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Forensic Medicine > Asphyxial Death > Flashcards

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
Q

What are the External Signs of Smothering?

A
  • Abrasions / Bruising around the nose + lips
  • Abrasions / Bruising / Lacerations on the Lip Mucosa
  • Broken Teeth
  • Fractured Nose
24
Q

Define - “Cafe Coronary”

A
  • 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
Q

Which Types of People are more prone to Choking?

A
  • Those with impaired swallowing reflex - due to stroke, or alcohol intoxication
  • Elderly with barely any teeth
  • Children
  • Those with mental disabilities / psychiatric disorders
26
Q

Define “Drowning”

A
  • Obstruction of airways, due to liquids
27
Q

What are the 2 Types of Drowning?

A

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
Q

What are the External Signs of Drowning?

A
  • 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
Q

What are the Internal Signs of Drowning?

A
  • 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
Q

Define “Suffocation”

A
  • It is Exhaustion / Displacement of Environmental 02
  • Due to enclosure in a very narrow confined space - such as fridge
31
Q

What are the Attributes to Suffocation?

A
  • HIGH Altitudes
  • Decompression in Airplanes
  • RAPID Chemical Changes
32
Q

Define “Positional Asphyxia”

A
  • 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
Q

What is the Criteria required to diagnose Positional Asphyxia?

A

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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