ASPHYXIA L DEATH

1. ASPHYXIAL DEATH Dr.I.B.GD Surya Putra P, SpF Department of Forensic Medicine Faculty of Medicine, GadjahMada University

2. CONTENT OF THE LECTURE • Definition of asphyxia • Causes of asphyxia • Phase of asphyxia • Appearence /clasiccal signs of autopsy • Types of asphyxia

3. PERSIAPAN PL

4. DEFINITION OF ASPHYXIA • Term “asphyxia” mean “lack of oxygen” • Etymologically the word means “absence of pulsation” • A condition where the cells or organs did not receive oxygen. • The condition can be partial (hypoxia) or total (anoxia).

5. CAUSE OF ASPHYXIA There are three causes of asphyxia : • Natural disease • Trauma (mechanical) • Toxic conditions

6. The Phase of Asphyxia • Dyspneu • Convulsion • Apneu • Paralyse • ALL PHASE NEED 4—5 MINUTE

7. THE CLASSIC SIGNS OF ASPHYXIA 1. CYANOSIS 2. PETECHIAE HAEMORRHAGES 3. VISCERAL CONGESTION 4. FLUIDITY OF BLOOD

8. CYANOSIS • Mean “dark blue” • The colour of soft tissue or skin change to blue or purple. And usually we look In the lip and under the nail. • However becomes observable until at least 5 g of reduced hemoglobin per 100 ml.

9. PETECHIAE HEMORRHAGES • Pinpoint hemorrhages produced by ruptured of small vessels, predominantly small venules. • Size from a tent of millimetre to about two millimetre. • Rupture is caused by sudden over distention or increases in intravascular pressure. • It is classically seen in the conjunctivae and sclerae (strangulation). • It often known as ’tardiev spot’

10. VISCERAL CONGESTION • It is due to obstructed venous return and capillovenous congestion. • There is dilatation of the vessels and stasis of blood.

11. FLUIDITY OF THE BLOOD • It is due to increased activity of fibrinolysin.

12. ASPHYXIAL DEATH Can be group into three categories: • Suffocation • Strangulation • Chemical asphyxia

13. SUFFOCATION There are six general forms : • Entrapment/environmental suffocation • Smothering • Choking • Mechanical asphyxia • Mechanical asphyxia combined with smothering • Suffocating gases

14. 1.ENTRAPMENT/ENVIROMENTAL SUFFOCATION • It is caused by inadequate or gross deficiency of oxygen in the environment. • But it is not due to by suffocating gases. • In this case volume of oxygen was 9.6% • It caused by fungus-like organisms ( for enviromental) • These death are almost accidental in nature.

15. 2. SMOTHERING • It is caused by the mechanical obstruction or occlusion of the external airways, i.e., the nose and mouth. • These death are usually either homicide or suicide, very rarely accident.

16. 3. CHOKING • It is caused by obstruction within the air passages. • The manner of death can be natural, homicide, or accident. • The diagnosis of choking death is made at autopsy when the airways is found occluded. • If the material in oro-pharynx is choking, if laryngo-pharyngx is called Gagging.

17. 4. MECHANICAL ASPHYXIA • This condition, if there is pressure on the outside of the body prevents respiration. • Divided into three types : • Traumatic asphyxia • Positional asphyxia • Riot-crush or “human pile “ death

18. Traumatic asphyxia: • It occurs when a heavy weight press down on individual’s chest or upper abdomen. Positional asphyxia : • It occurs when the position of the bodies trapped in restricted space. Riot-crush : • It occurs in riots, when the chest is compressed by stampeding people piling on top each other.

19. 5. TRAUMATIC ASPHYXIA COMBINED WITH SMOTHERING • It is a combination of both these entities. • An accidental form is overlay, where an infant is placed in bed for the night with either an adult or a larger child.

20. 6. SUFFOCATING GASES • This condition is caused by inert gases such as carbon dioxide and methane. • The gases makes reduction of atmospheric oxygen.

21. STRANGULATION • It is characterized by closure of the blood vessel and air passages of the neck as a result of external pressure on the neck. • They are three forms : • Hanging • Ligature strangulation • Manual strangulation

22. 1. HANGING • In hanging, there is compression or constriction of the neck structure by noose or other constricting band tightened by the weight of the body. • There may be either complete or incomplete suspension of the body. • Commonly, hanging is suicide. Accidental hanging is uncommon and homicidal hanging very rare.

23. Suicide : Different of suicide and homicide Hanging Homicide : Complete supension : the distance between foot an floor is far Victim : there is another wounds Scene : Untidy • The distance between foot and floor is near • Victim : just one wound in the neck • Scene: Tidy

24. Suicide or homicide hanging?

25. Suicide or homicide hanging?

26. 2. LIGATURE STRANGULATION • The pressure on the neck is applied by a constricting band that tightened by a force other than the body weight. • All cases are homicides.

27. 3. MANUAL STRANGULATION • It is produced by pressure of the hand, forearm, or other limb against the neck, compressing the internal structures of the neck. • All cases are homicide.

28. AUTOEROTIC ASPHYXIA • Principally caused by hanging • Transitory anoxia is intentionally induced to enhance sexual arousement produced by masturbation. • Loss of control, and accidental death occur. • Such deaths are rare, with the victim always a male, only a few cases involving female. • Typically found in a private area, sometimes wearing female clothing, erotic literature, sexual paraphernalia, and mirror

29. CHEMICAL ASPHYXIANTS • This condition occur due to chemical substance. • In chemical asphyxiants, the most common encountered by medical examiner is carbon monoxide, and cyanide.

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