ASPHYXIA

DR CHARAN
Asphyxia (Greek, 'pulsenessness' or 'absence
of pulse') means restriction of oxygen due to
mechanical interference with respiration.
Definition

 It is any condition that leads to:

- reduction of the oxygen supply to the blood and
the tissues below the the normal physiological
level (hypoxia).
- elevation of CO2 in the blood (hypercapnia).

**Hypoxia means (low oxygen) while anoxia

means (without oxygen).
Types of anoxia:

(1) Anoxic anoxia:

(2) Anemic anoxia:

- (3) Stagnant anoxia.

(4) Histotoxic anoxia.

Stages of mechanical anoxia or violent asphyxia:

Three stages:
 (1) Stage of forced respiration:
- It is due to stimulation of the respiratory center.
- Clinical picture: DYSPNEA
 (2) Stage of convulsions:
- It is due to cerebral irritation.
- Clinical picture: CONVULSIONS, CYANOSIS, HYPERTENSION, LOSS OF
CONSCIOUSNESS, CONSTRICTED PUPILS.
 (3) Stage of paralysis:
- Clinical picture: LOSS OF CONSCIOUSNESS, FLACCID MUSCLES & LOST
REFLEXES, DEEP CYANOSIS, DILATED PUPILS, IRREGULAR BREATHING
(Cheyne-Stokes respiration).
**Death occurs in about 5 minutes..
General signs

- Deep cyanosis.
- Proptosis of the eye balls.
- froth from the nose and mouth.
- Dark violet or blue extensive hypostasis.
 BLOOD =fluidity increased due to (fibrinolysin _
co2 _ ca+2 ,p change )
 Spots (tardieu spots ,silver spots )
 All organ congested

 N.B: Blood is dark and fluid in consistancy due to

increased CO2 and fibrinolysis respectively.
 CLINICAL EFFECTS OF ASPHYXIA

Asphyxia Sphincter relaxation Voiding of urine,

stools, semen

Capillary
Decreased oxygen endothelium
tension and reduced damage
Hb

Increased
Cyanosis capillary
permeability Tardieu’s spots

Unconsciousness Pulmonary
edema Capillary
rupture

Loss of muscle Increased

Capillary stasis intracapillary
power and engorgement
pressure
Tardieu’s spot
 Hanging

 Definition:
It is the mechanical anoxic death due to suspension
of the body from the neck by a ligature.

 Causes of death:
- Cerebral ischemia.
- Vagal cardiac inhibition.
- Mechanical anoxia.
- Transection of the spinal cord (judicial hanging).
Post-mortem picture:

 (1) General
 (2) Special features
- Protrusion of the tongue.
- Dribbling of saliva.
- Hypostasis of the lower half of the body.
- Neck signs:
.Elongated and the head is tilted to the opposite side of
suspension point.
.Ligature marks (HIGH UP in the neck, OBLIQUE,
INCOMPLETE, has an IMPRINT of the ligature).
** Homicidal, suicidal or accidental
 Types of hanging
Point of comparison COMPLETE HANGING INCOMPLETE HANGING
Other name High point hanging Low point hanging
Touching the ground Negative Positive
Circumstances Presence of a near-by table or Negative
chair
Main cause of death Cerebral ischemia Asphyxia
Face Less congested, sometimes pale Markedly congested
Hypostasis Lower half of the body According to the part touching
the ground
Type of knot Fixed knot or running noose Always running noose
Rope marks -Incomplete with fixed knot -Complete
-Above thyroid cartilage -Below thyroid cartilage
-Oblique -Transverse
-Deep and fades gradually -Deep all through
towards suspension point
Dribbling of saliva Positive Negative
Tear in carotid intima Positive Negative
Hyoid bone If fractured: outwards If fractured: inwards
 Strangulation
 Definition:
It is the mechanical anoxic death caused by
constriction of the neck by a ligature occluding the
air passages from outside.

 Causes of death:
- Mechanical anoxia.
- Reflex cardiac inhibition.
- Delayed edema of the glottis and choking.
Postmortem picture of strangulation:

 (1) General
 (2) Special features
All are neck signs:
- Ligature marks:
. Low in the neck below the thyroid cartilage.
. Transverse.
. Complete.
. Deep all through.
. Abrasions and contusions taking the shape of the ligating material.
- Inward fracture of the hyoid bone and the thyroid cartilage may be
fractured.
- Contusions and lacerations of the neck muscles.
**Homicidal, suicidal or accidental
 Throttling
«Manual strangulation»
 Definition:
It is the mechanical anoxic death caused by constriction of
the neck by the hand occluding the air passages from
outside.
 Causes of death:
- Mechanical anoxia.
- Reflex cardiac inhibition.
- Cerebral anoxia.
- Delayed glottic edema and choking.
Postmortem picture:

 (1) General
 (2) Special features
All are neck signs
- Multiple contusions and fingernail abrasions.
- Inward fracture of the hyoid bone (it is the most common
cause of hyoid bone fracture) and fracture of the thyroid
cartilage.
- Contusions of the deep tissues of the neck.
** Homicidal, suicidal or accidental
 Smothering

 Definition:
It is the mechanical anoxic death caused by occlusion of the
external respiratory openings by the hand or soft objects.
 Causes of death:
Mechanical anoxia
 Postmortem picture of smothering:
(1) General
(2) Special features
- Multiple contusions and fingernail abrasions.
- Contusions in the buccal mucosa.
- Ventral hypostasis in cot death.
 ** Homicidal, suicidal or accidental
 Traumatic asphyxia: Overlaying

 Definition:
It is the mechanical anoxic death due to
mechanical pressure by a heavy object on the
chest with or without abdominal compression
leading to prevention of respiratory movements.
 Causes of death:
- Mechanical anoxia.
- Injury to vital organs.
Postmortem picture

 (1) General
 (2) Special features
- Contusions and abrasions of the chest and abdomen.
- Fracture ribs.
- Rupture of internal organs.
- Line of demarcation between the discolored upper part
of the body and the lower part.
 ** Homicidal, suicidal or accidental
Burking is a combination
of homicidal
smothering and
traumatic asphyxia.
 Choking

 Definition:
It is the mechanical anoxic death caused by occlusion of the
respiratory passages from inside.
 Causes of death:
- Reflex cardiac inhibition
- Mechanical anoxia
 Types:
- Pathological
- Non-pathological
 **Homicidal, suicidal or accidental
Thank you