ASPHYXIA

By:
Annalyne R. Dadiz, MD
Pre test

1.Asphyxia due to failure of circulation

a. Anoxic Death
b. Stagnant Anoxic Death
c. Anemic Anoxic Death
d. Histotoxic Anoxic Death
Pre test

2. Phase of Asphyxial death which include

paralysis of the respiratory center of the brain
a. Dyspneic Phase
b. Convulsive Phase
c. Apneic Phase
d. Non of the above
Pre test
Matching Type:

3. Horizontal ligature mark on

the neck
4. V- shape ligature mark on the
neck
5. Ligature groove is deepest
opposite the site of the knotA. Asphyxia by Hanging
6. Ligature mark below the B. Asphyxia by
thyroid Strangulation
7. Ligature groove is uniform in
depth w/it’s whole course
8. Ligature mark below the
thyroid
9. Hyoid bone is frequently
injured
10. Hyoid bone is frequently
injured
Pre test

11. Type of Strangulation where assailant is

standing at the back and the forearm is applied
in front of the neck
a. Ligature
b. Mugging
c. Garroting
d. Palmar
Pre test

12. suspension of the body by a ligature which

encircles the neck and constricting force is the
weight of the body
a. Strangulation
b. Hanging
c. Ligature
d. suffocation
Pre test

13. Which is not true in cause of death due to

asphyxia by Drowning
a. Tracheal obstruction
b. Carotid Compression
c. Vagal stimulation
d. Atlanto –Axial dislocation
e. None of the above
Pre test

14. exclusion of air from the lungs by

obstruction of air passages by closure of
external openings to the air sacs
a. Hanging
b. Strangulation
c. Suffocation
d. Drowning
e. None of the above
Pre test

15. Average time required for death in

drowning to occur.
a. 1.5 -2.0 minutes
b. 4 minutes
c. 2-4 minutes
d. 2-5 minutes
e. None of the above
Pre test

We Will Answer later…..

 ASPHYXIA
I. Types
II. Phases
III. Classification
1. Hanging
2. Strangulation
3. Suffocation
4. Submersion or Drowning
5. Traumatic/ Compression/Crush
6. Irrespirable Gases
ASPHYXIA

• All forms of violent death resulting from

interference with the process of respiration.
*The supply of oxygen is reduced to below normal
level
Types of Asphyxial Death

I. Anoxic Death – failure of the arterial blood

to become normally saturated with oxygen.
II. Anemic Anoxic Death – due to decrease
capacity of the blood to carry oxygen
III. Stagnant Anoxic Death – failure of
circulation
IV. Histotoxic Anoxic Death – failure of the
cellular oxidative processes
Phases of Asphyxial Death

• Dyspneic Phase
• Convulsive Phase
• Apneic Phase
Classification of Asphyxia
• Hanging • Suffocation
• Strangulation • Smothering
• By ligature • Choking
• Manual/throttling • Drowning
• Special forms • Pressure on the chest
• Palmar
• Irrespirable gases
• Garroting
• Mugging/yoking
• Compression of the neck
with stick
Classification of Asphyxia
1. Asphyxia by Hanging – suspension of the body by a
ligature which encircles the neck and constricting
force is the weight of the body
 classification of hanging:

 As to the location
of the ligature
and knot:

- typical
- atypical
atypical hanging
 As to the amount of
constricting force:

- complete
- partial
 As to symmetry:

▪ symmetrical
▪ assymetrical
Classification of Asphyxia by
Hanging
1. As to the location of ligature and knot
a. Typical – symmetrical ligature
b. Atypical – one side only

2. As to the amount of constricting force

a. Complete – body is completely suspended
b. Partial – body is partially suspended

3. As to symmetry
a. Symmetrtical – knot at midline
b. Asymmetrical - knot is located elsewhere
Classification of Asphyxia by
Hanging
Asphyxia by Hanging

I. Mechanism of Death
- Ligature around the neck with a knot or sliding
noose, the other end to an elevated object
- Pressure at the region of the neck upon
suspension of the body
- Constriction of the air passage leading to
ASPHYXIA
Amount of tension in the ligature
to occlude structures
• Jugular veins: 2 kgs
• Carotid artery: 5 kgs
• Trachea: 15 kgs
• Vertebral artery: 30 kgs
Asphyxia by Hanging

II. Causes of Death

1. simple asphyxia by blocking the air passage.
2. Congestion of the venous blood vessels in the
brain
3. Lack of arterial blood in the brain due to
pressure in the carotid arteries
4. Syncope due to vasovagal reflex
5. Spinal column/cord Injury
6. Any combination of the above-mentioned causes
Ligature in Hanging

I. Material used

II. Mode of application of ligature – single/ 2 or more loops

III. Position of the knot -

- On either side of the neck
- Ligature found above the thyroid cartilage

IV. Course of the Ligature around the neck:

- Opposite the location of the knot
- Inverted V – shape
Post mortem findings in hanging
(external)
• Neck stretched with
head on the opposite
side of the knot
• Facies sympathetic
• Pallor of the face with
swelling and
protrusion of the
tounge
• Hands clenched
firmly
Post mortem findings in hanging
(external)
Post mortem findings in hanging
(external

• Lips purple
• Drooling with froth
• Penile erection with
emission
• PML with ecchymosis
of the legs
• Loss of sphincter tone
Post mortem findings in hanging
(internal)

- Engorgement of the lungs

- Venous system contained dark colored blood
- Distended big blood vessels (right side of the
heart)
- Congested blood vessels of the brain
- Congested kidneys
- Tardieu Spots: Sub pericardial and sub pleural
hges
Asphyxia by Hanging

• Ante Mortem Findings:

(vital reaction)
1. Redness/ Ecchymosis on ligature mark
2. Ecchymosis of pharynx and epiglottis
3. Line of redness/ rupture of carotid artery
intima
4. Sub pleural and sub epicardial hemorrhages
Evidence of Homicidal Hanging

1. (+) signs of struggle in clothings, furnitures

and beddings
2. Defense wounds
Homicidal vs Suicidal Hanging

Homicidal Suicidal
1. (+) signs of struggle in 1. (+) vital reaction in the
clothings, furnitures, beddings ligature marks around the neck
2. stains, injuries in the body 2. No marks in the body
3. Defense wounds 3. Suicide note by the victim
II. Asphyxia by Srangulation

2. Strangulation
a. By ligature
b. By manual/throttling
c. Special Forms
- Palmar
- Garotting
- Mugging (strangle-hold)
- Compressing of the neck w/a stick
 Strangulation

 by Ligature

 RARELY suicidal

 Usually homicidal and

accompanied by
evidence of struggle
or marks of violence
Asphyxia by Strangulation

1. Strangulation by Ligature – compression of

the neck by means of ligature tightened by
a force other than the weight of the body
Hanging vs Ligature

Hanging Ligature
Ligature mark above the Ligature mark below the
thyroid thyroid
Hyoid bone is frequently Hyoid bone is frequently spared
injured
Ligature mark is inverted V Ligature mark is usually
shape with the apex as the site horizontal . Knot is on the same
of the knot horizontal plane
Ligature groove is deepest Ligature groove is uniform in
opposite the site of the knot depth w/it’s whole course
Vertebral injury is frequently Vertebral injury is not observed
observed
Asphyxia by Ligature

• Causes of Death:
1. Asphyxia due to occlusion of the windpipe
2. Coma due to arrest of cerebral circulation
3. Shock or syncope
4. Inhibition of the respiratory center due to
the pressure on the vagus and sympathetic
nerves
Asphyxia by Ligature

• Post Mortem Findings

-External Examination:
1. Face is livid and swollen
2. Eyes are wide open, prominent, congested &
pupils are dilated
3. Tongue are swollen, dark colored and protruded
4. Bloody froth from mouth and nostrils
5. Tardieu spots beneath the conjunctiva, face,
neck, chest and lungs
Asphyxia by Ligature

• Post Mortem Findings

- Internal Examination
1. Intense venous congestion of both lungs with
numerous petechial hemorrhages
2. Blood-stained froth is found in big bronchi
3. Right side of the heart is filled with dark
fluid blood
4. Congestion of the brain
5. Congestion of visceral organs
Asphyxia by Ligature

• Examination of Localized lesions on the Neck

1. Mark of violence on the neck in the form of
ligature mark, abrasion or ecchymosis
2. Fracture of larynx or tracheal rings
3. Laceration of the tunica intima of the
carotid and jugular vessels
Homicidal, Suicidal or
Accidental Ligature

Homicidal Suicidal Accidental

Most common rare rare
Asphyxia by Strangulation

2. Manual Strangulation/ Throttling

- Constricting force applied in the neck is the
hand
Strangulation/ Throttling

• Manner of Death
- Occlusion of air passage
- Compression of blood vessels
- Vaso vagal reflex
Strangulation/ Throttling

• Post Mortem findings

1. Cyanosis of the face
2. Right side of the heart is distended w/blood
3. Over distention of the lungs w/interstitial
emphysema
Strangulation/ Throttling

• Findings on the neck:

1. Contusion with the form and shape of the fingers
2. Interstitial hemorrhages in the muscles of the neck
3. Fracture of the laryngeal cartilage may ocassionally
be found
4. Petechial hemorrhages and congestion of the larynx
and pharynx
5. There may be bruising of the tongue at its anterior
border, the tongue itself may be bitten and protruded
6. Hemorrhages present in the capsule of the thyroid,
submaxillary and even in the parotid glands
manual
strangulation
Homicidal, Suicidal or
Accidental Throttling

Homicidal Suicidal Accidental

Most common Not possible Possible
Asphyxia by Strangulation

3. Special Forms:
a. Palmar strangulation – pressure at the palm
of the hand of the offender placed in front of
the neck occluding the lumen of the windpipe
Asphyxia by Strangulation

3. Special Forms:
b. Garotting – a metal collar or bowstring is
placed around the neck and tightened at the
back
Asphyxia by Strangulation

3. Special Forms:
c. Mugging (strangle-hold) – assailant standing
at the back and the forearm is applied in front
of the neck
* Pressure on the neck is brought about by the
pressure of the fixed elbow
Asphyxia by Strangulation

3. Special Forms
d. Compression of the neck with a stick -
assailant with a piece of stick placed in front of
the neck pulls with 2 hands passing on both
sides of the post backwards
 Asphyxia by Suffocation

 MECHANISM: Closure of air opening

or obstruction of the air passageway

Types:
- Smothering
- Choking
- Burking
III. Asphyxia by Suffocation

- exclusion of air from the lungs by obstruction

of air passages by closure of external openings
to the air sacs
1. Smothering – use of hands or by some other
means ( overlaying, gagging, plastic bag
suffocation)
2. Choking – impaction of foreign body in resp
passages ( vomitus, food, membrane
diphteria, false teeth, resp he in PTB)
Smothering

• Closing of the external

respiratory orifices via
hand or other means
• Overlaying
• Accidental smothering
• Due to pressure of the
beddings and pillows or
drunk mother
• Accidental smothering
of an epileptic
Asphyxia by Suffocation

• Gagging: the
application of
materials to
prevent air to have
access to the mouth
or nostrils
• Plastic bag
suffocation
III. Suffocation

• Post mortem Findings:

- Same as other forms of asphyxia plus presence
of foreign body in the respiratory tract
Choking
Homicidal, Suicidal or
Accidental Suffocation

Homicidal Suicidal Accidental

Most common rare Most common (
(Smothering) choking)
asphyxia
by
drowning
IV. Asphyxia by
Submersion/Drowning

– prevention of free entrance of air into the

air passage and lungs by submerging the
nostrils and mouth in any watery, viscid or
pultaceous fluid for a time.
 Asphyxia by Drowning

“SUBMERSION”
 Nostrils and mouth are submerged in water
for some time to prevent the free entrance of
air into the air passage and the lungs

 It is not necessary for the whole body to be

submerged

 Children drown in “shallow” pools or ponds

 Drunks may drown in shallow creeks

Mechanism of Drowning
• Person who does not know how to swim who falls into deep body of water:
1. Body will sink (due to momentum and specific gravity)

2. Body will be bouyed (due to instinctive mov’t of the indiv. and the presence
of air underneath clothings
• Breath is held under water while on the surface, there is attempt to breath so…

3. Air and water gets into the mouth and nostrils

4. Endeavor to raise his hand causing him to sink into the water..

5. Alternately appears and disappears in water and attempts to breath so more

water gets in..

6. Entrance of water will cause violent coughing expelling the air in the lungs
and imperative desire to breath

7. Drawn in water gets into the lungs or stomach ( lungs balloon become soggy,
and edematous)
Phases of Drowning

1. “Respiration de surprise’ * one deep inspiration

when the mouth and nose are completely
filled/covered with water
2. Phase of Resistance - *short period of apnea due
to the irritation of sensory laryngeal nerve
endings by the cold water.
3. Dyspneic Phase -* force full respiratory
movement
4. Apneic Phase
5. Terminal Respiration – breathing stops
permanently
 Causes of Death in Drowning:

 TYPICAL
- cause of death is
asphyxia

 ATYPICAL
- cardiac inhibition due to vagal stimulation
- laryngeal spasm
- submersion when unconscious
Time required for death in drowning

• Fatal: 1.5 minutes

• Survival possible even after 4 minutes of
submersion
• Average time required for death in drowning is 2 to
5 minutes
Post mortem findings in
drowning
• Clothes are wet, face is
pale with foreign bodies
on body surfaces
• Skin: puckered, pale,
contracted (cutis anserina,
goose skin, goose flesh)
due to contraction of
arrector pili
• Penis and scrotum are
contracted and retracted
• Washerwoman’s hand
and feet: skin is bleached,
corrugated and sodden
Post mortem findings in drowning

• PML marked in the

head neck and chest
due to gravitation of
blood
• Firmly clenched hand
with foreign objects
cadaveric spasm
 Post-mortem findings:

 Wet clothes, pale face with foreign

bodies clinging on skin surface
 Cutis anserina or goose skin or
goose flesh
 Firmly clenched hands with objects,
weeds or stones

 Mouth closed or half-  Penis and scrotum are retracted

open with tongue  Washerwoman’s hands and feet
protruding  Livid eyes, conjuctival injection
 Physical injuries due to and dilated pupils
struggle
Internal findings in Drowning

• Emphysema aquosum
• Lung distention due to
inc lung secretion
• Emphysematous: air
plus fluid
• Edema aquosum
• Doughy, readily pits on
pressure and exudes
water and froths on
section
Internal findings in Drowning

• Champignon d’ ocume
• Whitish foam that
accumulates in the mouth
and nostril
• Tracheo bronchial lumina
is congested and filled
with froth and foreign
bodies
• Blood stained fluid inside
the chest cavity due to
water permeation
Internal findings in Drowning

• Heart
• Right distended
• Left empty
• Salt water
• Cl more on the left
• Fresh water
• Cl more on the right
• Gettler’s Test: chloride
level determination
• Atleast 25 mg difference
Internal findings in Drowning

• Stomach: fluid and foreign materials

• Absence of water tells that death is rapid or
submersion is made after death
• Brain: congested with BV engorged
Conclusive findings of Drowning

• Presence of materials or foreign body in the hands

• Clenching of hands
• Emphysema aquosum, edema aquosum
• Presece of water and foreign materials on the
stomach
• Presence of froth, foam, foreign bodies in the air
passage
• Water in the middle air
Floating of the body in Drowning

• Within 24 hours the body may float due to

decomposition
• Usually flexed: due to dominance of flexors
• Head is submerged due to higher SG than
the body
Tete de negri

• Dark bloated face

• Due to accumulation of
blood in the head
Homicidal, Suicidal or
Accidental Drowning

Homicidal Suicidal Accidental

(+) evidence of (+) heavy (-) mark of violence
struggle: physical articles/weight in the body, (+)
injuries, destruction found in pocket of testimony of
of clothings of the clothings, (+) suicide witness, (+)
victim note exclusion of
homicidal or suicidal
nature
V. Compression Asphyxia

• Traumatic/ crush asphyxia

• Asphyxia due to the immobility of the chest and
abdomen secondary to external pressure/crush
injury
• Causes:
• Sudden fall of masonry
• Pinned under the rubble
Post mortem findings

• Purplish black cyanosis

• Clothing may produce irregular pattern of
markings on the skin
• Petechial hemorrhage
• Fracture of ribs
Burking

• By burke and hare

• The assailant kneel/sit
on the chest and with
his hands close the
nostrils and mouth of
the victim
V. Asphyxia by Breathing of
Irrespirable gases
• CO: incomplete Accidental Suicidal death
combustion of carbon death
fuel
• Silent killer - Accidentally - Deliberately
• 250 times more stable imprisoned in a enclosed
than oxyhemoglobin room with themselves…
motor engine
• Dec the affinity and runniing
unloading of O2 to tissues
OXYGEN DEPRIVATION on
tissues
• Above 80%: fatal
• High conc exposure leads
to PAINLESS Death
Carbon dioxide

• Product of complete combustion of carbon

containing compounds
• Inhalation of pure carbon dioxide: immediate vagal
inhibition wth spasm of glottis and death
• Cause of Death: death due cerebral anoxia
Post mortem findings

• Face: cyanosis and swollen with oral froth

• Pupil are dilated and lungs are markedly congested
• Other findings are the same as other aspyxial
deaths
Hydrogen sulfide

• From the decomposition of organic substances

containing sulfur
• Colorless, transparent gas, sweetish taste with rotten
egg odor
• Post mortem findings
• Rapid decomposition /Putrefaction
• Offensive odor
• Blood in fluid state, dark brown: sulmethemoglobin
• Lungs are congested and edematous
• Other organs are congested and dark colored
Hydrogen Cyanide

• Found in cherry laurel, bitter almond, common

cherry, plum, peaches
• Amygdalin + water + emulsin= hydrocyanic acid+
glucose + benzaldehyde
• 60-90mg/2000ppm: fatal
• Post mortem findings
• Bright pink blood due to cyanomethemoglobin
Sulfur Dioxide

• Colorless, w/pungent odor

• Employed as disinfectant, bleaching agent,
also in eruption of volcanoes
• Irritation of air passage : sneezing, coughing,
spasm of glottis, irritation of eyes, congestion
and lacrimation.
• Post Mortem Findings:
-cyanosis and other signs of asphyxia
Sample Autopsy Report

• EXTERNAL EXAMINATION:

• The body is ebalmed, that of a normally developed, fairly

nourished adult female with a body length of 148.0 cm.
There is marborization all over the body. The head is
normocephalic. Face has grayish discoloration. Pupils are
dilated. Nasal septum is intact. The lips and nail beds are
pale. There is no blood in the ear canals. There are no
discernible masses in the neck. External injuries of the neck
to be described. The trachea is in the midline. There is 51.0
cms, vertical, post mortem incision, midline from the chin
and 39.0 cms, coronal, post mortem incision on the head,
from either side of the External Auditory Meatus passing
fronto parietal area. The chest is symmetrical. The abdomen
is flat. There is 5.0 x 2.0 cms contusion on the shoulder,
antero lateral, left. No gross deformity of the extremities
noted. The external genitalia are those of a normal adult
female.
Sample Autopsy Report

• EXTERNAL PHYSICAL INJURIES:

• Ligature Mark, Neck

• Contused and abraded, measuring 30.0 cm long, 5.0 cm at

its widest and 4.0 cm at its narrowest, with depth of
approximately 1.0 cm, located just above the level of the
thyroid cartilage, partially encircling the neck, with the left
extremity coursing backwards and superiorly fading at a
point 6.0 cm behind and 1.5 cm below the left external
auditory meatus, while the right extremity coursing
backwards and superiorly, fading at a point 5.0 cm behind
and 2.0 cm below the right external auditory meatus.
Sample Autopsy Report

• EXTERNAL PHYSICAL INJURIES:

• Ligature Mark, Neck
• Contused and abraded, measuring 50.0 cm long,
1.0 cm at its widest and 0.5 cm at its narrowest,
with depth of 0.5 cm, located above the level of the
thyroid cartilage, completely encircling the neck,
oriented diagonally directed backwards and
upwards where both extremities converge and
meet at a point 8.0 cm behind and 2.0 cm above
the left external auditory meatus.
Sample Autopsy Report

• INTERNAL EXAMINATION

• Cranial vault is previously opened, the brain tissues found in a blue

plastic inside the cranium. The anterior thoracic cage is cut bilaterally.
Organs previously sectioned but still found attached on their normal
anatomic positions.

• Multiple petechial hemorrhages are noted on brain tissues, blood vessels

are engorged. The brain weighs 1300 grams. No hematoma and no skull
fracture. The neck shows vital tissue reaction, in the form of multiple
petechial hemorrhages, in the underlying soft tissues along the course of
the ligature mark. The hyoid bone and the crico-thyroid cartilages are
intact. No fracture of the cervical vertebrae is noted. No atlanto-axial
dislocation appreciated. The heart weighs 350 grams, with areas of
subepicardial petechial haemorrhages, blood vessels are engorged. Cut
section shows congestion. The right and left lungs weigh 750 grams each,
congested, no pleural adhesions noted. Subpleural petechial hemorrhages
are noted at both lung surfaces. There are no masses noted. The liver
weighs 1,350 grams, pale, with glistening capsules and sharp edges. The
gallbladder is grossly unremarkable. Intestines are grossly unremarkable.
The pancreas weighs 100 grams, no haemorrhage nor calcification. The
kidneys weigh 150 grams, each. Their capsules are easily stripped. The
spleen weighs 90 grams, capsule is intact. Stomach has small amount of
whitish fluid
Thank You
God Bless

End