

eg:- plastic bag ariund the face and neck and lack of oxygen in immediate atmosphere.Medicolegal importance(MLI)It is commonly accidental and rarely suicidal and homicidal.Postmortem features:Externally no definite signs in the body.Plastic bag or some other objects around the place.General features of asphyxia present.Grossly congested internal viscera.Smoothering It is a mode of violent asphyxial death, where air entry to lungs is prevented by obstruction of the external airway like mouth and nostrils.MLI:-Homicidal smoothering: very commonSuicidal smoothering: very rareAccidental smoothering: drunk people and epilepticsPostmortem features:Externally fingertip bruises and finger nail abrasions over face.Contusions or lacerations in inner lips.Congested face.Internally bruising under external marks and grossly congested internal organs.Overlaying Something overlays and closes mouth and nostrils.Infant during nights by mothers breast while feeding.Small children by adults body parts during sleep.Unconscious persons.[ It is always accidental. ]Gagging some objects pushed deep into oral cavity(gag).MLI:It is almost always homicidal sometimes may be accidental.Newborn babies and elderly people are killed by this way.Postmortem features:Minimal injuries like abrasions and contusions in and around the mouth.Presence of gag inside oral cavity.Choking Air entry in lungs is prevented by some foreign body at the level of laryngeal opening and downward.MLI: Always accidental.Postmortem features:Externally general signs of asphyxia.Vomitus mass and food bolus present internally.

Cafe coronary is the best example and common situation.- Cafe coronary is a condition in which a healthy but grossly intoxicated person(resturant person), who begins a meal suddenly turns blue, coughs violently, then collapses and dies, without much fuss. Death appears due to suuden heart attack.HangingIt is a mode of violent asphyxial death, caused by suspension of the body by a ligature that encircles the neck, the constricting force being the weight of the body.The constricting force is full (complete hanging) or part of body weight (partial hanging).

MLI: All hanging deaths are taken as suicidal unless proved otherwise.

Medicolegal aspects:SuicidalAccidentalHomicidalJudicial Mechanism of death:Asphyxia Cerebral hypoxiaCerebral anoxiaVagal inhibition of heartCombination of above mechanismsFracture dislocation of cervical vertebra judicial hanging. 2 kg of pressure is enough to occlude the jugular vein. Points which are favour of suicidal hanging:-Closed room from insideSuicidal notePoint of suspension is accesible to victimNo injuries or poisioning to incapacitate the victimMinimal or no disturbances at sceneNo other causes of deathPostmortem findings:External findings:-Neck: may be stretched in prolong suspension-Face: plae and flaccid, may be congested-Eye: opened eyelids, conjunctiva congested, pupils dilated, protruded eyeball-Finger nails: cyanosed-Tongue: protruded-Frothy mucous collection in mouth & nose-Dribbling of saliva from lower angle of mouth(surest sign of antemortem hanging)-Relaxation of sphincters may cause involuntary discharge of faeces, urine, semen.-Hypostasis: above ligature, lower limbs,hands-Rigor mortis: slow onset-Ligature mark on neckInternal Findings:-Muscles: Platysma & sternocleidomastoid may be ruptured.-Thyroid cartilage: may be injured-Carotid artery: inner coat may be lacerated/rupture-Cervical vertebra: fractured & dislocated, commonly C2 & others are C1,C3,C4-Epiglottis: congested-Trachea & larynx: mucosa congested

Contd..-Lungs: congested,exude dark coloured frothy blood on section, sub-pleural air vesicles are ruptured, producing subpleural emphysema.-Heart: Rt.side full of dark fluid blood.Pulmonary artery & venacava engorged.

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