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Asphyxia Flashcards

1
Q

Asphyxia

A 
When the body is deprived of oxygen (<20 mmHg)
Pulselessness
Clinical triad or asphyxial stigmata:
C. Cyanosis
P. Petechiae
C. Congestion of organs
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2
Q

Tardieu spots

A 
0.1 to 2 mm
Bilateral venous congestion 
Present in neck and chest compression
M/C site: conjunctiva
Also seen in visceral pleura, skin and mucous membranes
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3
Q

Pressure at which structures around the neck are compressed

A 
Bourdel proposed pressures for obstructing these structures
J. Jugular vein - 2 kg
C. Carotid artery - 5 kg
T. Trachea - 15 kg
V. Vertebral artery - 30 kg
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4
Q

Types of suffocation

A
  1. Environmental lack of O2
  2. Choking
  3. Gagging
  4. Smothering: both choking and gagging
  5. Perthes syndrome
  6. Burking- sitting on top
  7. Overlaying
  8. Café coronary
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5
Q

Asphyxia and suffocation

A

Cause of death in suffocation is always asphyxia ➡️ purest form of asphyxia
Triad of asphyxia is always present

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6
Q

Perthes syndrome

Masque ecchymotique

A

Traumatic asphyxia
Chest is fixed
Eg., building collapse, stampede

Masque ecchymotique:
Line of demarcation (compression) b/w cyanosis and congestion above and their absence below

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7
Q

Café coronary

A

By Roger Hougew
Accidental, unexpected, sudden death
Seen in intoxication ➡️ bolus enters pharynx /larynx
➡️ vasovagal reflex
➡️ cyanosis/cough ➡️ death
Mode of death: cardiac arrest or laryngospasm

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8
Q

Wet drowning

A 
Typical drowning
Person inhaled water
Cardiac arrest M/C mode of death
Loss of pulmonary surfactant M/C cause of death
Fatal period: 5-8 min
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9
Q

Freshwater drowning

A

Hemodilution ➡️ hyperkalemia from RBCs ➡️ ventricular fibrillation ➡️ cardiac arrest
So earlier death

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10
Q

Seawater drowning

A

Hemoconcentration ➡️ hypernatremia ➡️ bradycardia

Delayed death

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11
Q

Examples of atypical drowning

A
  1. Dry drowning
  2. Delayed drowning:
    Near drowning/ 2° drowning/ post-immersion syndrome
  3. Hydrocution:
    Immersion syndrome/ submersion syndrome
    Sudden contact with cold 🥶 water
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12
Q

Dry drowning

A

Water does not enter lung
Water inside pharynx and larynx causes:
1. Vagal inhibition ➡️ cardiac arrest
2. Laryngospasm; sign of asphyxia may be present

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13
Q

Delayed drowning
Near drowning
2° drowning
Post-immersion syndrome

A 
Person dies 1-2 days after an episode of drowning
Causes:
1. Encephalopathy 
2. Metabolic acidosis
3. Electrolyte imbalance
4. Pneumonia
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14
Q

Changes seen in antemortem drowning

A
  1. Cadaveric spasm
  2. Water enters nose, mouth and lung:
    • Churning effect
    • Emphysema aquosum
    • Paltauf hemorrhagic
    • mud particles in trachea
    If unconscious, normal water goes into lung ➡️ edema aquosum
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15
Q

Churning effect

A

Seen in antemortem drowning due to mixing
Mucoid, tiny leather persistent frothing
Seen from nasal and oral orifices after death
Leads to:
1. Emphysema aquosum: 🫁 become heavy
2. Paltauf haemorrhage: subpleural haemorrhage

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16
Q

Non-mucoid frothing is seen in

A
  1. Poisoning
  2. Snake bite
  3. Decomposition
  4. Epilepsy
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17
Q

Features seen in both antemortem and post-mortem drowning

A 
1. Floatation of body:
 due to gas formation by decomposition
 In summer: 24 hrs
 In winter ❄️: 1-2 days
2. Cutis anserina: goose flesh, hair erected
3. Washerwoman hands
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18
Q

Washerwoman hands

A

Skin is puckered, granular in drowning (AM and PM)
2-3 hrs. Wrinkling
12 hrs. Bleaching
2 days. Soddening
3-4 days: cuticle peeled off like degloving

19
Q

Tests for drowning

A
  1. Gettler’s test: Cl-
  2. Mg and Sr in LR
  3. Diatom test: acid digestion technique
  4. Sehrt sign: stomach
  5. Svedhnikov sign: sinuses
  6. Sabinsky sign: spleen
  7. Wydler ring
20
Q

Gettler’s test

A

Cl- content of blood in ventricles
Freshwater drowning: 25% decrease in concentration
Seawater drowning: 25% increase

21
Q

Entry of diatoms into circulation

A
  1. Water
  2. Lung 🫁
  3. Pulmonary capillaries (diatoms <60 μ)
  4. Heart 🫀
  5. Systemic circulation
22
Q

Acid digestion technique for diatom test

A 
Best organ: femur
M/C used: sternum
Sample: dead body + water sample
15,000 species:
1. Oligohalophilic: fresh
2. Polyhalophilic: sea
23
Q

Sehrt sign
Sveshnikov sign
Sabinsky sign

A 
Sehrt sign:
 Rupture of gastric mucosa 
Sveshnikov sign:
 Water in paranasal sinuses
Sabinsky sign:
 Spleen becomes small and anemic
24
Q

Wydler ring

A 
Stomach content in drowning
Three layers:
1. Foam top
2. Liquid middle
3. Solid bottom
25
Magnesium and strontium | And drowning
When increased in left ventricle ➡️ seawater drowning
26
Hanging
Neck compression + body suspension Asphyxial death with neck compression like strangulation M/C method of suicide in India Accidental/ judicial/ homicidal
27
Suicidal methods
``` 1. Complex suicide: More than 1 suicide methods used 2. Complicated suicide: Death due to 2° unintentional trauma following original suicide method 3. Parasuicide: pseudosuicide Attempted suicide M/C cause: drug ingestion ```
28
Types of hanging
1. Complete hanging 2. Incomplete hanging 3. Typical hanging: knot at occiput 4. Atypical hanging: any other place
29
Complete hanging
Complete suspension of the body Cause of death: asphyxia Classical triad: cyanosis, petechiae, congestion are present
30
Incomplete hanging
Partial hanging If done part of the body is touching the ground Cause of death: bilateral venous congestion
31
Hanging | post-mortem changes
1. CPC cyanosis, petechiae, congestion 2. Tardieu spot 3. Protrusion of tongue sometimes 4. Semen emission- common findings 5. Ligature mark 6. Hyoid fracture: in 15-20% 7. Thyroid cartilage: less common 8. Haemorrhage of strap muscle in neck: 20%
32
Ligature mark
More specific finding of hanging seen in neck Mark is V shape, not seen over knot. Mark is above thyroid Eg of pressure abrasion/ contusion On dissecting skin- pale, glistening area is seen
33
Hyoid fracture in hanging
Seen in 15-20% of hanging cases Anteroposterior fracture aka Adduction fracture
34
Antemortem hanging
Death due to hanging 1. Maximum pressure is always on opposite side ➡️ compression of submandibular glands + stimulates pterygopalatine ganglion ➡️ dribbling of saliva 2. On the same side of knot, 👁 remains open and pupil dilated ➡️ la facies sympathique (cervical sympathetic ganglion dilation)
35
Accidental hanging
Eg sexual asphyxia, autoerotic asphyxia, Kotzwarrism This is accidental hanging Seen in perversion : M/C is masochism, transvestism By crime examination, it is differentiated from suicidal hanging
36
Judicial hanging
61 hanged after independence • Complete atypical hanging, below left angle of mandible (left aural region) • Removal of platform • It causes C2-C3 fracture/dislocation ➡️ leads to brainstem damage • With sudden loss of support- tear of carotid artery more occur ➡️ Amussat sign
37
M/C delayed cause of death in hanging
Hypoxic encephalopathy
38
Simon sign haemorrhage
Haemorrhage of intervertebral disc specially in lumbar/thoracic region Seen in hanging
39
Strangulation
Only neck compression is seen without suspension of body M/C homicidal Judicial strangulation M/C in Spain/Turkey known as Garotting/ Spanish windlass
40
Types of strangulation
1. Ligature 2. Throttling: by hand 3. Mugging: elbow 4. Bansdola: stick
41
Post mortem changes in strangulation
1. Asphyxial signs: CPC more prominent compared to hanging 2. Tardieu spot 3. Thyroid fracture: less common than hanging 4. Resistance injuries 5. Complete/Transverse ligature mark below/at the level of thyroid 6. Tissue contusion 7. Extensive haemorrhage/bruising 8. Periligature injuries, bruising 9. Hyoid bone fracture: not common
42
Prinsloo Gordon effect
Artifacts present in neck when it is not dissected last in a asphyxial death. Cranium is dissected first and neck the last to achieve a blood-less field.
43
Manual strangulation | fracture
``` Always homicidal Thyroid cartilage fracture: common at superior horn Hyoid fracture: 40-50% of cases usually at greater cornua Adduction fracture/inward compression fracture ```
44
Signs of manual strangulation other than the fractures
1. Six penny bruise: Multiple oval/circular bruises in the neck 2. In dissection haemorrhage or hematoma 3. Nail marks cause semilunar or crescentic abrasion 🌙 4. Intense cyanosis, congestion and petechiae - CPC

Forensic MBBS (7 decks)

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