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

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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