FMT- Asphyxia Flashcards
1
Q
asphyxia def
A
interference with exchange of o2 and co2 in body
2
Q
etiologies of asphyxia
A
MTP In PET
M- Mechanical causes
T- Traumatic causes
P- Positional causes
I- Iatrogenic
P- Pathological
E- Environmental
T- Toxic
3
Q
mechanical causes ex
A
hanging, strangulation, smothering
4
Q
toxic causes ex
A
opioids like morphine, barbiturates, strychnine
5
Q
env causes ex
A
high CO, high altitude
6
Q
traumatic causes ex
A
blunt trauma
7
Q
positional ex
A
hogtying, alcoholics
8
Q
iatrogenic ex
A
anesthesia
9
Q
pathological ex
A
laryngeal edema, tumors, abscess
10
Q
clinical effects of asphyxia
A
FC-PTC (PTC Punjabi Football Club)
F- Fluid blood
C- Congestion
P- Pulmonary edema
T- Tardieu’s spots
C- Cyanosis
11
Q
Hanging def
A
asphyxia caused by suspension of body by ligature
12
Q
hanging types
A
based on position of knot-
- typical- present on occiput
- atypical- place other than occiput
based on degree of suspension-
- partial
- complete
13
Q
cause of death in hanging
A
- asphyxia
- venous congestion
- combination of both
- fracture of cervical vertebra
- cerebral anemia
- reflex vagal inhibition
14
Q
delayed death causes
A
AEI
A- Aspiration pneumonia
E- Edema of lungs, larynx
I- Infarctn of brain
15
Q
secondary effects of hanging
A
AEH
A- Amnesia
E- Epileptiform Convulsions
H- hemiplegia
16
Q
time for death in asphyxia
A
3-5 minutes usually, may be delayed till 5-8 min
17
Q
autopsy of neck ext examination
(gen features, ligature, furrow)
A
gen features-
1. clothing
2. distributn of pms, rm, am
3. bleeding, discharge, urine or feces
4. petechiae, cyanosis
5. tongue protrusion
6. evidence of other trauma
ligature-
1. type
2. circumference
3. width
4. nature of knot
ligature mark (furrow)
1. pattern
2. neck circumference
3. width
4. skin changes
5. relatn to thyroid
6. course (angled or straight)
18
Q
autopsy of neck int examinatn
A
- modified y shaped incision
- ant neck structures exam
- tongue inspectn
- thyroid gland inspectn
- hyoid bone palpatn (note hemorrhages)
- larynx- intracartilagenous hemorrhages
- esophagous and larynx-traches post dissectn to observe petechiae, aspiratn
19
Q
external postmortem findings in hanging
A
Face (F-EPSTN)
1. swollen, cyanosed face
2. protruded eyeballs
3. dilated pupils
4. dribbling of saliva (surest sign of antemortem hanigng)
5. protrusion of tongue
6. bleeding from nose or ears
Neck-
1. ligature mark
2. dimensions of neck (inc in length)
3. bending of neck (opposite to the knot)
other parts-
1. tardieu’s spots
2. cyanosis of fingernails
3. pms in lower limbs and lower part of UL
4. hands clenched
5. males- discharge of semen
6. both sexes- fecal matter or urine
20
Q
internal postmortem findings in hanging
A
- neck (detail)
- brain- congested
- blood- purplish
- lungs- congested
- viscera- congested
(BB-LV) (BLACK BOOTS LOUIS VITTON)
21
Q
suicidal hanging features
A
- approachable point of suspension
- partial hanging
- history of previous attempt
- fibres of ligature material may be found in clenched hand
22
Q
homicidal hanging
A
very rare
23
Q
postmortem hanging features
A
- signs of dragging
- look at beam or branch of tree
(rope moved from below upwards)
24
Q
accidental hanging features
A
- children playing hanging
- adults (autoerotic)
25
lynching
homicidal hanging
practiced by whites on blacks in USA
26
judicial hanging
ligature around neck
knot below chin (submental)/ may also be placed subaural
hanging is complete
fracture of cervical column observed (hangman fracture)
fracture of c2 from c3
27
strangulation
violent asphyxial death by constrictn of air passage by a ligature or any other means of suspension
28
types of strangulation
1. ligature
2. manual
3. mugging
4. bansdola
5. Garroting
29
mugging
holding the neck in the bend of elbow or knee of assaliant
usually from behind
30
mugging other name
chokehold
31
bansdola
2 bamboo sticks placed around neck and tied at one end and then victim is squeezed to death
32
garroting
compression of neck by a ligature by tightening it using a lever
33
cause of death in ligature strangulation
1. asphyxia
2. cerebral anoxia
3. vagal inhibition
4. rarely fracture of cervical vertebrae
34
postmortem exam of ligature strang ext findings
face- FELT BLOODy
1. face congested
2. eyes protruded, pupils dilated
3. lips cyanosed
4. tongue swollen, protruded
5. bloodstained frothy fluid from mouth and nostrils
neck-
1. ligature mark well defined groove
2. horizontly placed
3. more prominent on front and sides than on back
4. may be oblique if victim has been dragged after strangulatn
other parts-
1. pms
2. involuntary disch
3. hands clenched
4. struggle, abrasions and bruises found
5. examine fingernails
35
postmortem exam of ligature strangulatn int findings
1. bruising of subcutaneous tissue
2. hyoid bone injury
3. fracture pf thyroid cartilage
4. tracheal rings fracture
5. bruising of root of tongue
6. larynx, trachea, bronchi congested
7. fracture of cervical vertebrae not common
8. lungs, brain, all organs conngested
36
proof of strangulatn
gen asphyxial features present
presence of cord ligature around the body does not prove the diagnosis (malicious purpose)
ligature strangulatn has to be diff from hanging
37
suicidal lig strang
rare
38
homicidal lig strang
common
victims are frequently women (sexual intercourse)
2 or more firm knots
abrasions and fingernail marks seen
clothing of victim is torn
ligature is loose when removed
39
accidental lig strang
uterus- fetus encircles umbilical cord around neck
children- while playing
adults- under influence of alcohol or drugs
40
pseudo/false strangualtn groove
seen on neck of dead infants or chidlren
produced from folds of skin due to bending of head
also seen in decomposde bodies wearing tight collared shirt, buttoned at neck or a necklace
41
manual strang other name
throttling
42
manual strang def
compression of enck by human hands
43
cause of death in manual strang
1. asphyxia
2. cerebral anoxia
3. vagal inhibition
44
how much time for applying pressure to cause death in manual strang
2 min or more
45
post mortem exam of manual strang
1. abrasions and bruises on neck front and sides
2. classical signs of asphyxia- cyanosis, tardieu's spots, edema, congestion of face
3. tips of fingers produce bruises on neck
46
what does tips of finger bruises reveal
1. relative positn
2. manner of grasping (directn)
3. amount of pressure
4. single/both hands used?
5. conditn of nails of assaliant
47
post mortem exam ext findings manual strang
1. single hand used- thumb on one side, fingers on the other
2. both hands used- thumb marks on one side, fingers on the other side
3. if struggle and resistance, bruising and abrasions on face of victim to stop the vitcim from shotuing and crying for help
48
post mortem exam manual strang int findings
1. extravasatn of blood in subcutaneous tissues under bruises and abrasions (most significant int sign)
2. tear of muscle of neck eg. sternomastoid
3. tongue bruised
4. inward compression fracture of hyoid bone (most diag finding of throttling)
5. fracture of sup horns of thyroid cartilage
6. laceratn of carotid sheath
49
diagnostic signs of throttling
1. bruising and abrasions on face and neck
2. engorgement of tissues at or above the level of compression
3. fracture of thyroid cartilage
4. gen signs of asphyxia
5. fracture of cricoid is pathognomic
50
suicidal throttling
impossible
51
homiciadla throttling
common mode
victims- infants, children, women (sexually)
fingernail abrasions on neck, presumption is homicide
52
accidental throttling
demonstratn of love, in joke, or a part of physiological exp
death can occur due to vagal inhibitn
53
how to tell how much force the assaliant used during throttling
1. damaged neck structrues- considerable force (intent to injure if not kill)
2. fracture of hyoid or larynx- homicidal
3. minor damgae or absence of damage- can still kill as in a karate chop
4. slight changes- guarded opinion
54
Hyoid bone fractures mostly seen in
Above 40 yrs age people
55
Types of hyoid bone fractures
1. Inward compression fracture
2. Anteroposterior compression fracture
3. Avulsion fracture
56
Inward compression fracture of hyoid
Seen in throttling
Greater cornu of hyoid compressed inwards
Can occur on both sides
57
Anteroposterior fracture of hyoid
Seen in hanging
Greater cornu of hyoid moves inward
Also seen in ligature strangulation, motor vehicle accidents
58
Avulsion fracture of hyoid
Occurs due to
1. Hyperextension of neck
2. Muscle over activity
59
Suffocation
Asphyxia caused by mechanical obst to passage of air
60
Suffocation classification
Group Chat with BOTS
Gagging
Choking
Burking
Overlying
Traumatic asphyxia
Smothering
61
Smothering def
Asphyxia due to mech obs of ext air passages
62
Smothering post mortem findings
Abrasions and bruises around mouth
Injuries on inside of lip
Bruising of gums
63
Medicolegal aspects of smothering
Accidental smothering in alcoholics or under drug influence
After birth infant can die from smothering if he is born with membs covering his nose and mouth
Children while playing
64
Choking def
Asphyxia due to obst of air passages
65
Gagging pm findings
Same as choking
66
Medicolegal aspects of gagging
1. Always homicidal (usually infant or elder)
2. Used to prevent victim from shouting for help, death is unintended
67
drowning def
experiencing resp impairment from submersion/immersion in a liquid
68
classificatn of drowning
typical and atypical
69
typical drowning def
water is inhaled leading to severe chest pain
70
types of typical drowning
fresh water and sea water drowning
71
fresh water and sea water drowning flow chart
death in both due to heart failure
hemodil in fresh water and hemoconc in sea water
72
dry drowning def
water does not enter lungs due to laryngeal spasm
73
2 causes of death in dry drowning
1. reflex cardiac arrest due to vasovagal stimulatn
2. laryngeal spasm
74
atypical drowning examples
dry drowning
immersion synd
secondary drowning
shallow water drowning
75
immersion synd other names
hydrocution, submersion inh, cold water drowning
76
immersion synd causes
1. cold water stimulates nerve endings
2. water striking epigastrium
3. cold water entering ears, larynx, nasal passage
4. falling/diving with feet first/duck diving
77
mech of immersion synd
sudden immersion in cold water
cardiorespi reflex (2-3 mins)
cold shock response
immediate peripheral vasoconst
inc heart rate
inc workload
inc catecholamines
fatal arrythmia
78
near drowning other name
post immersion synd
79
near drowning def
when person survives beyond 24h after submersion
80
near drowning causes of death
death is due to complicatns like ards, pneumonia
(pt is initially well after resuscitatn but then suffers respi decompensatn)
81
shallow water drowning other name
submersion of unconscious
82
shallow water drowning notes
predominantly men
children and young adults
under influence of alcohol or drugs
83
overall causes of death in drowning
1. asphyxia
2. vagal inh
3. vent fibri in fresh water drowning
4. cardiac arrest in salt water
5. laryngeal spasm
6. apoplexy (subarachnoid hemorrhage due to rupture of berry aneurysm)
84
symptoms in drowning case
mental confusion, auditory and visual hallucinatns, tinnitus, vertigo
85
rx of drowning (immediate response and long term)
immediate response- artificial respi with closed chest cardiac massaging
long term- defibrillator in case of fibrill
