Mechanical

Asphyxia
Done by: Haneen Khaled Qatameen
objective
 Definition
 Types of anoxia

 Stages of mechanical anoxia or violent

asphyxia::
 The ‘classical’ features

 The autopsy diagnosis of 'asphyxia‘

 Mechanism of death
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:

- Ambient.‫بيئة‬
- Central.
- Paralytic.
- Mechanical (violent asphyxia).
- Obstruction of the blood flow to the lungs.
(2) Anemic anoxia:
- Chemically combined hemoglobin.
- Hemolysis.
- Hemorrhage.
(3) Stagnant anoxia.‫راكد‬
(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..
 The ‘classical’ features
 are found where the air passages are obstructed by pressure applied to the
neck or to the chest .

 The classical features of ‘asphyxia’ are:(although not diagnostic, are important.)

1 congestion of the face;
2 oedema of the face;
3 cyanosis (blueness) of the skin of the face
4 petechial haemorrhages in the skin of the face and the eyes.

 A fifth feature – increased fluidity of the blood – is now not accepted.

 Very non-specific, very unreliable

 The slower the death, the more prominent asphyxial signs.
Petechiae
 are pinpoint hemorrhages produced by rupture of
small vessels, predominantly small venules.

 Rupture appears to be mechanical in etiology and is

caused by sudden over distention following abrupt
increases in intravascular pressure

 These are most common in the visceral pleura and

epicardium. also seen in the conjunctivae and sclerae.
Cyanosis

 caused by an increase in the amount of reduced hemoglobin.

 It does not become observable until at least 5 g of reduced hemoglobin is
present.

Congestion
is the red appearance of the skin of the face and head.
It is due to the filling of the venous system when compression of the neck or
some other obstruction prevents venous return to the heart.

Oedema
is the swelling of the tissues due to transudation of fluid from the veins caused
by the increased venous pressure as a result of obstruction of venous return
to the heart
 The autopsy diagnosis of 'asphyxia'
 Sings of asphyxia is very unspecific.

 Even co-existence of these findings, does not prove that

death resulted from mechanical asphyxia.

 post-mortem diagnosis – blood gases – impossible –

very rapid changes.

 careful assessment of the history and circumstances of

the death + exclusion of other causes + cautious
evaluation of the signs diagnosis.

 Most important – cause for airway obstruction.

 Asphyxial deaths can be loosely
grouped into three categories:

 1. Suffocation
2. Strangulation
3. Chemical asphyxia
 Mechanism of death
 a combination of these
 1) Compression of the neck(Occlusion of neck vein

Compression of the carotid arteries….Reflex vagal

inhibition
) (hanging andstrangulation)
2. Blockage of the airway (suffocation, gagging)
3. Compression of the chest, neck, or face (postural
or positional asphyxia)
4. Chemical and lack of available oxygen in the
atmosphere
Strangulation …. Pressure on the neck

 Hanging

 Strangulation with Ligature

 Throttling (manual asphyxia)

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
 Hanging

 Definition:‫شنق‬
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).
 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 ‫عقدة‬or running noose Always running noose
Rope marks‫حبل‬ -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 with Ligature
 Definition:‫خنق‬
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: ‫زي‬incomplete hanging
. 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
 SUFFOCATION
 Situations in which accumulations of irrespirable gases occur are
commonly industrial or agricultural;
 they may be found in the deep tanks of ships where rust formation has removed
oxygen,
 in farm silos containing grain, or
 in deep wells in chalk where carbon dioxide has accumulated.
 The individual entering these situations without protective
equipment will be rendered unconscious extremely quickly and will
die rapidly unless removed from the hypoxic environment.
 In all these situations, asphyxial signs may be minimal as collapse
and death may be so rapid.
 Rapid deaths are also reported when a plastic bag is
placed over the head, either as a deliberate suicidal act
or accidentally by children. Typically, no ‘classic signs’
are seen and the face is usually pale when the bag is
removed. The bag need not be tied around the neck to
be effective.
Exit’ suicide
with a plastic
bag. The face
is usually
pale and
devoid of
asphyxial
signs.
suffocation:
 six general forms of suffocation:
 1. Entrapment/environmental suffocation
 2. Smothering
 3. Choking
 4. Mechanical asphyxia
 5. Suffocating gases
environmental suffocation
, an individual inadvertently enters an area
where there is gross deficiency of oxygen.
 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.‫المهد‬
 ** Homicidal, suicidal or accidental
 SMOTHERING
 Smothering with a pillow or other object (including a hand)
pressed over the nose and mouth will only very rarely cause any
petechiae, any significant cyanosis or congestion unless the victim
struggles and fights for breath against the obstructed airways.
 Smothering may be virtually impossible to

diagnose if it is applied to those who cannot or

do not resist – the old, the infirm or the very
young. If the victim does struggle‫كفاح‬, there may be
bruises and abrasions to the face, on the lips or
inside the mouth (where lips are pressed against
teeth).
Mechanical asphyxia is almost always
accidental in manner. It can be
subdivided into three types:
 Traumatic Asphyxia
Traumatic asphyxia occurs when a heavy weight presses down on an individual’s
 chest or upper abdomen, making respiration impossible. Causes of death:

- Mechanical anoxia.
- Injury to vital organs
 Positional asphyxia

Positional asphyxia is virtually always an accident and is associated with

alcohol or drug intoxication. In this entity, individuals become trapped in
restricted spaces, where, because of the position of their bodies, they cannot
move out of that area or position.
 Riot-crush

Riot-crush, as the name implies, occurs in riots, when the chest is compressed
by stampeding people piling on top of each other. Respiratory movements
are, thus, prohibited by this human pile
Postmortem picture of traumatic asphyxia

 (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
 GAGGING

 The air passages may be obstructed when a cloth or soft

object is pushed into the mouth, or placed across the
mouth, often during a robbery when the victim is tied up
and the cloth is used to ensure
their silence. At first, breathing can
take place via the nose, but as time
goes on, nasal mucus and edema
close the posterior nares and
progressive asphyxia develops.
 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
 Drowning
 Definition:
It is the mechanical anoxic death due to submersion of the
respiratory openings under water.

 Causes of death:
- Direct causes: mechanical anoxia
- Indirect causes:
. Reflex cardiac inhibition due to vagal stimulation
. Head injury or other fatal injuries.
Posrmortem picture of drowning

 - Sure external signs:

. Froth
. Cadaveric spasm
 - Probable external signs:
. Related to anoxic anoxia: cyanosis
. Related to presence of the body in water:
skin is pale&wet
Goose skin‫اوزة‬
Washerwoman skin
Postmortem injuries
. Affection of postmortem changes due to presence in water:
Cooling, hypostasis, adipocere, putrefaction
**Homicidal, suicidal or accidental
Chemical Asphyxiants

In chemical asphyxia, inhalation of a gaseous compound prevents

utilization
of oxygen at the cellular level. The most common chemical asphyxiant
encountered by a medical examiner is carbon monoxide.
 Hydrogen cyanide

 Hydrgen florid

 Sexual Asphyxia (Autoerotic Asphyxia, Autoerotic Deaths)

These are asphyxial deaths, principally caused by hanging, in which
transitory anoxia is intentionally induced to enhance sexual
arousement produced by masturbation
References
 DiMaio Forensic Pathology
 Forensic-Color Atlas of forensic pathology
 Simpsons forensic pathology
Thank You