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

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

PERSIAPAN PL

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).

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

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

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

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.

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’

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

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

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

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

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.

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.

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.

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

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.

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.

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

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

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.

Different of suicide and homicide Hanging 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

Suicide or homicide hanging?

Suicide or homicide hanging?

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.

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.

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

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

THANK YOU