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Asphyxial Death Flashcards

Page 41

1
Q

Define “Asphyxia”

A
  • State of lack of oxygen and XS carbon dioxide
  • Such as hypoxia / hypercapnia
  • resulting in loss of consciousness or death
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2
Q

What are the Causes of Mechanical Asphyxia?

A

1) Neck Compression

2) Restriction of Respiratory Movement of Chest + Abdomen

3) Airway Obstruction - via smothering / drowning

4) Exhaustion or Displacement of Environmental 02

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3
Q

What are the Classical Signs of Asphyxia Classified into?

A

1) Non-Specific

2) Specific

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4
Q

What are the Non-Specific Signs of Asphyxia?

A
  • Congestion / Cyanosis of the face - due to venous congestion (return to heart)
  • Petechial Hemorrhages / Tardeu’s Spots - due to arteriole damage, from ischemia
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5
Q

What are the Specific Signs of Asphyxia?

A
  • Ligature Mark - from hanging / strangulation
  • Fingernail Abrasion - from manual strangulation
  • Fluid in the air passages + stomach - due to drowning
  • Foreign Body in the Larynx
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6
Q

Define “Neck Compression”

A
  • Circumferential Squeezing of the Neck
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7
Q

What are the 3 Types of Neck Compression?

A

1) Manual Strangulation

2) Ligature Strangulation

3) Hanging

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7
Q

What are the Internal Signs of Neck Compression?

A
  • Larynx Injury - fractures of the hyoid / thyroid - ONLY in Manual
  • Laryngeal Bleeding
  • Intramuscular Bleeding
  • Intimal Carotid Artery Laceration, aka Amussat’s Sign from stretching - ONLY in Hanging
  • Simon’s Bleeding = Stripe-like Hemorrhages on Ventral Surface of Inter-V Discs from stretching - ONLY in Hanging
  • Hangman’s Fracture = Fracture of Cervical Vertebrae from stretching - ONLY in Hanging
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7
Q

What is the Mechanism of Death in Neck Compression?

A

1) Airway Occlusion

2) Occlusion of Neck Veins - showing the classical signs

3) Occlusion of Carotid Arteries - showing cerebral anaemia / coma

4) Reflex Vagal INHIBITION aka Nerve-Effect - due to compressing carotid sinus

5) Fracture / Dislocation of the Cervical Vertebrae

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8
Q

Define “Manual Strangulation”

A
  • It is asphyxia caused by neck compression from human hands or other parts of the body
  • ONLY HOMICIDAL
  • Possibly ACCIDENTAL - from Erotic Asphyxiation
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9
Q

What are the External & Internal Signs of Manual Strangulation?

A
  • Bruises from the finger tips
  • Fingernail Abrasions
  • Bruising around the fascia / muscles of the thyroid
  • Haemorrhages of the pharynx / tonsils / base of tongue
  • Fractures of the Hyoid Bone / Thyroid Cartilages
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10
Q

Define “Ligature Strangulation”“

A
  • It’s asphyxia due to full / partial compression of neck circumference
  • By a ligature tightened by an EXTERNAL force
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11
Q

What are the Attributes of a Ligature Mark?

A
  • Skin over mark is dry + hard
  • Base of Mark = Pale, with abrasions of edges
  • Encircles the neck horizontally at the neck’s midsection
  • Crossing above / below the prominence of larynx - passing back to the nape of neck
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12
Q

Define “Hanging”

A
  • Neck Compression, by a ligature constricted by body’s own weight
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13
Q

What are the 2 Types of Hanging?

A

1) Typical = where noose runs from mid-line above thyroid cartilage symmetrically upwards on both sides of neck to occipitial region

2) Atypical = where body’s partially suspended

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14
Q

How to DIFFERENTIATE Hanging, from Strangulation?

  • Positional Hanging
A
  • Hanging is situated HIGHER on neck, usually being directly under the chin anteriorly
  • Passing around beneath the jaw-bones and rising up at the sides / back of the neck
15
Q

What are the Main Objects of the Forensic Autopsy?

A

1) Whether / not the death was due to Strangulation?

2) IF SO, was it homicidal / accidental / suicidal?

16
Q

What are the Features of Hanging?

A
  • OBLIQUE Position
  • Amussat’s Sign, Simon’s Bleeding & Hangman’s Fracture - all PRESENT!
17
Q

What are the Features of Ligature Strangulation?

A
  • TRANSVERSE Position
  • ABSENT Signs
18
Q

What is Accidental Hanging commonly associated with?

A

ABNORMAL Sexual behaviour, aka Autoerotic Asphyxia

19
Q

What are the Features of Sexual Asphyxia?

A
  • Mechanism = Production of Cerebral Hypoxia
  • Done by Ligature Strangulation, which can be voluntarily tightened / loosened
  • Use of anaesthetic agents - “huffing”
  • Placing head in a plastic bag
20
Q

Define “Traumatic Asphyxiation”

A
  • Restriction of the respiratory movements of chest + abdomen
  • Due to mechanical fixation and inability to use the muscles needed, for breathing - such as diaphragm + intercostal muscles
21
Q

What are the Features of Traumatic Asphyxia?

A
  • Mechanical Fixation of Chest / Abdomen
  • Non-Specific Signs of Asphyxia
  • Face + Neck are grossly discoloured
  • Eyes / Sclera are engorged w/ blood
  • Chest Injuries - such as fractures of ribs + sternum, and lung laceration, or diaphragm rupture
22
Q

Define “Airway Obstruction”

A
  • Aka, “Smothering” - which is obstruction of external orifices by hand / other materials.
  • Victims are mainly children + women
23
What are the **External Signs** of **Smothering**?
- **Abrasions / Bruising** around the **nose + lips** - **Abrasions / Bruising / Lacerations** on the **Lip Mucosa** - **Broken** Teeth - **Fractured** Nose
24
Define - **"Cafe Coronary"**
- Aka, **"Accidental Smothering"**, or **"Choking"** - Which is the obstruction **by a foreign body** in the **respiratory tree** - tends to be **food** - The bolus tends to stop at **larynx, carina or right bronchus** - **Could be HOMICIDAL** - mother's choking newborns, **causing Baby Blue's Syndrome**
25
Which **Types of People** are **more prone to Choking**?
- Those with **impaired swallowing reflex** - due to **stroke, or alcohol intoxication** - **Elderly** with **barely any teeth** - **Children** - Those with **mental disabilities / psychiatric disorders**
26
Define **"Drowning"**
- Obstruction of airways, **due to liquids**
27
What are the **2 Types** of **Drowning**?
1) **Freshwater** = Causes **Hemodilution** and **RBC Lysis (breakdown)**, leading to **Hyperkalemia (K+)** and **Hyponatremia**, thereby **dissolving the surfactant** and the **alveolar collapsing** 2) **Seawater** = Causes **Hemoconcentration** - where **40% water** is pulled from circulating blood and **into the alveoli** causing **severe pulmonary oedema**
28
What are the **External Signs** of **Drowning**?
- Wet Clothing - **Moist, Clammy** Skin - **Bright Pink LIVIDITY** - **Goose** Skin - **Bleaching + Wrinkling** of **Palms + Soles** - occurs **AFTER 24 - 72h** - **Frothing** - caused by **XS mucus secretion, from water irritation**
29
What are the **Internal Signs** of **Drowning**?
- **STIFF Foam** in the **airways** along with **grit, gravel + mud** - Water in **air passages + stomach** - **PALTAUFF'S Hemorrhages** = They're LARGE **Subpleural** Hemorrhages - **Emphysema Aquosum** = Heavy, spongy lungs - Water in **middle ear** - **Diatoms** = **Algae / Plankton** is found in the **bloodstream, BM + various organs**
30
Define **"Suffocation"**
- It is **Exhaustion / Displacement** of **Environmental 02** - Due to **enclosure** in a **very narrow confined space** - such as **fridge**
31
What are the **Attributes** to **Suffocation**?
- **HIGH** Altitudes - **Decompression** in **Airplanes** - **RAPID Chemical Changes**
32
Define **"Positional Asphyxia"**
- When **victim's position** interferes with **adequate breathing** by causing **partial / complete airway obstruction** - Usually an **ACCIDENTAL** Case - Found in **inverted / head-down position** for an **extend time period** = this **suppresses respiration + circulation** - Associated with **drunkenness** or **disabilities**
33
What is the **Criteria** required to **diagnose Positional Asphyxia**?
1) Body **position** should **obstruct normal gas exchange** 2) It's **impossible to change positions** 3) Other causes of natural / violent death **are to be EXCLUDED**

Forensic Medicine (11 decks)

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