Examples:
Absence or reduction of oxygen tension in the external atmosphere.
Obstruction of the external respiratory orifices.
Blockage of the internal respiratory passages.
Restriction of the respiratory movements or paralysis from brainstem or cord
damage or the use of curare-like drugs.
Disease of the lungs that prevents or reduce gaseous interchange.
Reduction in cardiac function leading to impairment of the circulation (stagnant
anoxia).
Reduced ability of the blood to transport oxygen (CO).
Inability of the peripheral tissue cells to utilize the oxygen delivered to them
(cyanide).
Mechanical Asphyxia:
Suffocation: death from deprivation of oxygen in the environment.
Smothering: blockage of the external air passages by a hand or a soft fabric.
Gagging: fabric or adhesive tape occludes the mouth while the nasal passages
remain patent.
Choking: blockage of the upper airways by some foreign body.
Manual strangulation: applying neck pressure by the hand.
Ligature strangulation: applying external pressure to the neck by a ligature
Mugging: applying neck pressure by an arm crooked around from the rear (arm-
lock).
Classic signs of Asphyxia:
• Petechial hemorrhages.
• Congestion & edema.
• Cyanosis.
• Engorgement of the right heart and fluidity of the blood.
Venous engorgement may leads to frank bleeding from the nasal mucosa and the
external auditory meatus.
Vary in size up to 2 mm.
If larger than this it is called ecchymoses.
In the brain, petechiae occur in the white matter.
Non spesific sign of asphyxia:
Post mortem phenomenon
Present in congestive deaths
In abnormal posture
It is most notable in the tongue, face, lips, pharynx and larynx above the level of
venous obstruction.
Congestion is associated with tissue swelling if the venous obstruction continues.
Hypoxia might be an added factor in edema.
Froth may be profuse in cases of strangulation which emerge from the mouth and
nostrils.
Non specific sign of asphyxia.
Cyanosis depends on the absolute amount of reduced hemoglobin, at least 5 gm
of reduced hemoglobin per 100 ml blood before cyanosis appears.
Cyanosis follows congestion of the organs.
Cyanosis may be overshadowed by hypostasis.
Engorgement of the right heart and fluidity of the blood:
Suffocation
Reduction of oxygen concentration in the respired atmosphere.
Found in decompression chambers, effect of partial vacuum & near explosive
situation.
Physical replacement of other gases or chemicals.(CO, CO2, cyanide……)
Children may asphyxiate by being trapped in a small air-tight space.
Rapid death is common before hypoxia can have had any physiological effect.
Cause of death is over stimulation of the chemoreceptor system, leading to a
parasympathetic (vasovagal) cardiac arrest.
Classic signs of asphyxia are almost always absent.
Autopsy findings are negative
Plastic bag suffocation:
Manner of death: suicide or homicide or accidental.
It can be rapid and leave no signs of asphyxia.
Mechanism of death: cardio-inhibitory rather than hypoxic.
or in cases of infants
SIDS (cot death):
Autopsy findings:
• Multiple oval or semi lunar bruises
• Abrasions around the mouth and nostrils
• Circumoral area of pallor
• Examination of the mouth
- SIDS
Fabric or adhesive tape occludes the mouth while the nasal passages remain patent.
Can be d/t moving of the gag backwards into the nasopharynx.
occlusion of the airway(signs of asphyxia) OR
- neurogenic cardiac arrest which may be accelerated by excess catecholamine
release from the adrenaline response.
Causes:
Foreign bodies
Dentures and hemorrhage
Acute obstructive lesions
Food material
Inhalation of irritant fumes (chlorine in swimming pools)
Accidental or homicidal (burking)
2. External: signs of asphyxia and line of demarcation
3. Internal: signs of asphyxia and the lungs are usually dark & heavy
Mechanism of asphyxia:
Pressure on the chest forces blood into the great veins and as the venous valves in the
subclavian vessels prevent displacement into the arms, the extra volume is forced up
the valveless jugular system to congest the head and neck.
Inspiration would be impeded by the weight of abdominal viscera upon the diaphragm.
- Afferent: glossopharyngeal nerve to the tenth nucleus in the brain stem.
- Efferent: return via the vagus supply to the heart.(parasympathetic)
Vagal inhibition
Sudden unexpected deaths
Death occur rapidly without any signs of asphyxia
Other causes:
Blows to the neck (commando punch)
Blows to the larynx
Impaction of food in the larynx
Cold water in immersion
Blows to the testicles
Dilatation of the uterine cervix
Blows in the epigastrium
- Seen in domestic homicides, in sex related murders and in child killings.
- Autopsy in manual strangulation:
Bruises:
discoid (from finger-pads) - 1 to 2 cm in size
cluster at the sides of the neck
under the angles of the jaw
fresh (dark red or purple)
superficial raised heamatomas
- Abrasions:
from assailant or victim - fingernails abrasions
along the margin of the jaw line
straight or curved
fingernail scrapings should be taken (victim and assailant)
(bruises in the neck tissues)
b) X-ray to determine the state of the laryngeal cartilages
Injury of the carotids
Fracture of the thyroid or hyoid horns
Abrasions on the neck
Fingernail marks
Internally:
superficial hemorrhage under the ligature mark
damage of neck structures
there may be laryngeal injury
injury of the carotids
- deeply imbedded in the skin
- edema of the tissues above the ligature
- position of the ligature (encircle the neck horizontally at a lower level)
During play
At place of work
Sexual asphyxia
until hypoxia caused death.
Methods of hanging
Hanging marks:
suspension point -complete or incomplete circles (split knot or fixed knot)
impression of the knot
abrasions -narrow red zone around the ligature mark -situated high up on
the neck
Post-mortem hypostasis
Damage of neck structures
Damage of the carotids
Mechanism of death in hanging
Reflex cardiac arrest
Cerebral ischemia (3-11 seconds)
Congestive death
Airway obstruction (base of the tongue or crushing of larynx)
Spinal cord-brainstem disruption