ASPHYXIAL DEATHS😊

ASPHYXIAL DEATHS

TYPES BASED ON MECHANISM

Hanging

• Neck compression

• Caused by body weight suspension

Strangulation

• Only neck compression

• No body suspension

Suffocation

• No neck compression

HYOID BONE FRACTURES

M/c cause:

• Throttling > Hanging > Ligature

Types

• Adduction # (M/c)



• Inward compression
• Seen in throttling

• Abduction #



• Outward compression
• Seen in hanging

• Side-to-side compression #
• One end displaced outwards
• Other end displaced inwards
• Seen in hanging

HANGING

Types Based on Knot Position

• Typical hanging
• Knot in occiput

• Atypical hanging
• Knot elsewhere

Types Based on Suspension

• Complete hanging
• Whole body suspended
• No body part touches ground
• Whole body weight = Constricting force
• Faster death

• Partial hanging
• Partial body suspended
• Body part touches ground
• Partial body weight = weight of the head = Constricting force
• Slower death (Suicidal)

Autopsy Findings

Order of Autopsy

• Cranium opened first

• Neck opened last
• For bloodless dissection
• To avoid Prinsloo’s Gordon artefact
• Posterior pharyngeal wall hemorrhage

Hypostasis

• Glove & stocking pattern
• Implies vertical body position
• Does not confirm hanging

Face

• Indicates antemortem hanging.



• Pale / Congested
• Dribbling of saliva
• La facie sympathique

Dribbling of Saliva

• Surest sign of antemortem hanging

• Seen opposite knot side

La Facie Sympathique

• Pressure on cervical sympathetic chain

• Signs:
• Ipsilateral eyelid opening
• Ipsilateral pupillary dilatation

Ligature Mark

• Characteristics of ligature mark
1. Pressure abrasion
• Pale, hard, dark brown, parchment like
2. Oblique
3. Incomplete
4. Above thyroid cartilage

• Transverse ligature mark seen in:
• Partial hanging (D/t low point of suspension)
• Slip knot with running noose

Internal Findings

Hyoid fracture

• Seen in 15–20% of hangings

• More common >40 yrs

Seen in hanging with long drop.

• Eg: Judicial hanging

• Carotid artery
• Amussat sign = Transverse intimal tear

• Vertebrae
• C2 (Hangman’s #)
• Rare: C3, C4

• Simon’s hemorrhage
• Intervertebral disc hemorrhage

Judicial hanging

• Knot position in India & UK:
• Left subaural (below angle of jaw)

• Fastest death:
• Knot beneath the chin (submental position)

• Mechanism
• Sudden stoppage of a moving body
• Causes fracture–dislocation at:
• C2–C3 or C3–C4 level (Hangman’s #)

• Cause of death
• Brainstem rupture
• Occurs between pons and medulla
• Leads to:
• Destruction of reticular formation
• → Irreversible loss of consciousness
• Destruction of respiratory centers
• → Irreversible apnea
• Death is instantaneous
• Heartbeat may continue for 15–20 minutes
• Spasmodic muscle jerks may persist
• No asphyxial signs

HANGMAN'S FRACTURE:

• Pars interarticularis fracture.

• Definition:
• Fracture dislocation of C2 over C3.
• Axial loading with hyperextension

• D/t distraction and extension force

• Spondylolysis:
• Defined as Pars interarticularis fracture.

• Spondylolisthesis
• Slipping of C2 over C3

Manner of Hanging

Suicidal

• M/c method: Hanging > Poisoning

• Painless, rapid

Homicidal

• Judicial hanging

• Lynching (mob, extrajudicial)

Accidental

• Autoerotic asphyxia

• AKA: Hypoxiphilia, Asphyxiophilia, Kotzwarism
• Asphyxiation Sexual gratification (Erotic hallucinations)
• M/c in male perverts
• Masochism
• Other signs at scene of crime :
• Transvestism
• Naked body
• Porn material
• No suicide note

STRANGULATION

Methods

1. Ligature strangulation

2. Manual strangulation (Throttling)

3. Mugging (Elbow/forearm)

4. Bansdola (Bamboo stick)

5. Garrotting (Thin Cord like)

Ligature Strangulation

• Ligature mark:
• Transverse
• Complete
• Below thyroid cartilage.
• Blood extravasation under skin
• Bruising around ligature mark +

Throttling

• External:
• Nail marks
• Six penny bruises

• Internal:
• Extensive Soft tissue contusion
• Adduction hyoid #
• Cricoid cartilage #

Mugging

• Elbow: Carotid choke

• Forearm: Air choke (Trachea occluded)

• Mnemonic: Garrotting
• "Gar" → imagine "garland" (goes around the neck)
• "Rot" → leads to death (rotting)

SUFFOCATION

1. Smothering

• Mouth + nostril closure

• Accidental
• Children with plastic bags
• Adults in mud/sand

• Homicidal
• Pillow/hands used

• Hand smothering signs:
• Perioral abrasions/bruises
• Lip injuries

2. Gagging

• Cloth/pad pushed in mouth

• Pharyngeal obstruction

• Asphyxia

3. Choking

• Foreign body in airway

• Air hunger, gasping

• Asphyxia

• Management: Heimlich maneuver

Cafe coronary syndrome

• Food bolus in airway
• Death cause: Vagal inhibition (due to intoxication)
• Sudden collapse

• Mimics MI

• RF: Elderly, intoxicated

4. Traumatic & Positional Asphyxia

• Masque ecchymotique

• Burking
• Smothering + Traumatic asphyxia
• sitting on their chest and blocking their nose and mouth

DROWNING

Most Cases

• Accidental

Types

• Dry drowning:
• Reflex Vocal cord spasm to prevent water entry → but leads to choking
• No water in lungs

• Wet drowning:
• Water enters lungs

Hydrocution / Immersion Syndrome

• Cold water immersion (<5°C than body)

• Vagus stimulation → Bradycardia → Cardiac arrest

Secondary Drowning

• Post immersion syndrome

• Due to complications after rescue:
• Electrolyte imbalance
• HIE
• Metabolic acidosis

Mechanisms

Autopsy Findings – Antemortem Drowning

Specific Findings

Cadaveric spasm

• Grass/mud clutched

• Surest sign of antemortem drowning

Froth at mouth/nose

• Fine, copious, tenacious, persistent

• Seen in violent struggle

• Due to mixing of Air, water, mucus and surfactant during struggling

• Absent in:
• Dry drowning
• Hydrocution
• Unconscious drowning
• Intoxicated

Non-Specific Findings

• Can be seen in ante & postmortem drowning

• Cutis anserina
• Also seen in rigor mortis of erector pili

• Washerwoman’s hand/foot
• Due to water imbibing into skin layers
• Wrinkling
• Peeling
• Bleaching
• Soddening
• Suggest the time since immersion (TSIN)
• Warm water > cold water

Lung Changes:

Emphysema Aquosum

• Conscious drowning

• Froth +

• Emphysematous bullae

• Voluminous, crepitant lungs

• Ballooning

• Mud in airway (Specific)

• Paltauf hemorrhage
• Due to rupture of Alveolar wall

Oedema Aquosum

• Unconscious drowning

• Massive lung edema

• ↓ Frothing

Other Findings

• Water in:
• Stomach
• Intestine
• Sinuses
• Middle ear

• Middle ear hemorrhage

TESTS FOR DROWNING

Gettler’s Test

• Principle: Compare Cl– in right vs. left heart

• Interpretation:
• Normal : Left = Right (Cl-concentration)



• >25% difference between left & right side.

Diatom Test

• Diatoms:
• Unicellular algae
• Outer wall has silica :
• Resistant to heat, acid & putrefaction.

• Microscopy :
• Observation :
• Presence of diatoms in
• spleen,
• heart,
• bore marrow.
• Inference :
• Antemortem drowning
• Diatoms entered d/t intact circulation

Limitations:

• Getlers & Diatoms test
• Not useful in:
• Dry drowning
• Hydrocution