ASPHYXIA

Aspect Explanation
Definition Asphyxia is a condition caused by interference with respiration leading to
deficient oxygen (O₂) supply and excess carbon dioxide (CO₂) in blood and
tissues (hypoxia + hypercapnia).
Pathophysiology Any obstruction of oxygen intake, transfer, or utilization → tissue hypoxia → loss
of consciousness → death if prolonged.
General Features • Cyanosis (bluish discoloration) • Congestion of organs • Petechial
hemorrhages (Tardieu spots) • Engorged right heart • Dark fluid blood

TYPES OF ASPHYXIA
Type Cause / Mechanism Examples
1. Mechanical Asphyxia Physical interference with breathing Hanging, strangulation, smothering, drowning,
traumatic asphyxia
2. Pathological Asphyxia Disease process affects respiration Asthma, laryngeal edema, pneumonia
3. Toxic (Chemical) Asphyxia Interference with O₂ transport/utilization at cellular CO, HCN, H₂S poisoning
level
4. Environmental Asphyxia Lack of O₂ in surrounding air Confined spaces, mines, wells
5. Neurological Asphyxia Paralysis of respiratory center Head injury, stroke, narcotic overdose

MECHANICAL ASPHYXIA:
Type of Mechanical Mechanism External Findings Internal Findings Cause of Death Medico-Legal
Asphyxia Importance
1. Hanging Constriction of neck by • Oblique, non- • Congested organs • Cerebral anoxia (venous Mostly suicidal (rarely
ligature, body suspended continuous ligature mark Carotid intimal tears • congestion and airway accidental or homicidal)
by its own weight → (above thyroid cartilage) Fracture of hyoid or block)
compression of airway • Salivary dribbling • thyroid cartilage (elderly)
and neck vessels Face congested or pale •
Protruded tongue,
dribbling saliva
2. Ligature Strangulation Tightening of ligature • Horizontal, continuous • Subcutaneous tissue Cerebral anoxia due to Homicidal (almost
around neck without ligature mark (below under mark bruised • venous obstruction and always)
suspension thyroid cartilage) • Fracture of hyoid/thyroid airway compression
Bruising and abrasions cartilage common •
on neck • Face Congested lungs and
congested, petechiae on brain
conjunctiva
3. Manual Strangulation Compression of neck by • Fingernail abrasions • Deep neck muscle Cerebral anoxia from Homicidal (diagnostic of
(Throttling) hands or forearms and bruises on neck • bruising • Fracture of airway and vascular assault)
Face congested, tongue hyoid or laryngeal compression
protruded • Petechiae in cartilage frequent
eyes
4. Smothering Obstruction of mouth • Abrasions or bruises • Congested lungs • Fine Asphyxia due to airway Homicidal (accidental in
and nostrils by hand, around mouth, nose • froth in airways blockage infants)
pillow, or soft object Foreign material in mouth
(fibers, dust)
5. Gagging Forcible obstruction of • Ligature or cloth in • Congestion and Airway blockage Homicidal (common in
mouth and pharynx by mouth tied at back • hemorrhage in pharynx assaults, kidnappings)
gag, cloth, etc. Bruising of lips, oral and larynx
mucosa
6. Choking Internal airway • Cyanosis, signs of • Food bolus or object at Asphyxia from blocked Accidental (common in
obstruction by foreign struggle • No external laryngeal inlet • airway drunk or elderly)
body (food, dentures, neck marks Congested lungs
etc.)
7. Traumatic / Crush External pressure on • Cyanosis and petechiae • Engorged right heart • Respiratory restriction Accidental (stampede,
Asphyxia chest or abdomen on face, neck, upper Congested organs crowd crush)
preventing expansion chest • Subconjunctival
hemorrhages
8. Burking Combination of • Facial congestion and • Pulmonary congestion Combined asphyxia and Homicidal (historical—
smothering + traumatic petechiae • Pressure and edema mechanical compression “Burke & Hare murders”)
asphyxia marks on chest
9. Drowning Aspiration of water • Fine persistent froth at • Water and froth in Asphyxia from inhaled Accidental (mostly);
leading to airway mouth/nose • Cutis airways • Lungs water and laryngospasm Suicidal/Homicidal
blockage and hypoxia anserina (goose skin) • voluminous, waterlogged possible
Washerwoman’s hands • Diatoms in marrow

DROWNING
Aspect Explanation
Definition Death due to aspiration of fluid (usually water) into air passages leading to
asphyxia.
Types 1. Wet (Typical) – Water enters lungs → frothy fluid in airways. 2. Dry (Atypical)
– No water entry due to vagal inhibition (sudden cardiac arrest). 3. Secondary
drowning – Death due to delayed pulmonary edema after survival. 4. Immersion
syndrome – Sudden cardiac arrest due to vagal inhibition without inhaling water.
Characteristic Findings • Fine, white, persistent froth at mouth/nose • Lungs bulky, voluminous
(“emphysematous”) • Presence of water in stomach and sinuses • Cutis
anserina (goose skin) and wrinkling of fingers/toes
Special Tests • Gettler test → Cl⁻ content difference between right & left heart chambers (>25
mg%) • Diatom test → Presence of diatoms in bone marrow indicates drowning
in natural water
Medico-Legal Importance • Differentiate between ante-mortem vs post-mortem immersion • Helps decide
manner of death (suicidal, accidental, rarely homicidal) • Useful in identification
and reconstruction of events

ASPHYXIANTS
Type Agent Mechanism Characteristic Feature Medico-Legal Significance
1. Carbon Monoxide (CO) Car exhaust, fire smoke Forms Carboxyhemoglobin → Cherry red discoloration of Accidental (most), rarely
prevents O₂ transport skin and tissues suicidal
2. Hydrogen Cyanide (HCN) Fumigants, electroplating Inhibits cytochrome oxidase → Bright red blood, almond smell Suicidal/Homicidal
blocks cellular respiration
3. Hydrogen Sulfide (H₂S) Sewage, pits Combines with cytochrome Blackish discoloration of skin, Accidental
oxidase → cell hypoxia offensive odor
4. Carbon Dioxide (CO₂) Mines, wells Displaces O₂ → anoxia No specific postmortem sign Accidental
5. Methane (CH₄) Coal mines Simple asphyxiant; displaces No odor, explosive risk Accidental
O₂

Medico-Legal Importance (Overall)