Violent Asphyxia

Question 1

Def of Asphyxia

Answer 1

Lack of O2 - but literally means no pulse - hypoxia or anoxia are more accurate.

Question 2

Classification of Asphyxia

According to mechanism

Answer 2

1-Anoxic anoxia:{next}
2-Anemic anoxia:{next}
3-Stagnant anoxia:
Flow of blood to tissue (advanced Heart failure).
4-Histotoxic (cellular) anoxia (hypoxia):
Diminished ability to utilize O2 (Cyanide).

Question 3

Types of Anoxic anoxia

Answer 3

• central: (depression in respiratory center).
• peripheral: (paralysis of respiratory muscles).
• mechanical: (Violent Asphyxia).

Question 4

Types of anemic anoxia

Answer 4

• Abnormal Hb: (COHb in CO poisoning).

* Hemolysis: (incompatible blood transfusion, Naphthalene or Arsine intoxication).

Question 5

Stages of Asphyxia

Answer 5

1-Stage of dyspnea: response to hypoxia > stimulate respiratory center > ^^ rate and depth with cyanosis.
2-Stage of convulsions:{next}
3-Stage of irregular breathing: IRREVERSIBLE BRAIN DAMAGE > irregular (Chyne-stocks) breathing.

Question 6

Stage of convulsions

Answer 6

•Cerebral irritation due to anoxia and CO2 accumulation
1-^^ BP > rupture of venules&raquo_space; petechial hge (TARDIEU SPOTS).
2-^^ intra alveolar pressure > rupture of superficial unsupported alveoli&raquo_space; shiny gray spots (SILVERY SPOTS).

Question 7

Classic signs of Asphyxia (External) ** لونين + حاجتين طالعين على بره

Answer 7

1-(Dark blue) HYPOSTASIS.
2-CYANOSIS (due to accumulation of REDUCED Hb >/= 5gm/100ml in blood)
3-BULGING EYES with subconj hge.
4-protruded TONGUE.

Question 8

Classic signs of Asphyxia (internal)

Answer 8

1-DARK blood.
2-CONGESTION mucus.
3-TARDIEU SPOTS.
4-SILVERY SPOTS.

Question 9

Def of Smothering

Answer 9

Violent asphyxia due to OBSTRUCTION of the EXTERNAL ORIFICES by hands or others (pillow).

Question 10

What is GAGGING (imp)

Answer 10

Adhesive tape occlude the mouth to prevent shouting (as in robbery) + later blockage of nose by mucus or edema&raquo_space; lead to DEATH.

Question 11

Conditions of Smothering

Answer 11

•Homicidal (COMMON)
لازم يكون فيه فرق قوة
•Accidental (overlying):
-Brest-fed
-Infant lie in PRONE position.

Question 12

Mechanism of death in Smothering

Answer 12

ASPHYXIA

Question 12

PMP of Smothering

Answer 12

1•General ext and int signs of ASPHYXIA
2•Local:
-outside: semilunar nail abrasions and bruises.(Absent if pillow or glove)
-inside: inner surface contusion (lips cheeks and gums, maybe broken tooth).
3•Struggling: signs of resistance.

Question 13

Def of Throttling (manual strangulation)

Answer 13

Violent asphyxia due to PRESSURE on the neck by hands (one or both hands/ from front or back).

Question 14

Conditions of Throttling

Answer 14

Homicidal: specially in WEAK PERSONS. برضه لازم فرق قوة
Accidental: may occur in wrestling sports.

Question 15

What is MUGGING (imp)

Answer 15

Application of pressure to neck by an ARM CROOKED from the REAR طريقة بستعمل من الشرطة بس ممكن تتعمل غلط وتؤدي للوفاة

Question 16

Causes of Death

in Throttling

Answer 16

A B C
•Asphyxia due to airway occlusion.
•Brain anemia due to pressure on (Carotid arteries).
•Carotid sinus compression with
REFLEX VAGAL INHIBITION.

Question 17

PMP of Throttling

Answer 17

1-general ext and int signs of Asphyxia.
EXCEPT:death from VAGAL inhibition > Hypostasis is PALE.
2-Local signs:
-outside: semilunar and LINEAR(by victim) abrasions
-inside: contusion of soft tissue
And INWARD FRACTURE of Hyoid bone laryngeal and cricoid cartilages.
3-signs for strangulation.

Question 18

Def of Strangulation

Answer 18

Violent Asphyxia due to PRESSURE applied to neck using LIGATURE (e.g. Rope, tie, wire, belt,…)

Question 19

Conditions of Strangulation

Answer 19

1-Homicidal: most common ما يحتاج فرق قوة.
2-Accidental:
•during delivery by umbilical cord.
•children playing with rope.
3-Suicidal:(rare)tourniquet mechanism.

Question 20

Cause of death in Strangulation

Answer 20

As in Throttling :)

{ A B C }

Question 21

PMP of Strangulation

Answer 21

1•General ext and int sign.
2•local:
-Outside: LIGATURE MARK: abrasions and bruises with VITAL REACTION around the marks.
-Inside: contusion of tissue and inward Fracture of hyoid and laryngeal cartilage.
3•Sign of Strangulation.

Question 22

Characters of Ligature in Strangulation

Answer 22

1- TRANSVERSE.
2- SYMMETRICAL.
3- COMPLETE.
4- usually BELOW larynx.

Question 23

Def of Hanging

Answer 23

Violent asphyxia due to SUSPENSION of body from neck by ligature (the constricting force through BODY WEIGHT).

Question 24

Conditions of Hanging

Answer 24

1-Suicidal (commonest form).
2-Accident (Rare)children.
3-Homicidal (very Rare) EXCEPT in Post mortem to simulate suicide.

Question 25

Causes of Death in Hanging

Answer 25

{ B A C } *f
•Brain anemia|commonest
•Asphyxia due to air passage obstruction (pharynx).
•Carotid sinus compression > ^^ VAGAL reflex > reflex cardiac inhibition.
*Fracture dislocation of 1st, 2nd or 3rd cervical vertebrae in (JUDICIAL Hanging) #must be FREE FALL for >/= 2m.

Question 26

PMP of Hanging

Answer 26

1•general ext and int signs
2•local:
-outside: ligature mark
-inside: contusion of subcutaneous tissue and muscles of neck. And (OUTWARD) fracture of hyoid.
4• Dark Hypostasis in lower body.
5• DRIPPING of saliva due to pressure on sub maxillary salivary glands.
6•transverse intimal rupture(Carotid a.)

Question 27

Characters of ligature in Hanging

Answer 27

• OBLIQUE
• INCOMPLETE
• ASYMMETRICAL
• HIGH (Above the larynx)

Question 28

Def of Traumatic (crushed) Asphyxia

Answer 28

Violent asphyxia due to External Compression of chest and abdomen PREVENTING respiratory movement.

Question 29

Conditions of Traumatic Asphyxia

Answer 29

• Accidental: in CROWD.

* Homicidal: BURKING by sitting on chest and abdomen.

Question 30

Causes of Death in Traumatic Asphyxia

Answer 30

• Asphyxia.

* Injuries to Vital organs.

Question 31

PMP of Traumatic Asphyxia

{ it provides most extreme demonstration of “CLASSIC SIGNS of ASPHYXIA” } (imp)

Answer 31

1- Classic signs of CYANOSIS, BLUE Congestion and petechia (mostly in face and upper chest)
2- Conjunctiva showed Congestion and hge.
3- local bruises and abrasions from weight compressing.

Question 32

Def of Drowning

Answer 32

Asphyxia due to SUBMERSION of Respiratory Orifices under water or any fluid.
(Commonest cause of violent asphyxia)

Question 33

Dx of Drowning

Externally

Answer 33

A-Probable signs:
1-Cooling rate is twice than air.
2-Goose skin (cutis-anserina) due to contract (erector pilar) of hair follicles.
3-Corrugated sodden skin of hands and feet (washer-women skin).
4-Pale Hypostasis(upper part of body).
B-Sure signs:
1-Froth (foam)
2-Cadaveric spasm (involving hands). > victim was alive when drowning.

Question 34

Characters of drowning Foam

Answer 34

Results from mixing of (water, air and mucus)

•whitish. •fine. •odorless. •gradually reappear if wiped away.

Question 35

Dx of drowning

Internally

Answer 35

A-air passages:
Froth and foreign body.
B-lungs:
Oozing froth,PALE LUNGS (water expels blood from capillaries) and HEAVY LARGE lungs.
C-stomach: unpalatable water and F.B
D-PLANKTONS (diatomes)