Asphyxial Deaths

Laila Shoukat
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Asphyxia

 A form of lack of oxygen resulting from mechanical

interference with the process of respiration i.e Anoxic
Anoxia- Parikh

 Specific effects of asphyxia:

 Cyanosis

 Increased capillary permeability

 Petechial haemorrhages

 Later two are non specific signs of asphexia

 Additional findings:

 Signs of airway compression by pressure in

hanging and ligature strangulation

 Occlusive blocking of nose and mouth in

smothering

 Obstruction in gagging

 Flooding of airways in drowning

 Blunt force trauma in traumatic asphyxia

Autopsy Procedure in Asphyxia:

 V shaped incision on the neck

 Layer by layer dissection of neck
 Evisceration
 Careful carotid artery examination
 Hyoid larynx radiology

 Autopsy Findings:

 Signs common to all forms of asphyxia

 If sufficient signs are not present then called: death consistent with
asphyxia

 Intense venous congestion and cyanosis with pronounced lividity

 Petechial haemorrhages
 Right sided dilation of heart
 Externally

 Face:
 is pale if no obstruction to venous drainage
 In some cases of hanging

 is cyanosed, petechial haemorrhages, swollen if obstruction to

venous flow
 Suffocation and strangling

 Lips, nail and ears

 Neck
 Froth
 Tongue
 Hands
 Sphincters
 Lividity
 Body temperature: rises by 2 to 3C
 note while calculating time since death
Tongue protrusion between clenched
teeth
 Internally:

 Dark blood due to reduced hemoglobin

 Engorgement of right side of heart
 Lungs
 Petechiae
 Terminal vomiting
 Autopsy may be confusing due to
 Inhaled vomiting
 Movement of body after death
 Uncoordinated movement during terminal moments
Asphyxial Death- Hanging
Complete and incomplete Hanging

 Complete:

 Weight of the whole body acts as constricting

force as feet do not touch the ground

 incomplete\ Partial:

 When weight of only head (and not the whole

body)act as constricting force, weight of the head
is sufficient to casuse death.
Typical atypical hanging
Hanging:
 Cause of death:

 Cerebral ischemia and anoxia due to arterial obstruction.

 Cerebral congestion due to compression of jugular veins.
 Blockage of air passage by obstruction
 Vagal inhibition
 Spinal cord injury
 Combination of any of above
 Most common cause is compression of neurovascular bundles in neck and
not airway obstruction- Parikh

 Symptoms:

 Flashes of light before eyes

 Ringing in ears
 LOC
 Death
Asphyxial death - Hanging
 Tension producing death in hanging

 Carotid arteries occluded by 3.5 kg (cerebral

ischemia)
 Jugular veins occluded at 2 kg (cerebral
congestion)
 Trachea 15 kg
 Vertebral artery 16.6 kg (Parikh), 16-30 kg (Dr.
Roohi)
 Blockage of laryngeal passage due to tongue 20 to
40 kg- Dr. Roohi
 Fatal period: if injury of [Link] death
instantaneous. If no injury 5-8 minutes are fatal
period.
Hanging-Asphyxial Death
 Postmortem appearances
 Externall
 Neck: stretched upward
 Head: inclined opposite to knotg
 Face: pale or may be congested
 Hands and nails beds: cyanosed
 Eyeball: prominent
 Tongue: protude due to congestion
 Exposed part: dark
 Saliva: dribble from corner of mouth opposite to knot
 Lividity: Arms and legs and skin of face and neck above
the ligature
 Petechiae: only on arms and legs
External- Postmortem- Hanging-
Asphyxial Death:
 Ligature Mark
 Pressure mark on the neck at the site of ligature
 Appears as groove
 In the early period after death, it looks pale later becomes
yellow, brown, hard and parchment like
 Abrasions
 Complete hanging
 Incomplete hanging
 Noose
 Fixed
 Running
 Character
 Nature of ligature
 Body weight
 Time
 No. of turns
Internal findings-Postmortem- Hanging-
Asphyxial Death:
 Internal findings:
 Local injuiry not common
 Structures:
 Platysma fibers break
 Sternocleidomastoid fibers break
 Thyroid cartilage post horn fracture
 Hyoid>40 yrs
 Proof of ante-mortem:
 Hyperaernia of trachea and epiglottis
 Lymph node congestion and hemorrhage
 Frictional intimal tears of carotid with sub intimal haemorrhage
 Subcutaneous tissue appears as dry and compressed white
band
 All above findings are never seen in postmortem hanging
 Other internal findings of asphyxia may be present
Asphyxia- Hanging
Was the Hanging Antemortem
 Ligature mark with petechial hemorrhages
and ecchymosis into or around ligature.

 Carotid intima

 Lymph nodes congestion

 Absence of fatal injuiries:

 IS LIGATURE STRONG ENOUGH TO BEAR THE
WEIGHT OF THE BODY
 IS LIGATURE MARK CONSISTENT WITH ITS
MATERIAL
Asphyxia- Hanging
Was it Suicidal, Homicidal or Accidental:
 Suicidal:
 Secluded place
 Readily available material as ligature
 Self suspension position
 Hands and feet tied
 Hx of other suicidal attempts
 Signs of struggle absent
 Suicide Note
 Psychological autopsy

 Homicidal:
 Rare
 Senility\drugged\multiple offenders
 Suspected when
 Knot at the back of neck
 Mouth gagged
 Limbs tied
 Injuires that are not self inflicted
 Signs of struggle- crescentic abrasions closed to ligature impression
 Judicial Hanging( justifiable)
 Lynching( Non justifiable)
Asphyxia- Hanging
Was it Suicidal, Homicidal or Accidental:
 Accidental:
 Children caught
 in cords of windows
 In tree branches during tree climbing
 Autoerotic\sexual asphyxia:
 Masochism and transvestism
 Ligature and padding
 Crime scene
 Pics and proof showing this act is done before
 Padding under noose, feminine attire, clothing, expose
genetilia, pornographic literature
 Imp to avoid costly homicidal investigation and false suicide
verdict which can affect claim to life insurance
Asphyxia- Hanging
Difficulties in Diagnosis:
 Ligature mark
 Hazardous to diagnose hanging without ligature mark
 Show resist in putrefaction because of avascularity

 Nail marks due to throttling

 Ecchymosis (vital but rare)

 Injuries:

 Ante-mortem:

 Suicidal-cut throat
 homicidal-multiple rib fracture, contusion of whole body, visceral rupture
 Accidental- during convulsion body may hit furniture and sustain injury

 Postmortem:

 Body falls after ligature is cut

Asphyxia-Ligature Strangulation
Cause of death
 Pic from book- Parikh
Other signs
Symptoms
 Death by sudden compression
 Cyanosis
 Bleeding from nose and mouth
 Clenched hands
 Convulsion
Post-mortem
 Externally
 No signs in vagal inhibition
 Tongue
 Injuries
 Ligature mark
 Circular if ligature at the level of thyroid cartilage or below
 Oblique if the victim dragged by the ligature or strangled in
recumbent position
 Portable and easily concealed ligature: electric cord, laundry
wire
 Stick
 One bruises front of neck
 Two one front and other behind
 Foot irregular bruising
 Internally:
 Widespread internal tissue damage than in
hanging
 Neck muscles, laryngeal cartilage،, tracheal ring,
and carotid arteries are injured
 Subcutaneous tissue ecchymosed
 Superior horn of thyroid cartilage injured but hyoid not
 Hyoid fracture>40 yrs
 Stick or foot extreme injury to cervical structures
common
Was it suicidal, homicidal or Accidental
 Suicidal:
 Ligature is tight even after death
 Found in situ
 Knot usually infront
 Body free from any torture signs

 Homicidal:
 Common form of murder, strangling assumed homicidal until proven
otherwise- Parikh
 Ligature:
 Knot in the back
 Mouth gagged
 Limbs tied
 Other injuries
 Signs of struggle
 In case of female assault case, ligature is something readily available, nylon
stocking etc
 Extensive injuries if more force is applied
 Infanticide by umbilical cord ( other signs of violence may present)
 Accidental
 Newborn
 Occupational
 Other ways
Types of strangulation
 Mugging (choke hold)
 Compressing victim’s neck against arm
 No external or internal signs of injury
 Garroting
 Ligature is thrown at victims neck from the back
and quickly tightened
 Garroting ( mode of execution) was performed in
spain, turkey andPortugal
 Bansdola
 Neck compressed between two sticks or hard
objectsusually bamboo (bans)
Garroting
Garroting
Diff btw Hanging & Strangulation:
Throttling- Strangulation- Asphyxial
Death
 Throttling:
 A form of strangulation affected by hand (manual strangulation)

 Externally:
 Signs of Asphyxia
 Time \ pace
 Constricting forces
 Injuries
 One hand used
 Both hands used
 Crescentic abrasions
 Nails
 Back of neck
 Internally:
 Thyroid
 Hyoid
 Bruising at the base of tongue
Throttling bruise
Throttling- Strangulation- Asphyxial
Death
 MLA of throttling:
 Was death due to throttling
 Nail marks and bruising of neck due to thumb and fingers
 Swelling
 Bruising of larynx, trachea, and surrounding muscles and vessels
 Fracture of cornuae and hyoid bone
 General signs of asphyxia

 Was it Suicidal, Homicidal, Accidental:

 Suicidal
 Impossible
 Homicidal:
 Common form- Parikh
 Women , infants. Adults
 Assault
 Importance of time factor
 15 to 20 secs are enough to dispose healthy adult
 Accidental:
 Vagal inhibition
Smothering-Suffocation
-Asphyxial Death
 Form of asphyxia caused by mechanical occlusion of external air passages viz. nose and mouth
by hand, plastic bag, or other material.

 Autopsy:
 Visit by pathologist and photographer is imp to crime scene
 V shaped incision is continued to ear lobes; face, inside of the mouth, tongue
 IN HOMICIDAL:
 Abrasion present when nose & mouth closed by hands, but not when done by soft pillow
 Sometimes injuries in frenulum of lip or tongue may be only signs due to pressure on them as they are delicate –
absent in children as they cant struggle
 Glue sniffing:
 Xylene causes drowsiness
 Causing breathing of the glue material
 Increase moisture causes adherence of plastic to face
 Smothering- anoxic anoxia

 MLA:
 Accidental
 Mostly- Parikh
 Alcoholics\epileptic (post ictal)- fall on to abed, or in bins Positional\postural Asphyxia
 Infants:
 placental membrane on nose and mouth
 weight of bed sheet
 Autoerotic: envelop head in a plastic bag
 Overlaying
 Accidental smothering of a child, due to its mother or other persons sharing the same bed, rolling over the baby during
sleep, and thereby asphyxiating it
Lips injuries in smother
Smothering-Suffocation
-Asphyxial Death
 Suicidal:

 Becoming common in elderly by using a plastic bag

 Homicidal:

 Common method of infanticide

 Burking:

 Burke and Hare method

 Burke sat on chest of intoxicated victim, with one hand
covered his nose and mouth, with other hand moved up his jaw
 Hare used to pull him round the room by feet
 Mixture of traumatic asphyxia and smothering
Choking & Gagging-Suffocation-
Asphyxial Death
 A form of asphyxia caused by mechanical occlusion of
the lumina of the air passages by a solid object- Choking

 Death in choking can happen

 Asphyxia
 Vagal inhibition
 Laryngeal spasm
 Bronchospasm

 Gagging is a means to effect choking by prevention of air

entry through mouth and nose.
 A cloth stuffed tightly in the mouth, so air can not enter through
throat either
 Saliva, mucus, vomit and other fluid moisten the cloth, giving rise to
airtight occlusion
 Autopsy:

 Tongue:
 Position
 bite marks (post epilepsy)
 Hx of epilepsy
 Bite marks on the tip and side of the tongue
 Empty urinary bladder

 Foreign body and secretions in choking

 Pt even if resuscitated may die due to secretions

 Café coronary, carry out toxicological analysis for

drugs
 MLA:
 Accidental:
 Impaction of food, fish bone, and denture in air passage
 Inhalation of vomited material
 Café coronary:
 Condition of accidental choking caused by a bolus of food
producing complete obstruction of larynx
 Usually happens in café or pubs
 Happens in people where gag reflex is suppressed
 Toxicology for alcohol and drugs
 Cause of death either asphyxia or reflex cardiac arrest due to vagal
inhibition
 On autopsy, there can be bolus of unchewed food impacted in larynx,
marked cyanosis.
 Insurance
 litmus paper test of bolus
 Heimlich manoeuvre
 Homicidal:
 Infanticide
 Bleeding in respiratory passages
 Cut throat
 tonsillectomy\ tooth extraction- criminal negligence
allegation
 Gagging mostly homicidal
 children
 Assault
 Robbery

 Suicidal:
 Rare
 In prisoners and psychiatric patients
Traumatic Asphyxia-Suffocation-
Asphyxial Death
 A form of asphyxia resulting from trauma to the chest or
external pressure on the chest, abdomen or back which
prevents normal respiratory movements (crush asphyxia)

 Examples:

 Stampede- Pressure on chest

 Non penetrating trauma
 Pinned down by car
 RTA
 House collapse
 Commonest accidental cause: farmers- overturn of tractor, fall of earth
from ill prepared trenches in trench workers- Parikh
 Hogtying positional asphyxia:
 Victim is handcuffed with hands behind his back, with or without tying his
ankles to the cuff
 Autopsy:

 Deep cyanosis of face

 Numerous petechiae

 Demarcation line
 Compression of chest displacing blood into veins and capillaries of head and neck
 Head and neck veins engorged, their hydrostatic pressure rise  capillaries burst
 Deeply cyanosed head and neck
 Valves
 Level of compression

 Traumatic emphysema:
 Injury to the lung causes redistribution of the air producing bullae in the edges of the lung in
the edges of lungs

 Injuries include:
 Fracture of ribs, multiple, bilateral and at angle of ribs
 Damage to diaphragm
 Heart and lungs injuries
Traumatic asphyxia
TRAUMATIC asphyxia
 MLA:
 Mainly accidental
 Homicidal- burking, Bansdola
 Mother overlaying on child

 Bansdola
 Homicidal compression of chest by means of
bamboo or bamboos
Drowning-Asphyxial Death
 A form of asphyxial death in which access of air
into the lungs is prevented by submersion of the
body in water or other fluid medium
 Classification
 Typical:
 Obstruction of air passages and lungs by inhalation of fluid
 Wet Drowning
 Fresh water
 Salt water
 Atypical
 Very little or no inhalation of fluid in the air passages
 Dry
 Immersion Syndrome
 Submersion of the unconciouss
 Near drowning or Secondary Drowning Syndrome
Atypical Drowning:

 Dry Drowning:

 Immersion Syndrome:
 Vagal inhibition leading to Cardiac Arrest due to
 Sudden impact with cold water
 Falling in water withfeet first, or duck diving by inexperienced
 Horizontal entry into epigastrium with a consequent impact
on epigastrium

 Submersion of the unconcious:

 In epileptic people, heart diseases, drunk, having head
injury,, cerebral aneurysmal rupture causing collapse
 Complete picture of drowning is absent, lung ballooning and
froth may be absent or negligible respectively
DUCK DIVING
 Near drowning or secondary drowning syndrome;
 Person survives from the drowning event it is called as
near-drowning and complications are called as near-
drowning syndrome.
 It is due to hypoxic encephalopathy and secondary
changesbin lungs knowns as fibrosing alveolitis as a
result of infection
 Rigid stiff lungs which are heavy but not edematous
 Brain shows typical ischemic red neurons
 Lungs show feature of ARDS
 Death occurs after some hours and even days after
resuscitation from combined effects of cerebral hypoxia,
pulmonary edema, aspiration pneumonitis, electrolyte
disturbance and metabolic acidosis
Drowning-Asphyxial Death
 Mechanism:
 Non swimmer falls, he sinks due to force of fall and weight of body
 Natural buoyancy- person rises
 When on surface, violent attempts to breath and shouting gets water in
lungs replacing air in it
 This increase specific gravity and body sinks
 Irregular movements of person can bring him on surface but after
inhaling water person goes down
 Happens several time until person is exhausted
 Convulsive movementsSuspended animation\coma
 Death
 Moreover water in respiratory passage can act as irritant, increasing
mucus production
 Water, air, mucus churned up together due to efforts of respiration producing
Fine froth

 Cadaveric spasm
 Symptoms
 Auditory and visual hallucination
 Return of memory of past events
 Mental confusion

 Cause of death:
 Asphyxia
 Obs in air passages as fluid inhaled
 Laryngeal spasm
&
Drowning-Asphyxial Death
 Fatal period:
 Fresh water 4- 5 mins after complete submersion
 8-12 mins after complete submersion in salt water
 Autopsy
 Externally
 Fine and persistent froth at the nose and mouth-
pathonegmonic
 Cadaveric spasm
 Cutis anserina\Goose skin
 Washer woman hands and feet
Internally- Autopsy- Drowning-Asphyxial
Death
 Internally:
 Changes in respiratory tract:
 Emphysema aquosum (ballooning of the lung)
 More marked in salt water
 Fine blood tinged froth in air passage
 Water transudes to pleura- putrefaction

 Biochemical changes in blood

 Gettler’s test: chloride content in blood
 Presence and character of water in stomach
 Can contain mud, algae etc
 If deceased did not drink this water prior to drowning it is imp as water in
intestine means it has gone from stomach through peristalsis (absolute
proof of ante-mortem drowning)- Parikh

 Presence of diatoms in the tissue

 Other signs
 Presence of diatoms in the tissue:
 Valid only if
 It can be shown that deceased did not drink this water
before submersion
 Species in bone marrow sample are present in sample
from the drowning site
 Species are present in same order of dominance , for
the admissable size range and approxiamtely in the
same proportions
 Other findings:
 Haemorrage in middle and inner ear
 Careful examination of all organs in
determining the manner of death
MLA- Drowning-Asphyxial Death
 MLA:
 Was death due to drowning or body was thrown in
water after death
 Fine froth- persistent profuse
 Material grasped in hand
 Fine froth in air passages
 Increased volume and edematous condition of the lungs
 Diatoms in tissues of bone marrow and brain
MLA- Drowning-Asphyxial Death
 MLA:
 Suicidal:
 Common- Parikh
 Women tie their clothes in a way to keep their body parts
covered, sometimes carry child
 Tie- until found that deceased could not have ties itself in that
manner
 Body should be free from injuries but injuries by nibbling of
fishes frog can be there
 Homicidal:
 Not uncommon
 Victim body concealed for some time
 Carried by water current to diff location
 Postmortem decay, injuries by fishes and passing boat make it
difficult to identify
 Triple bride murder- Bride in a bath
 Accidental
 Children, bathers, intoxicated persons, epileptic
persons
 Women can fall in well, having injuries, so
distinguish it from homicide
 Precipitant labour- bath tub
A dead body has been recovered from the
water, how to find time since death

.
MLA- Drowning-Asphyxial Death
 MLA:
 Time since death:
 Non water proof wrist watch may stop and tell
time and date
 Cooling rate after body out of water is twice more
than air
 Rigor mortis early and stay for more time
 Bleaching appearance of skin 4-8 hrs, and sodden
appearance in 18 to 24 hrs
 Skin of hands and feet glove off in 2 to 4 days
Degloving of skin after immersion
MLA- Drowning-Asphyxial Death
 Difficulties in diagnosing death in drowning:

 Absence of signs
 Shock\laryngeal spasm
 Postmortem drowning
 Decomposed body
 Submersion of the unconcious

 Injuries:
 Injuries before or during drowning do not bleed after body out from
water, as water has washed away blood. Microscopic examination in
doubtful cases
 Injuries by fishes usually in projecting parts- mimic homicidal
 distribution, postmortem nature, nibbled irregular margin
Decomposition in Drowned Bodies:
 Head: heavier thus tend to lie lower than rest of the body
 Blood gets into head, and color give suspicion of asphyxation

 Neck swells a collar band may appear giving suspicion of

asphyxation

 Skin degloving
 Putrefaction resisted as for putrefaction, air, moisture and
warmth are necessary
 Exclusion of air
 Protection from clothes
 Low water temperature
 In warm water algae covers the body orifice which is imp in
assault victim
 Diatoms resist putrefaction
 Floatations of the body:
 Since abdomen has gases it is light so abdomen is up,
and since spine is heavy so it is immersed in water
 Occurs in summer in 24 hrs, 2-3 days in winters

 Factors affecting floatation:

 Age
 Sex
 Condition of the body
 Season
 Quality of water
 Sea water
 Pond water
 Decomposed bodies:
 fine froth replaced by postmortem froth
 Lungs soft, blood stained fluid in plueral cavities
 Stomach empty
 Diagnosis:
 Possible in early stages as froth can be in trachea if opened in situ
without handling (no froth in nostrils)
 Not justifiable to call drowning in advance decay
 Biochemical test
 Diatom
 Intoxication
 If both these are negative then cause of death not given
 Even if all signs are absent it could still be a case of
drowning\consistent with drowning based on
circumstantial evidence.