SUFFOCATION

Represented by -
Prabhakar shinde
( BAMS 3rd year)
Guidence by -
Dr. Nilam malage sir
Suffocation

 Definition-
 It is defined as mode of violent asphyxial
death in which entry of air into lungs is prevented by
means other than compression of neck & drowning
Types
1. Smothering.
2. Gagging
3. Choking
4 Crush asphyxia (traumatic asphyxia)
5. Bansdola.
6. Burking.
7. Irrespirable gases (is strictly not violent asphyxial death).
8. Burying alive.
1. Smothering

 Defination-
 It is the type of suffocation in which entry of air to lungs is
prevented by closure of nose & mouth.
 Examples
 a)Manual smothering i.e. Closing nose & mouth with hands.
 b)Closure of nose & mouth by a piece of cloth or pillow.
 c)Mother holding the child tightly to breast while feeding.
 d) Child born with caul ([Link] with intact membranes).
 e) Child covering his face with bed clothes or sleeping face down
on soft pillow.
 f)Prisoner or insane tying a plastic bag on head for suicide
 g)Plastic bag tied on head for inhalation of narcotics glue
sniffing(usually xylene)
Gagging

 Defination-
 It is suffocation by blocking of the oropharyngeal area
may be by piece of cloth or even by thumb, the item
blocking is referred to as gag.

 Sometimes initially the passage may be patent through

the nose ,but later due to oedema,saliva&mucus
obstruction.
Examples

 a) Gagging is usually homicidal,

 e.g. Gagged & raped; person may be gagged by burglars
(to avoid shouting).
 b) Gagging is common method of infanticide.
 c) Accidental gagging may result in epileptic due to tongue
falling back and thus blocking the entry of air.
Choking

 Defination
 It is accidental suffocation by obstruction of
respiratory passages (glottis,larynx, trachea, bronchi
etc)
Caused by –
a)Inhaled foreign body
e.g. Fish thorn, piece of meat, seed, coin, marble,cotton,
rubber balloon
b)Vomitus, regurgitated milk in infants
c) Due to inhaled blood from cut throat injury, tonsillectony,
after tooth extraction or from injury to nose etc.
d) Respiratory pathology e.g. Tumour, inflammation,
Laryngeal oedema, drug allergy, blood, pus or secretion
e)Irritant gases causing laryngeal spasm.
 Cafe coronary
It refers to sudden death while ng food, due to choking of larynx
(death in cafe i.e. Cafeteria-restaurant) It occurs mainly in senile
and in those under influence of alcohol or sedatives. In these the gag
reflex is poor and therefore at times the bolus of food obstructs the
larynx, stimulating the laryngeal nerve, so stimulating the vagus
nerve, and thus resulting in sudden cardio-respiratory arrest and
thereby sudden death.
 Thus death usually occurs in chair while eating food in cafeteria
and since death is sudden, it resembles myocardial infarction
hence the name cafe coronary. There is no pain or cry.
Treatment

If the person is found alive, treatment is given by

 a)Violent thumping in the interscapular area, or
 b) Abdominal compression, or,
 c) Removal with forceps or finger.
P.M Findings

Post mortem findings are

 a)Large piece of poorly chewed food / meat, found in
larynx.
 b)Signs of asphyxia.
 c)No pathology of heart.
Crush asphyxia

Defination
 If refers to crushing injury to chest wall.
It may be –
 a) Penetrating injury –
Any penetrating injury (i.e. Injury by a sharp pointed object) into the thoracic
cavity causes pneumothorax, so collapse of lung and so asphyxia
 b) Non penetrating injury – Crushing of chest
e.g
a)Crushed between vehicles.
b)Being caught in large crowds so that respiration
is not possible – (usually multiple deaths result).
c) Being trampled under feet.
d) In mines or trenches/collapse of
building/falling of earth, stones or heavy
objects on chest.
e) During assault – Assailant jumped or stamped
on chest.
e)Steering wheel injury.
On meeting with an accident, the chest of the driver
hits onto the steering wheel resulting in transverse
fracture of sternum,fracture of ribs and usually injury to
pleura,lungs,pericardium and heart.
Bansdola

 It is compression of chest with 1or 2 sticks

Burking

 It was the method used by Mr. Burk and Mr. Hare, who used to kill
people for selling dead bodies to Edinburgh Medical School (During
1927-28, they sold 16 bodies to Dr. Robert Knox. Reported by
Christison).
 Mr. Burk used to sit on chest of inebriated person, smother with
his left hand, and push the chin with his right hand; while Mr.
Hare holding the feet of the victim used to move him in the room,
till he was dead.
 Burking is a combination of smothering and Crush asphyxia
Inhalation of irrespirable gases

 a)Hypoxia at high altitude.

 b) Irrespirable gases.
 c) Being in confined space eg. Box, refrigerator, deep well.
 d) Improper oxygenation during anaesthesia.
 e)Smoke from burnt articles.
 f) Inhalation of irritant fumes of acids.
 g)In some countries, gas chambers are used capital punishment.
Burying alive

 In tribal areas – to take revenge; or sometimes a person wrongly

diagnosed as dead, may be buried alive.
 Suffocation occurs from a combination of smothering, gagging,
choking and crush asphyxia.
Cause of death

 1. Asphyxia.
 2. Neurogenic shock (especially in smothering and crush
asphyxia).
 3. Venous congestion (especially in crush asphyxia)
 4. Cerebral anoxia
 5. Laryngeal spasm (especially in gagging & choking).
 6. Injury to thoracic viscera (in crush asphyxia).
Fatal period

 May vary from sudden death to death within 4-5

minutes
[Link]

 1)Local-. A) External
B) Internal
 2)General-. A)External
B)Internal
Local External [Link]

 Local external P.M. Findings depend upon the

type/method of suffocation.
 1. In Smothering
 (Findings are classical only in manual smothering. In
others, only vague contusions are found).
 Findings are –
 a) In general, the area of compression of face appears
pale, rest of the face is cyanosed with petechial
haemmorrhages.
 b)Injuries due to nails and finger tips, on the
nose,mouth,cheeks and chin.
 DueTo finger tips – contusions are produced, and due to nails –
abrasions are produced
 Abrasions due to nails are placed, vertically if the hand is kept
horizontal, however the abrasions may at times be
horizontal/oblique.
 c)On the nose
 I)Bleeding from nose.
 II) Nose is depressed / flattened.
 III) There is fracture of nasal sepm and nasal bone.
 d) On the mouth
I) Lips externally may show abrasions /contusions or
at times no injury.
II) Inner surface of lips lacerated because of their
crushing between hand and teeth.
III) Bleeding from the mouth.
IV) Teeth may be fractured or loosened.
V) Tongue may be bitten.
VI) There may be biting of inner surface of cheeks.
 e) In case both the hands are used for smothering, (one
kept on nose and mouth and other on posterior part of
neck), there may be fracture of cervical vertebrae
2. Gagging
On examination of oral cavity, the gag is recovered.
At times there may be mild bleeding.
3. In Choking
No local external findings,
[Link] Crush asphyxia,Bansdola
&Burking
 a)There are abrasions, contusions or lacerations on
chest, because of it’s compression.
Nature of injury depends upon the nature of object.
 b)In penetrating injuries, a tract of the injury is seen.
 c) In non penetrating injuries, fractures of ribs &
sometimes also of sternum & vertebrae, may be
palpable.
5. Irrespirable gases
No local external findings.
6. In burying alive
Sand or mud is seen on clothes, hair, body, nose and
mouth and in other natural orifices.
[Link] [Link]

Depend upon type of suffocation.

1) In smothering and gagging
No question of internal findings, as findings are restricted to oral
cavity only – seen on external examination.
2) In choking
a) Item causing obstruction of respiratory passages is discovered.
B) The area shows inflammation and oedema.
c)There may be slight bleeding at site of choking.
3)In crush asphyxia,bansdola &
burking
 a)There is laceration of muscles of chest & back.
 b)There are large haemmorrhages seen in muscles.
 c) Usually there is fracture of multiple ribs. At times
there may be fracture of sternum and/or vertebrae
also.
 d) In penetrating injury, collapse of corresponding lung
is seen due to pneumothorax or haemothorax.
 e) In cases of non penetrating injury – due to
compression of chest, there occurs laceration of pleura
& lungs in which case the corresponding pleural cavity
has blood and lungs may be collapsed.
 Lung collapse may even occur due to injury by
fractured rib ends. Even heart may be lacerated.
 There may be laceration of diaphragm.
 At times there may be laceration of spleen, liver or
intestines.
 (Laceration of abdominal viscera is more common in
cases of compression between vehicles, fall of large
load on trunk or being trampled under feet).
 4) Irrespirable gases
. No local internal findings.
 5) Burying alive
Sand or mud is seen in respiratory passages, oesophagus and
stomach.
[Link] EXTERNAL P.M. FINDINGS
 1] Findings of asphyxia are more pronounced in
smothering and crush asphyxia only.
They include cyanosis, bulging eyes with petechial
haemmorrhages, bitten protruded tongue, bloody froth at
nose and mouth, clenching of hands, and incontinence of
urine, faeces & semen.
At times, due to violent respiration, there may be
rupture of tympanum].
2] In other forms of suffocation, cyanosis alone may be
present.
 3] In deaths due to irrespirable gases, at times the colour
of P.M. Lividity may be typical,
e.g. –
-Cherry red in CO
. -Bluish green in hydrogen sulphide
4]In crush asphyxia and bansdola because of compression of
chest, there is retrograde flow of blood from superior vena
cava to smaller vessels and capillaries, resulting in
engorgement of blood in upper half of body,
and so –
 a)Upper half of body is cyanosed and congested.
 b)There are multiple petechial haemmorrhages
 c)Eyes become red shot
 d)There is bleeding from ears and nose.
 Site of compression is therefore said to be producing a
line of demarcation
[Link] INTERNAL P.M. FINDINGS

 1) There is bloody froth in respiratory passages.

 2) The lungs are congested and contain bloody froth.
 3) There are tardieu spots on pleura, lungs, meninges and brain.
 4) Right chambers of heart are full.
 5) Cranial and abdominal viscera is congested.
 6) Blood is cherry red in carbon monoxide inhalation.
MEDICOLEGAL ASPECTS
 Death due to suffocation is usually accidental, sometimes
homicidal and very rarely suicidal.
 A)Suicidal suffocation

 1. Prisoners or intoxicated may sometimes commit suicide

by gagging or by tying a plastic bag on head.
2. In western countries, suicide by inhalation of
fumes from fire place in room, or car exhaust in garage is
fairly common.
B)Homicidal suffocation

 1. Homicide can be committed by smothering, crush asphyxia

or bansdola.
2. Gagging is a common method of infanticide,
3. Rarely, person may be buried alive.
4. In some countries, gas chambers are used for
capital punishment.
C)Accidental suffocation

 1. Children while playing / sleeping.

 2. Born with a caul.
 3. Falling in mud / vomitus.
 4. Auto erotic asphyxiation.
 5. Inhaled foreign body.
 6. Cafe coronary.
 7. Large crowds / collapse of buildings.
 8. In confined spaces.
 9. Fire place in closed room/leakage of cooking gas.
Thank you