Asphyxia: Defective aeration of the blood

Physiological and chemical state in a living

organism in which acute lack of oxygen is
associated with inability to eliminate excess
CO2
Hypoxia: lack of oxygen in the blood
Classification
Pathological:
 Anemic anoxia: CO2 poisoning
 Anoxic: high altitudes
 Stagnant: Shock, circulatory failure
 Histotoxic: Poisoning due to cyanide,
barbiturates, ether, chloroform, etc
Medico-legal:
 Non-mechanical: CO2/ cyanide poisoning
 Mechanical:
 Pressure on the exterior of the neck:
Hanging, strangulation
Pressure on the chest: Traumatic asphyxia
Obstruction to air passages from exterior:
Smothering
Obstruction to the air passages from interior:
Gagging, Choking
Submersion deaths: Drowning
Classical signs of Asphyxia
1) Cyanosis
2) Congestion
3) Fluidity of the blood
4) Petechial hemorrhages
Vicious cycle of Asphyxia
Asphyxia

Deficient Reduced
oxygenatio O2 to
n tissues

Reduced Capillary
pulmonary blood dilatation
flow
Stasis of
Reduced blood
venous return
to heart
HANGING
Type of violent mechanical asphyxial death
due to constriction of the neck structures by
a ligature around the neck and the
constricting force being the weight of the
body
Types
Typical hanging
Atypical hanging
Complete hanging
Incomplete hanging
Degree of tension and compression of neck
structures
2kg: Jugular veins
4-5 kg: Carotid arteries
15 kg: Trachea
30 kg: Vertebral arteries
Causes of death in hanging
Asphyxia
Venous congestion
Cerebral ischemia
Reflex vagal inhibition
Fracture dislocation of the vertebra
Judicial hanging
Capital punishment in countries like India
Person made to stand on a trap door
Drop of six feet
Knot suspension on the front of the neck
Long sudden jerk (Hangman’s fracture)
Immediate death
Absence of signs of asphyxia
Postmortem findings (General)
Pale/congested face with petechiae
Subconjunctival hemorrhages
Le-facies sympathique
Swollen and brownish black tongue with tongue
bite and froth
Dribbling of saliva from the angle of mouth
Stretched and elongated neck in cases of
prolonged suspension/long drop
Emission of semen
Postmortem lividity common in the limbs
Cyanosis
Postmortem findings (Local)
Presence of a brownish, dry and parchment
like ligature mark incompletely encircling the
neck, directed obliquely upwards and
backwards towardsthe knot, fading out at the
point of suspension, position of the ligature
mark above the level of thyroid cartilage
Internal postmortem findings (after
bloodless neck dissection)
Dry, white and glistening subcutaneous tissue
Petechial hemorrhages sometimes present on
the soft tissues above and below the ligature
mark
Ladder tears
Hyoid fracture sometimes present
STRANGULATION
Type of violent mechanical asphyxia caused by
compression of the neck structures
Constricting force not the weight of the body

Types:
1) Ligature strangulation
2) Manual strangulation (Throttling)
3) Garrotting
4) Mugging
5) Bansdola
Postmortem findings in ligature
strangulation(External)
Location of the ligature mark at or below the level of
the thyroid cartilage
Knot of the ligature material on the back of the neck
Ligature mark completely encircling the neck in
more/ less horizontal manner
Appears pale at first and later becomes brown and
parchment like
Multiple marks may be present denoting several
turns of the ligature were made around the neck
Injuries such as abrasions and contusions on other
parts of the body
Postmortem findings (Internal)
Engorgement and hemorrhages into the
tissues in the vicinity of the ligature mark
Contusion of the straps muscles
Inward fracture of the hyoid bone(10-15%)
Fracture of thyroid cartilage
Congestion of the pharynx and airways
Blood-stained froth in the airways with
pulmonary edema
Congestion of other visceral organs
Differences between Hanging and
Strangulation
Hanging Strangulation
Age Adolescents and No age limit
adults
Manner of death Mostly suicidal Mostly homicidal
Face Usually pale with no/ Congested with
rare presence of common presence of
petechiae petechiae
Dribbling marks of May be present Very rare
saliva
Ligature mark At the level above the At or below the level
thyroid cartilage of thyroid cartilage
Other injuries around Rare Common
the ligature mark
Injury of the muscles Rare Common
of the neck
Manual Strangulation
Throttling
Neck of the victim compressed by using bare
hands
Postmortem Findings (External)
Oval/ irregular bruises and linear/ crescentic
scratches
Pattern of occurrence:
 Thumb imrpint on the right side of neck and
fingermarks on the left side,one below the
other (due to use of one hand from the front)
 Thumb and finger impressions on both sides
(due to two hands from the front)
 Finger impressions on front and sides and
thumb imprints on the back (due to use of one/
both hands from the back)
Postmortem findings (Internal)
Contusions of the subcutaneous tissues and
muscles
Hyoid bone fracture (inward compression)
Fracture of superior horn of thyroid cartilage
Pulmonary edema with froth in the airways
Congestion of other viscera with petechiae
Garotting
Type of strangulation
Victim attacked from behind without warning
Ligature slipped around the neck and quickly
tightened/victim seated and a coonstricting
force exerted on the neck by tightening a
metallic contraption
Mugging
Type of strangulation
Victim’s neck constricted with the bend of
the elbow/ knee
Bansdola
Type of strangulation
Neck of the victim constricted by using two
bamboo sticks tied together and the other
end tightened using the hands
Gagging
Pad/ piece of cloth thrust into the mouth
Death usually not intended
Mechanism of asphyxia:
 Blocking of the mouth by gag leading to airway
obstruction of the mouth
 Moistening of the gag with saliva, mucus and edema
fluid
 Gag further sucked into the oropharynx due to
violent respirations
 Obstruction of the pharynx/larnyx leading to asphyxia
Burking
Combination of homicidal smothering and
traumatic asphyxia
Method employed by William Burke and
William Hare during (1927-1928 A.D) in the
UK to kill people and sell the bodies to the
famous anatomist Dr. Robert Knox
Method:
Used to invite a homeless person for food and
alcohol at their home

Make the victim lie on the floor after the victim

got drunk

Burke would kneel on the chest and cover the

nostrils and mouth with hands and Hare would
pull the victim around by pulling the feet
Postural asphyxia
Person not able to breathe due to the his/
her position and not able to recover
Person incapacitated by drug/ disease/
alcohol
Upper portion of the body lower than the
rest
Diaphragm pushed up by the abdominal
viscera leading to decreased respiratory
movements
Traumatic/ Crush Asphyxia
Trauma to the chest/ external pressure on the
chest, abdomen or back
Prevention of normal respiratory movements
Eg; Buried under debris, Burial under sand,
grain or coal, stampede, crush by vehicle
Postmortem findings
External:
 Intense cyanosis on the face, neck, shoulders
and chest
 Conjunctival congestion and hemorrhages
 Swollen and congested face, lips and scalp
 Bleeding from the ears and nostrils
Internal:
 Dark, heavy lungs with sub-pleural petechial
hemorrhages
 Contusion of soft tissues of chest
 Fracture of the ribs
Mechanism of traumatic asphyxia
Heavy pressure on the chest

Compression of the heart

Overfilling of blood vessels of the head and

neck

Congestion of the face and sparing of arms

due to prevention of displacement of blood
into the arms by subclavian veins
Chocking
Mechanical occlusion of the lumina of the
internal air passages by a solid/ semi-solid
object such as a lump of meat, coin, button etc.
Death due to either of the following: Asphyxia,
vagal inhibition, laryngeal spasm, bronchospasm

Mechanism (either of the following):

 Food drawn into the larnyx while swallowing
 Food regurgitated into the larynx from the
stomach
Café coronary:
 Form of choking death
 Victim well nourished
 Intoxication by alcohol may be present
 Death all of a sudden during meal at a café
 No signs of respiratory distress
 Postmortem findings: A bolus of food lodged in
the pharynx/ larnyx
 Death due to parasympathetic overactivity due
to stimulation of laryngeal/pharyngeal mucosa
Drowning
Aspiration of fluid into the air passages
Submersion in water/ fluid medium

Types:
Wet drowning
Dry drowning
Near drowning/ Post-immersion syndrome
Immersion syndrome
Submersion of unconscious
Fresh and sea water drowning
Stages
(Brouardel’s Experiment)
Stage of surprise: 5-10 secs
Stage of respiratory arrest: 1 min
Stage of deep respiration: 1 min
Stage of 2nd episode of respiratory arrest:
1min
Stage of terminal gasps: 30 secs
Mechanism
Person falls into water
Tends to sink
Rises up to the surface of water
Cries for help/ breathes when above the surface
Violent efforts of respiration, inhales water
Irritation of mucous membrane by air and water
entering in to the airways
Copious secretion of mucus
Churning
Copious tenacious persistent white/ blood-tinged
frothy fluid blocking the airways
Pathophysiology (Fresh water drowning)
Inhalation of water into the respiratory tract
Haemodilution
Hyperkalemia
Ventricular fibrillation
Cerebral anoxia
Death (4-5 mins)
Pathophysiology (Sea water drowning)
Inhalation of water into the respiratory tract
Haemoconcentration
Crenation of RBCs
Myocardial anoxia
Death (8-12 mins)
Postmortem findings (External)
Wet body/ clothes
Froth from the mouth and nostrils
Congested eyes with/ without petechial
hemorrahges
Hypostasis
Cutis anserina
Maceration of the skin
Cadaveric spasm
Injuries
Postmortem findings (Internal)
Froth/ fluid/ debris in the air passages
Emphysema aquosum
Paltauf’s hemorrhages
Dilatation of alveoli with elongation and
thinning of alveolar septa in histology
Watery/ fluid in the stomach
Middle ear hemorrhage
Tests for Drowning
Gettler’s test
Strontium level
Magnesium level
Specific gravity of plasma
Diatom test
Gettler’s test
Based on sodium chloride content of blood
Right and left side of heart
Right: 600 mg, left: 100 mg
Difference of 5mg/ 100 ml: Normal
Difference of 25 mg/ 100 ml: drowning
Diatom test
For diagnosis of drowning
Diatoms: ubiquitous
Principle: when a person drowns in the water,
diatoms can be carried to the lungs and to the
bood-stream and reach different organs,
presence indicates that the person is alive at
the time of drowning (ante-mortem)
Procedure:
Tissue/ bone marrow

Add conc. HNO3

Boil and collect supernatant fatty yellowish fluid

Centrifuge

Examine under dark ground microscope for the

presence of diatoms