Asphyxial deaths
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This article deals with asphyxial deaths, where "asphyxia" is used in the conventional context, i.e. it is not used appropriately when considered from the perspective of its etymology (as pointed-out by Knight).[1]
Asphyxia is, etymologically, lacking pulsation; in common usage it is essentially hypoxia (blood lacking oxygen)[2] and anoxia (tissues lacking oxygen).[3]
An introduction to forensic pathology is in the forensic pathology article.
Overview
DiMaio classification[4]
| Asphyxia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Strangulation | Chemical | Suffocation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hanging | Ligature | Manual | Mechanical | Choking | Smothering | Environmental | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positional | Overlay | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Practical classification
| Suspected asphyxia | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Signs of neck compression (Strangulation) | No signs of neck compression | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hanging | Ligature | Manual | Abnormal skin colour | No abnormality | |||||||||||||||||||||||||||||||||||||||||||||||||
Hanging
Classic:
- V-shaped furrow on the neck.
- V "open" at the point of suspension.
Drowning
Classic:
- Autopsy is often negative, i.e. there is no anatomical cause of death.
Drowning is difficult to prove on autopsy.[5] The diagnosis is often based on circumstance, i.e. the scene.
Macroscopic
External:
- Plume of froth at the mouth/nostrils (fresh drowning only).[5]
Internal:
- Lung emphysema.
- Froth in the trachea.
- Patlauf spots[6] -- ???
Micro/Lab
There are a few tests of debated value:[5]
- Diffusion of particulates into the blood (left ventricle) from the water.
- Diatom test.
- Haemodilution.
- Mostly useless - CPR interferes with it, not reliable if there putrefaction or autolysis.
- Transport of aveolar element into blood circulation.
Carbon monoxide
Carbon monoxide (CO) is a common way to commit suicide.
Pathophysiology:
- CO binds to haemoglobin -- prevents oxygen from binding there.
Findings:
- Salmon pink skin.
- CO level (blood test) elevated (???).
Manual strangulation
Features:[7]
- Petechiac of sclerae (white part of eye) & conjunctivae (cover sclerae); present ~ 90% of the time.
- Hyoid bone fracture.
- Thyroid cartilage fracture.
- Haemorrhage in strap muscles of the neck.
See also
References
- ↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 352. ISBN 978-0340760444.
- ↑ URL: http://dictionary.reference.com/browse/hypoxia. Accessed on: 12 September 2010.
- ↑ URL: http://dictionary.reference.com/browse/anoxia. Access ed on: 12 September 2010.
- ↑ DiMaio, Vincent J.M.; Dana, Suzanna E. (2006). Handbook of Forensic Pathology (2nd ed.). CRC Press. pp. 155-64. ISBN 978-0849392870.
- ↑ 5.0 5.1 5.2 Piette MH, De Letter EA (November 2006). "Drowning: still a difficult autopsy diagnosis". Forensic Sci. Int. 163 (1-2): 1–9. doi:10.1016/j.forsciint.2004.10.027. PMID 16378701.
- ↑ Bohnert M, Ropohl D, Pollak S (2002). "[Forensic medicine significance of the fluid content of the sphenoid sinuses]" (in German). Arch Kriminol 209 (5-6): 158–64. PMID 12134758.
- ↑ DiMaio, Vincent J.M.; Dana, Suzanna E. (2006). Handbook of Forensic Pathology (2nd ed.). CRC Press. pp. 155. ISBN 978-0849392870.