* Commm feature (9 aSphyxfal aeatns= mechanical Obs a “wr to respiratory process leadmg fo hypoxic hypoxia: . a Yo % but there're 2 types of aspieias , discuss —> donot have mechanical “obs = wesu(focation — 2:Ttaumale asphysta + g 8 0 3s z CHAPTER S 5 bypoxte oxi = é hyporte hyp 7 3 Asphyxial deaths Ci perce s ¢ z. Asphyxia in forensic medicine is defined as cireumstanees lending to. sate af hypoxek © 9 § anoxiaaswresult ofmechanis ion to the respiratory, passage. The obs! z Ss i aa be at any point from mouth and nose to the lungs. Among those classified as sphyxial ow nose & iy y : z deaths, theve are gvo types of deaths that are aot linked with obstruction to.the respiratory Paes 3E passage os such MISGIESSimeRe, ase tions leading to death, ‘These include Orophartoy gF g & ee suffocation and traumaticrasphyxia, In sulfocation, hypoxia/anoxia is due to OD cro Ni adopbayo 3 BES Zp oxygensinstherenvironment: It is seen when a person is locked up in an aivigt fi Ey & compartment/room or ibthe bends covered swithrayplastic:bag and in £3 o vt aumaticasphyatn or cushasphyxiah de to the impairmentiorabsenee LT" 3 EX y pais ‘ofrespiratoryymovement such as with a qrachen wee 2) Heavy weight thavis:compressing-the:chestiand:abdomen., Sevarat people “police put cee ‘est an chest & prescure Leng tire. 3 : oo ungs> é 3 Cardinal features of asphyxia \ | eo 3 : The cardinal features associated with asphyxia are’ petechialyhaemorthages. eyanosis. . can be s.congestion and wedema. However, mere presence of these features does not confirm that wythm /in the death was due to asphyxia because all of these’features'could'beseenvevenrinideaths ou . 5, gs following natural!disease. On the other hand. deaths due to suffocation and drowning do ¥ not show the cardinal signs of asphyxia. Therefore, post-mortem diagnosisiof death due to asphyxiavis prudent‘only when the cardinal:featutes of asphyxia-are accompanied. wi evidence of mechanicalrobst toitheirespiratoryspassage, ¢.g-' fingernail" marks! on 2 neck in mantial strangulation, the ligature markcin thenneckin ligature strangulation. (some Petechiat WY also talk about fluidity of blood-with which makes the number of the so called cardinal bx cyanosis ,edma features five- which is sometimes phrased as “obsolete diagnostic quintet of L. Adelson) Congertron > when have {hese cardinal features + absence of ay Cardinal features of asphyxia of asphyxta te=Gyanosis Hb level ¥ 0% + Cyanosis is seen as bluishidiscolouration oP lips, fingernails and tip of th s It develops when the amount of reduced!haemoglobin in blood exceeds 5'Grr ho cyanosis - ml: In asphyxial deaths, cyanosis is observed in the above-mentioned However, bluish discolouration of fingertips could develop in dead bodies ex; to air for more than 6-8 hours. Therefore, p osisinad Ghhours'does not hevessarily indicate that the death was due to anasphyxi This is due to passive loss of oxygen after death through skin. Cyanosis is also deaths following natural disease consequent to hypoxic states as in asthm: cyanotic congenital heart disease. Spptacent haemorrhages Petechial haemorthages deyelop:mainlysimitissuesiabove Therefore, in ligature"strangulation, ae i sclera, forehead, cheeks, apper’eyelids and behind the ears. The petechi torthe'rupturevof-venules consequent‘torthe increased: pressure.due:to:cons ofilarge-veinsiin the neck. Hypoxic damage to the walls of the venules are al ‘Scanned with CamSeannetsurface of + Sn side dhe bocty, when dlgsecting im epicardrum Cout ie : ral & visceral pleura (around lungs) may get perechi where petechiae may to play role in the rupture of these blood vessels. Otherareas where pet heer Sain erence natural’ diseases including Petechial haemorthages are seen in a variety of natu aa tytn fet uke tomboeytrei esi £ evan cis develop due tothe side effects of certain drugs, Hypostatic a ty on the ef evidane to to resp. passages. <2 haemorrhages simulating petechial haemorrhages. Sa re £ A aboveitheilevelioftconstriction in § 3 Congestion is seen mainly inthe'skiwand tissues a i 7 $y 24 Steere loecemeicmniin ben a Seek engested. Congestion of organs is scen in congestive cardiac failure and 88 2° ‘organophosphate poisoning, eos & g a> Grown seat ge Ps Oedema develops when the hydrostatics pressuresinthes blood: vessels :isiraised Cj z foll - Oedema is seen Rye in the faeia tissues, brain and in the lungs in ligature and manual-strangulation, Bay Osdema of internal organs is also seen in many conditions other than asphy) ee gs pulmonary oedema in left ventricular failure, cerebral o¢ inga asé condition, = * x AAs explained above, the diagn presence of these so-called for injuries or other forms the respiratory passage, &_Classi ‘Smothering _ 1. 2. h © mouth from hond oF 3. Gagging _ Satfoms mouth w- sett materi 4. Hanging — unm tre 5. Ligature strangulation. & Manual strangulation - manuasy Squey niaK. 2 POPHEIE cheat bi 9. 1 traumatic asphyxia - Choking ~ food er any Crush asphyxia or Sexual asphyxia 0. Postural asphyxia - Browning eck 9 Upper amr ways. from oul stde ; compress the chest. MMe te pockite 5 mechanteat obstractten. BRB Death duc to suffocation occurs when @ person is enti This follows when a person is ttappe 8s carbon dioxide or nitrogenvor when the headvis covered:byra’plastionbag, Oe (6 eae on oa ee, ‘Scanned with CamSeanner(— cyanosis 5 tileblé , ne edema. injuries or specificwdingnostic features in these deaths. The diagnosis is made only from circumstantial evidence and by exclusion of other causes for the death, ; Deaths duc to suffocation are reported in children trapped in cupboards/refrigerators an ir t in miners. =< =p Sombedy'S closing your nose © mouth bom han ol ‘mothering, is closurevofmoutheandsnosespreventingsentry of airsintovthesrespiratory passage. It can happen accidentally when a drunkard falls ina prone position with the face mechanical pressed against’soft material such as bedding. A similar mechanism operates in infant obshuc® fs deaths duie to overlaying where the mouth and nostrils are covered by bedding. Smothering there. is also used as a method to-kill physically weak elderly persons and infants, Smothering is — putt unite Well-established method of committing infanticide. As there is minimal or absent other forms, resistance from the victim, the injuries are mostly confined to the face. ‘The injuries are suffocan’ grouped around the nose and mouth and they are in the form of contusions and abrasions tracamartre caused by the fingertips and fingernails respectively. However, in the case of infants, death asfhyxta, could ensue with minimum amount of pressure applied using a soft piece of cloth which roechanieatas. willleavenomark. —p if a pittow prested agamst face of méant, child’ die wlo ant ma ool not there, —* so.here From externaty nose & moth are bl BIGARGy -er myo weesar. smothering 9 989 dup, choking Chacheal (i -rnay be nat yo Gagging is stuffing’ the mouth withra'sofrmateriat suchvasapieceioficloth. In some cases, ae Ahough of kit, Stuffing is done with paper and sometimes even leaves of trees have been used. Death ra hbnes i ay De te ‘occurs when the material is pushed against the"posterior wall ofthe oropharynx, obstructing | eyeing swt Piventmg their entry'fromboth'the nose'and mouth. The salivainithemouthplayspartinsealing” & oral cavky Scsawmg the crevices that may be present within the stuffed material. This type of deaths is obstruct 9993. commonly encountered:during:robbery and rape, where the intention of the assailant n ~ so: foberirg. oubertoTkillithe:vietim. homredad 4eHanging Shanguianon S Nigature otian. E_F Hanging isa ype of aspiyxialideath where the vitin’s neck 2S -BE , Celingtheneek, with the constricting force being the entre orp © FBS Y Aweightaslowas 6~$ kgis sufficient to bring about death, Circum : ge 3 the majority of cases are suicidal. Accidental hanging is seen amor £8 6 8 E with ropes, workers who get entangled in ropes and in young males whe $5 § & sexual asphyx is SZ G5 g ,, strmgulation maybe-nung.tomimio'sucidal hanging. ludicia g ve a 8 condemned todeatinis executed by hanging. % = © S & | Classification of hanging: Cgee EE $é o> PE gues g Seyea B) Incomplete hanging (partial hanging): Incomplete han} gtzi52 orthellowest’part of the bodyris touching the ground/flaor _Cpart of bed weight app. arse Difference b/w ligature strmgu. & hanging — fi ph ote langing -, body weight of the persen catice to conshicy the Ligature str.- Qnsther external force Appued by the hands of ‘Scanned with CamSeannerconstrict the ot force iS enough fe * * Dy sncomplete hanging- a v-Small amt - ngng. \ I be tn v-akward positions mm incomplete hang" : €eK. perton vat neck, perten . i . Therefore, ‘it hess. btocs oie ofthe bay ouhing the wom, a ean) \ one could die by suspending his or her body from a lowly ® ?ep ending on He ‘suspension such as a door handle. Potinon of mee, nau > ©) Typical hangings In typical hanging the knor of the ligature on the n¢ : ; laced in the midline at the back of nek. ; . " =f 1) P) Atypical hanging: Atypical hanging is when the ‘xoiomahansalaniet " SU j ‘perston other than atthe back af theneck inthe midline. Atypical Hanging is a {he commonest form of hanging and the knot in the majority ce nae Dehindanear. + Sudo hanging {3 atypical hongmg, been eee - behind 6" below the eictine at the back of neck. * External findings and inj Bi m0 a5, juries in acase ofhanging’ ~~ estty <— AeGaieraRenturey Features cordial, < eeatare in most cases of hanging, the faceispale because them asphyxia I . : Reo nem i i., eyanosis, e and oedemay when the. mechanism of death is slow constriction of the neck | because the asphyxial death as in incomplete hanging x compression carota smut i gnostic) feature of hangin; + 5 ie, | Face pate Thedistribution of hypostacis ig circumferential as of | hhypostasis may be confined to the back. a ssi licatedeat istead, the n of the body, which therefore May occur e Commonly seen features include MY dbere's no ay that how athe person reach to veh Place + igh Suspretous Complete suspension) anc ‘sbetbir itt sa Tis also vital to observe the Frm hangma victim is already dead, then the li f neck afier securing the knot wit SmEMBERL to the point Of suspension is di * pol lotto the important to pais important to m: Untie me Keot ber the beay on + Cul the rope & “4 body which hanging the beady doin, Clore by, body rita agamst wat 7 Gat He gata Ut bit 7 WAN 3- Termmal convulsions. 24 fom the kno) - Secu ine ree & body ha Molenty on terminal con + body ht on Serace Zsanoand * Merging — internet erate Leb: 12 damage wy manat shasta? nw ‘Scanned with CamSeannetcould prolapse: underneath, andibleed, The blood will be scen to be dripping down'the legs tothe:floor as G petechial ges will be quite marked on the hypostale are: by ue. ae r. ‘BOLIRuIFEMIATANANjUFIeSTATINENEKY — specitre types °F Inyurfes occa Q fail The ligature in complete hanging reaches the uppermost part-of the neck under the. Bye £ Toate cmmencing from the lower most position, the ligaturestuns in an obliquely * * & eet Fea oe wean backward direction owardsthekna. The gare sualylavesan, mprinol foe ig Ugature remove itsipattern/weaveson therskin in the Form of an imprint abrasion» which becomes pared * E945 mare Wihithe passagetoftine. The ligaturemarkeis'very-aint or absent under the knot in most uyeeie vane pana BASE, espeniall eeETRHBInSRomes Tah, The ligature mark is deepest atthe lower most. 23 ° 9 ss Rhee Sica usually a point diagonally opposite to that ofthe knot on the & © 5 the mech oposite ide of neck The appearance and depth of the ligtuemarksis determinedibythe =. Physical charactristes of the ligature (lexture, weave, thickness) timeperiod ofhanging, & ‘complete or partial suspe ion, weight-of the:bod m hav, cotor o€ 4 betweenthe:skin and the ligature and whether there fs puttefactiomornec A we ligase, geen bam ‘shit a a long:period: ‘ofsuspension, a heavy'body, absence’ ‘of'anyrintervening material between cs il Fang To tooke- oes the neck and the ligature, such as a collar ofa shirt ora scart and complete suspension etc. feature © en Will favour formation'of aprominent-ligature:mark-and vice veren Occasionally, a few if couse ro anstuh Aye Vertically directed seratch abrasions may be Sen are the ligature mark and these arise 7 aw® Ot contige mares 88. resull of attempts by the victim to rescue himself from the predicament he ware payne Aigatore cin dusection Recessarthy Say In the majority of cases, the intemal finding'in the neck are minimaliona tt phe cases which show changes, the findings include mild contusic stemmomastoid muscle under the ligature mark, Fracture of one ot both superior comu of thyroid cartilage, Common) and intimal tear of upper part of common-carat jadicialshanging, the sudden vandeviolent=drop_fromea: high dislocationof the cervical ‘spine. ly, presence’of anysintervening. material Mechanisms of death in hanging: due te caroted “elt Vagal is the comin h du | Sinus ctmettaten Carotid body by the ligature, which results in rapid death: ‘are minimal or absent and the face is pale, Venous'congestion due to compression of jugular vein the veins above the ligature. This impedes the arterial Mow t causing death due to ischaemia of the brain, Death longer time, hence congestion and cyanosis are more pi of death is seen more commonly in partial suspension, due to compression of both comm | ligature. Here again, face is pale iue to lack of blood A Asphyxia due to obstruction the base of the tongue is pres constricting ligature. This is | aie bradycardia ar + heart stop é no time to make lasphyzrat deaturs. 3p of the respiratory passage a sed against the posterior the basis on which hanging ‘Scanned with CamSeanneree - eight «S the force of ¢, man av cons freon « + Pn Ng shangula*—Pextemat force wis the force f ie to pure asphyxia is Hhysia, However, the actual incidence of death due to pur asphyxia, However, the a races f spine leading to brain’stemvinjury when there ‘Y Fracture istoeaion of uppereervealspineteading to bins isa sudden, violent drop from a height as in judicial hanging, 3 of the neck. bub Sastesas|at névy abe ae a Upature © mace caanrctin oF the ne ‘SoLigaturestrangulation , seerscignr acte ag the fore. of cosine n bangtog ate i . The Ligature strangulation is constriction-of themeckousing:wligature: easiplinothencn. Te circumstances of ligature strangulation are almost always homicidal ae P9 Semebodsh strangulation has been reported but its extremely rare Homicidal igaure'strany ass hands. usually mostly associated with robberyrorirape. The victim is initially overpowered is i ia Fertgemts's assailant climbs on the victim's body and the ligature is applied from fron e Bhs en diay, tz isalso applied from behind especially ifthe vietim is taken unawares. Accidental lig ae: Vs roreuy one's Stfangulation is very rare, ~ €9! smati children plouing w stings ,robes etevs: can epee ligature Strongulations happens Use as" canene> Features of ligature strangulation =m howe there mae PBs stranguta® A. General features and injuries on the rest of the body. Paternal pressure exerted upon the tigature [mn the majority of victims, the face'isWeeply:congested and oedematous includingithe : area/f neck abovestherligature and petechiiae are found on cheeks, forehead, upper eyelids and behind:thevears. The eyes'are protruding with extensive subeonjunctiyal ons and scleralpetechialsshaemorrhages. The lipswareideeplyseyanosed (bluish discolouration). The lungs'are“oedematous with subpleural petechialthaemorthages. The livery kidneys "and spleenvare™deeply:congested. If the victim has been sexually abused the clothes ate disturbed. ere's a Quayeel bw assay lant & vichm. fo resiavning ‘© ffert of vastemtnt: © reyithenay) etpeu oC, AG teRcoripl cod MR RCTE CF ntand resistancefromithe:victim a) "Injuries duetorrestraining byrass: } There may be grip marks caused by the assailant in the form of circulator oval shaped contusions 1-2 em in size on upper arms, forearms and neck and curved imprint | tutte Finger <—abrasions. These injuries are caused by the finger pulps and fingernails respectively. In traits. addition, there may be contusions and abrasions caused by fingertips and nails on the ; lips and around mouth. Sometimes the assailant sits or kneels on the chest of the victim resulting in contusion of skin and soft tissues of the anterior chest wall and fractures of the sternum or ribs, especially if the victim is a female and the assailant is @ heavily built person. It is also not uncommon to find contusion on the face due to fist blows, b) Injuriesduetorcounter:pressure The victim is usually Pushed to the floor and the assailant strangles from aboye, hence the victim suffers a Broup of injuries duc to counter pressure while trying to release himselffherself from the grip of the assailant. Injuries are chiefly caused by movement of the skin against the ground underneath and these include grazed or linear abrasions ‘Scanned with CamSeannetUg + Strangat hanging —e onsirichon forte 3 whole or part of the beely weight « —» constrretion fereas hands t ligature encircling neck. manual strangle” —» goneireten Ces y onty ‘Ihe arms “hands cite é Tr hanging , Minimal mt ernal Fincings there. ty Nig-shangu. “manual Strang. Set more ady. vivid & atto elaborated findmgs enuyot the nee. 4 Ligature strangutattn — constriction the neck Fe the constricten around he peer once unconclous, hand automancally reteored —» nao ah So, iF Some one ctecicte In heenfeideal attempts C ey # detec. in meastat. and contusions, They are usually found on the back of the head, shoulder blades, etPow's buttocks and calves. If the attack took place in an outdoor setting there may be additional injuries caused by thorns and other parts of plants. In addition, if the victim is dragged along the ground it will cause grazed abrasions. Whe vietim is a female and had been subjected (o rape there may be inj sexual organs and the genitalia, ana breasis. to para- rat's ture marks , bat 4 Hangng also cause to leave tga ithe shape: B. Injuries in the neck ddr ‘The ligature mark on theneck is seen as an imprintabrasion ofthe ligature that is used> ay 56 an and it is seensin the fornvofa’groove with a parched:surface. The exact appearance of IPOS thence. the ligature, mark depends on the type of ligature used. Ropes and nyloneords produce Can vany from ansimprinvofithe-weave ofithestigaturevused. A ligature made from a broad andisofl Sinote ton to material, such as a sarongior-saree may leaveva‘faintmarkontheneek. The ligature is eee Pie usually found horizontallysin:thesmiddle orlowershalfiofithemneck and it may encircle. °F, the entire circumference of the neck or be found only on the front of the neck. The ‘number of turns around the neck can vary from a single turn to several turns of the 4 igature and in some cases the ligature is secured by a knot. When the victimsteuggles toreseaperfromtheattack, the assailant will use his hands to pindownutheswictinmholding - producescircular"orwovalashaped. a bysthesneck=oremandible This will in eontisions from the fingenpulps end imprintcurved-abrasionsefromthesfingernails. Internally in the neck, haemorrhagessinto:the:subcutaneousitissue and muscles may be alongrthercourse'ofithe:groove. ® seen If the ligature is thin and hard like a wire it can Jacerate the strap muscles. Additionally, diffuse areas of contusi ‘may be seen in instances where force had been used Fractures involving the superior:comuofithe:thyroid,cartilage and greaterhorn’ofthe: hyoid’bone may occur, though it is less commonly seen than in manual strangulation, A tightly applied thin ligature can cause damage to the intima of the common carotid inthe internal tissue ~~ by direct application of fingers. ~-* * AMET: + Pp manual strangulation get maxtmam MY. then lige stangula™ & then hanging. in hargmg (t's rare fe have frachires on the greater hon Of ‘hysia "bona F (tirottlingy a vw i es Manual strangulation or throttling is constriction’of themecksofthesvictimvusingyihe hands'oPtherassailant: Circumstances are always'homicidal, Manual strangulation is commonly associated with robbery, rape and infanticide. Once the neck is properly tt grasped, the victim immediately loses the power to resist and d terres iin afew minutes. Ustially, the assailantyclimbs:onstoprofthe victi from the fronuor pushes'againsta’hard'sunface like a wallvand compresses the thehands. It could also be donesfronyibehind, especially if the vietinvis'taker Ly one er both hands - Grusualty bol hands ax force ( applied with a hand & Wgatute cuoana Ug. srangutatien some people can use a othenife if you b S/4- In suicides, lounique to 12 commit suietde — Ug-strang © verorely suvcictat, ‘Scanned with CamSeannetFeatures of manual strangulation: A. General features and injuries on the rest of the body ‘i el The favs and oedematous including the aren of neck above the lev‘ OT ine, pchne re ound on cet Tohead an Ups eyes and ise deeply:eyanosed. tn the eyes, there are extensive subconjunctival and scleral petechi ‘haemorrhages. The lungs-ate deeply congested and oedematous with petechiaevunder the visceral pl leura. There is congestion of liver, kidneys and the spleen. Injuries on the body are due to restraining’ by the assailtnt, resistance fromthe vietim and due to Counter pressure, The appearance, distribution and pattern of the injuries caused by these mechanisms will be the same as those described under ligature strangulation. Bi Injuries inthe neck maximum mternal iryurted im ees are found in a Manual strangulation. External 4 Second Injuries are usually found on the front and si are circular or oval sha Ug -Shanguja? —* Least ~ hanging. ides of the neck. The characteristic injuries sped contusions, 1-2 cm in size and may be associated -with adjacent curved imprint abrasions. The contusions are cau: abrasions by the fingernails. The distribution and sever largely on the resistance offered by the vi distribution of injuries on the neck include relative positions of the victim and) whether one or both hands were used and the presence of intervening clothe the injuries are asymmetrically distributed, anda lesser number of injuries gnu side where the thumb has been applied. Additionally, more injuries are fol Re opposite side of the neck. There is often shifting and reapplication of th this leads to the format ion of larger contusions. Injuties m: becomes unconscious and sed by the finger pulps and ity of these injuries depend . The other factors that determi ay be minimal if death occurs very quickly due to vagal i Downwardly directed linear abrasions may be seen on the neck and they are the victim's fingers while trying to distadge the grip. Internal {In manual strangulation, internal injuries in the neck are m i hanging and fi Additionally, the internal injuries in the much more extensive than the extemal injuties. ‘The injuries inelude d extravasation of blood in the dermis, subcutaneous tissue, platysma and sternomastoid'muscles. When there is appli fingers directed on the larynx causes fractures of the Superior comu o r and greaterhoms of the hyoid bone. The number of fractures may vary depe the force used, Fractures are more frequently seen inthe elderly in whom the have undergone calcification. Application of intense pressure in the middle us the forearm, can produce fracture of the thyroid laminae or the cricoid Fracture of the hyoid bone is much commoner in manual strangulation than in * UN'S vitmpartent to examme for anti-movtum factors. ‘Scanned with CamSeanner{sr Cnasophorynt) 9. Canyne) oe C tracheot) pupnBulation, The fracture is associated with a small area of haemorthage around it and helps to distinguish from a post-mortem fracture. Sometimes the triticeal:cartilagesin In most of ages in the epiglottis and laryngeal surface the victims there are submucosal haemor internally, Mechanisms of death in manual strangulation are the same as those in hanging and ligature strangulation, , aaa SS vagal mbibition mb Cardia mhibiton ep Cerebral ischemia 8293Ig are Wfterence frm lever of TN CHORIg? —- mosity acddentat - Choking is a form of asphyxial death where the obstruction Dbstractien. io inhalation ote foreign body. the larynx or trachea due Circumstances of death from choking: Choking is always accidental, commonly seen among children playing with seeds and marbles ete, Sudden deaths due to choking is also ported among drunkards and inmates of mental hospitals. A large piece of meat or such item of food gets into the trachea during vigorous eatin " i i by these people. Choking occurs in unconscious patients who may inhale regurgitated fo 0d. . 2 7] ynisms of death in eh we. ‘ TaD 1 Due to obstruction of air passage (larynx/trachea) by the foreign b 2 aa 3 2. Vagal inhibition (reflex cardiac arrest) due to stimulation of larynx a 32 E- foreign body (afferent impulses travel through sensory nerves to i 9 = az efferent impulses are sent through the vagus nerve to the heart) _ es P SEL Autopsy features: & F— FF Features of asphyxia, such as congestion, cyanosis, oedema and petechiae $3 Be face. Examination of the tracheobronchial passages reveal the presence of the He +$O§ foreign body in the larynx or trachea. Mucosa around the foreign body { © SE + 3 congested. Lungs are congested and oedematous. Liver, spleen and kidney & & e ge g _ The person’s lite could be saved by instituting first-aid measures immediately 2 oS dealing a firm blow with the flat of the hand on the back of the chest and ins Z e child by holding the child in head down po: & A There's no respiratory obstuction in suffocation & tracumahe Csutfocanes - ne resprrable air in environment) x In traumane asphyxia - should produce a negative pressure & enviemmental pressure, Py chest Caviky or the am to enter * Nafuraty by inereasmg volume of sthorasfe cavity —» negative * Po TY 5 Intercostal musctes & ribcage, ciaphragm mates thorase ¢ extemal pressure comes fiom outside, eannst move thorasie cav: ‘Scanned with CamSeannerVypercapnea - cnerease ami. of (COs J fm bleed. —> uncanciomimn’s \ Some sexual acts Same happens. ish discolouration) oftbody sy features: All vitins show marked congestion (reddish discolouration ‘eyanosivatace, protrusion of thereyes, aedemavofiface and petechial crest ive injuries (crush injuries) caused by the \ ‘ jomen show extensive injuries (crus seb ia oo seh anne Fractures of ribs/sternum/spine and crush injuries of internal ongans. - eae Laver Ince tatens, cplente ruptures ete. Some young males, mainly in western countrigs engage in acts to ach es Sena to enhance their sexual geatilication during masturbation, Hypoxic ae k by a ligature covering the head with plasti bag or by controlled eanstetion of the neck by @ gare nlaced around the nee. The ligatre aroun! the neck is usually padded and is st up fn complex manner, sometimes involving the genitalia, and pressure exerted on the necks controlled by hand or a leg. ‘The person ean die due to asphyxia when the controlling mechanism fails, A visit to the undisturbed scene will reveal the complicated arrangement of the ligature and the vietim is often found nude or semi-nude with pornographic material strewn in the vieinity, The room is usually found to be lacked. — from inside: Anypercapneas edn - peoture eni820- = Samew iraumane asphyxta . mn postural asphyxia, the vietin’s breathing is impaired by the posttton'of the body, where the upper half of the body is found in a lower position (head-down or inverted Position), so that the weight of the abdominal organs will push the diaphragmndoy type of head down position is seen when someone slips out of the bed ini due to alcohol or drugs, when a person gets trapped while creeping thro _\When suspended from ankles during torture, The asphyxial state i by the collection of secretions in the oral cavity. Heart failure is also saidit significant role in bringing about the death in head-down position: ‘The post-mortem features include extreme congestion of the head, [ae limbs, cerebral oedema and pulmonary oedema. Can’t justify the typed paragraph Sp neck dis cchen — viva, paper. because In Standard autopsy technique employe “Ln non-asphyetd case, ‘The autopsy*invavcase‘ofshanging, (and other types of asphyxia deaths) shot ‘ include a special dissection’ofithenesk. In the standard autopsy procedure ( dissect the types of non asphyxial deaths), all body cavities’are‘opened. The headhis bocty. incision across the top of the head® i From chin halves of the are cach reflected forwards and backwards to expose tht avoid. the Skull vault is removed afer sawing through the skull, horizontally at | midiine'® —supraorbital prominence. The dura is removed frat 1m the brain surface by i Jo sup.pubic "Ong the cut surface of the skull base. The brain is released from ard base and taken out of the cranium. The chast and abdomin: Make incision midline skin incision running from the prominence of the thyroid ca the symphysis pubis, Then the chest and abdominal viscera are ri Check entire organs "Reviating from that, — normal autopsy - Special neck dissection 18 performed m asphyesal © one mastotd —+ other mactord. Caco, verter’) bran i catyana remove Dep becly fo dram blood: i Seance whom Stemnuns e1% cud 4 cligeetem mothering ULE cases —s Facial aisechen B@d can go Ruther la ‘Scanned with CamSeannera Bn cages of death due to any form of pressure on the neck & in deaths where dhere are other types of my. re nect Cegt bullet Mf, Stab to necks, patholegical causes ke expandmg tumore)+ attachments and all organs from tongue to rectum are removed en masse and dissection of all organs are done on the autopsy table, In cases of death duc to any form of pressure on the neck and in deaths where there are other types of injuries to the neck such as a firearm injury, a special dissection of the neck should be adopted, Special dissection of neck to be done in asphyxial deaths or when neck injuries duc to other causes are suspected, The essential steps of this procedure include, in-situ, layeribyslayersdissection of neck structures inva'bloodless field. This is toxvoi \leeding fiom-veins that occur from:cutveins (in the routine method described above) in the neck which can be confused n ceding from inj k that are caused by the asphyxiating agent. (This is the so called Prinsloo-Gordon arlefact) 1% step ~ At fitst the brain is removed using the standard incision on the head and skull After bleed followed by clevation of the chest above the level of the head by keeping a wooden block _G{aCoed compl under chest. Then the thoracic and abdominal organs are removed after separating the neck y structures by a horizontal incision through the thoracic inlet. (is this really necessary? Some é advocate only removing the brain is good enough.) Following this, the blood is allowed to tee se drain from the upper and lower ends of the cut neck veins far about |Sminutes. Sp-dissectrom — 2”! step — Then an incision is made on the skin of the neck in the shi Barba. from one mastoid to the upper end of the sternum Gugular notch) a mastoid process. starting from the tip of the V-shaped skin flap described above. The underlying subcutaneous tissue is done carefully this incision is that it also provides room for examination of the facial This could be done by further extension of the reflecting of the skin o In case there are fractures of thyroid cartilage or hyoid bone, attention whether there is associated bleeding around the fracture site, Pre: ante-mortenm fracture and absence: meanstthattthe:fracture:has:0 Having removed fot dissected whenever itis indi * fn manual Strangutatin assatrent try fo close victrn!> modi there can be confutrons ayound moth area. 8°, Wher ‘Scanned with CamScanneri _ s better “The advantages of special neck dissection could be summarized as follows: a alee rete Visualization of tratimavinjuriesipathological conditions of the neck swuctwnes He A Tess field (devoid of post-mortem artetscts), It also allows to apprecicte ANAT pathological conditions in relation to diferent neck structares-this may be WaPOCk™ Firearm injuries, sabs or exiension of cancerous lesions in the neck, The Meo ee cosmetically more acceptable as it allows better presentation of the body in the co! i . It Could be estended as a special facial dissection in cases of smothering ete. It also facilitates the collection of lower jaw by the odontologist in relevant cases for identification, It facilitates post mortem angiography in selected cases. One recognized drawback is that the dissection technique is relatively more time consuming. ‘Scanned with CamScanner