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Final Prof Part-1 > FMT- Asphyxia > Flashcards

FMT- Asphyxia Flashcards

1
Q

asphyxia def

A

interference with exchange of o2 and co2 in body

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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

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3
Q

mechanical causes ex

A

hanging, strangulation, smothering

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4
Q

toxic causes ex

A

opioids like morphine, barbiturates, strychnine

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5
Q

env causes ex

A

high CO, high altitude

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6
Q

traumatic causes ex

A

blunt trauma

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7
Q

positional ex

A

hogtying, alcoholics

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8
Q

iatrogenic ex

A

anesthesia

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9
Q

pathological ex

A

laryngeal edema, tumors, abscess

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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

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11
Q

Hanging def

A

asphyxia caused by suspension of body by ligature

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12
Q

hanging types

A

based on position of knot-

  1. typical- present on occiput
  2. atypical- place other than occiput

based on degree of suspension-

  1. partial
  2. complete
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13
Q

cause of death in hanging

A
  1. asphyxia
  2. venous congestion
  3. combination of both
  4. fracture of cervical vertebra
  5. cerebral anemia
  6. reflex vagal inhibition
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14
Q

delayed death causes

A

AEI
A- Aspiration pneumonia
E- Edema of lungs, larynx
I- Infarctn of brain

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15
Q

secondary effects of hanging

A

AEH
A- Amnesia
E- Epileptiform Convulsions
H- hemiplegia

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16
Q

time for death in asphyxia

A

3-5 minutes usually, may be delayed till 5-8 min

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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)

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18
Q

autopsy of neck int examinatn

A
  1. modified y shaped incision
  2. ant neck structures exam
  3. tongue inspectn
  4. thyroid gland inspectn
  5. hyoid bone palpatn (note hemorrhages)
  6. larynx- intracartilagenous hemorrhages
  7. esophagous and larynx-traches post dissectn to observe petechiae, aspiratn
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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

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20
Q

internal postmortem findings in hanging

A
  1. neck (detail)
  2. brain- congested
  3. blood- purplish
  4. lungs- congested
  5. viscera- congested
    (BB-LV) (BLACK BOOTS LOUIS VITTON)
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21
Q

suicidal hanging features

A
  1. approachable point of suspension
  2. partial hanging
  3. history of previous attempt
  4. fibres of ligature material may be found in clenched hand
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22
Q

homicidal hanging

A

very rare

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23
Q

postmortem hanging features

A
  1. signs of dragging
  2. look at beam or branch of tree
    (rope moved from below upwards)
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24
Q

accidental hanging features

A
  1. children playing hanging
  2. adults (autoerotic)
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25
Q

lynching

A

homicidal hanging
practiced by whites on blacks in USA

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26
Q

judicial hanging

A

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

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27
Q

strangulation

A

violent asphyxial death by constrictn of air passage by a ligature or any other means of suspension

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28
Q

types of strangulation

A
  1. ligature
  2. manual
  3. mugging
  4. bansdola
  5. Garroting
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29
Q

mugging

A

holding the neck in the bend of elbow or knee of assaliant
usually from behind

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30
Q

mugging other name

A

chokehold

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31
Q

bansdola

A

2 bamboo sticks placed around neck and tied at one end and then victim is squeezed to death

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32
Q

garroting

A

compression of neck by a ligature by tightening it using a lever

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33
Q

cause of death in ligature strangulation

A
  1. asphyxia
  2. cerebral anoxia
  3. vagal inhibition
  4. rarely fracture of cervical vertebrae
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34
Q

postmortem exam of ligature strang ext findings

A

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

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35
Q

postmortem exam of ligature strangulatn int findings

A
  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
Q

proof of strangulatn

A

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
Q

suicidal lig strang

A

rare

38
Q

homicidal lig strang

A

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
Q

accidental lig strang

A

uterus- fetus encircles umbilical cord around neck
children- while playing
adults- under influence of alcohol or drugs

40
Q

pseudo/false strangualtn groove

A

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
Q

manual strang other name

A

throttling

42
Q

manual strang def

A

compression of enck by human hands

43
Q

cause of death in manual strang

A
  1. asphyxia
  2. cerebral anoxia
  3. vagal inhibition
44
Q

how much time for applying pressure to cause death in manual strang

A

2 min or more

45
Q

post mortem exam of manual strang

A
  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
Q

what does tips of finger bruises reveal

A
  1. relative positn
  2. manner of grasping (directn)
  3. amount of pressure
  4. single/both hands used?
  5. conditn of nails of assaliant
47
Q

post mortem exam ext findings manual strang

A
  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
Q

post mortem exam manual strang int findings

A
  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
Q

diagnostic signs of throttling

A
  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
Q

suicidal throttling

A

impossible

51
Q

homiciadla throttling

A

common mode
victims- infants, children, women (sexually)
fingernail abrasions on neck, presumption is homicide

52
Q

accidental throttling

A

demonstratn of love, in joke, or a part of physiological exp
death can occur due to vagal inhibitn

53
Q

how to tell how much force the assaliant used during throttling

A
  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
Q

Hyoid bone fractures mostly seen in

A

Above 40 yrs age people

55
Q

Types of hyoid bone fractures

A
  1. Inward compression fracture
  2. Anteroposterior compression fracture
  3. Avulsion fracture
56
Q

Inward compression fracture of hyoid

A

Seen in throttling
Greater cornu of hyoid compressed inwards
Can occur on both sides

57
Q

Anteroposterior fracture of hyoid

A

Seen in hanging
Greater cornu of hyoid moves inward
Also seen in ligature strangulation, motor vehicle accidents

58
Q

Avulsion fracture of hyoid

A

Occurs due to
1. Hyperextension of neck
2. Muscle over activity

59
Q

Suffocation

A

Asphyxia caused by mechanical obst to passage of air

60
Q

Suffocation classification

A

Group Chat with BOTS
Gagging
Choking
Burking
Overlying
Traumatic asphyxia
Smothering

61
Q

Smothering def

A

Asphyxia due to mech obs of ext air passages

62
Q

Smothering post mortem findings

A

Abrasions and bruises around mouth
Injuries on inside of lip
Bruising of gums

63
Q

Medicolegal aspects of smothering

A

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
Q

Choking def

A

Asphyxia due to obst of air passages

65
Q

Gagging pm findings

A

Same as choking

66
Q

Medicolegal aspects of gagging

A
  1. Always homicidal (usually infant or elder)
  2. Used to prevent victim from shouting for help, death is unintended
67
Q

drowning def

A

experiencing resp impairment from submersion/immersion in a liquid

68
Q

classificatn of drowning

A

typical and atypical

69
Q

typical drowning def

A

water is inhaled leading to severe chest pain

70
Q

types of typical drowning

A

fresh water and sea water drowning

71
Q

fresh water and sea water drowning flow chart

A

death in both due to heart failure
hemodil in fresh water and hemoconc in sea water

72
Q

dry drowning def

A

water does not enter lungs due to laryngeal spasm

73
Q

2 causes of death in dry drowning

A
  1. reflex cardiac arrest due to vasovagal stimulatn
  2. laryngeal spasm
74
Q

atypical drowning examples

A

dry drowning
immersion synd
secondary drowning
shallow water drowning

75
Q

immersion synd other names

A

hydrocution, submersion inh, cold water drowning

76
Q

immersion synd causes

A
  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
Q

mech of immersion synd

A

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
Q

near drowning other name

A

post immersion synd

79
Q

near drowning def

A

when person survives beyond 24h after submersion

80
Q

near drowning causes of death

A

death is due to complicatns like ards, pneumonia
(pt is initially well after resuscitatn but then suffers respi decompensatn)

81
Q

shallow water drowning other name

A

submersion of unconscious

82
Q

shallow water drowning notes

A

predominantly men
children and young adults
under influence of alcohol or drugs

83
Q

overall causes of death in drowning

A
  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
Q

symptoms in drowning case

A

mental confusion, auditory and visual hallucinatns, tinnitus, vertigo

85
Q

rx of drowning (immediate response and long term)

A

immediate response- artificial respi with closed chest cardiac massaging
long term- defibrillator in case of fibrill

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