Asphyxia

By Dr. Naveen

 

1. Definition: It is a pathological changes caused by lack of oxygen in respired air, resulting in hypoxia and hypercapnia. Death is said to have occurred due to asphyxia when, respiratory function ceases first and initiates the process of failure of the other two vital systems.

In asphyxia, there is prevention of exchange of air between the atmosphere and to the lungs alveoli and there is lack of oxygen supply to the tissues.

Asphyxia may be mechanical, toxic, traumatic or pathological.

1). Mechanical

(1). Constriction around or pressure over the neck, as in cases of hanging, strangulation by ligature ,throttling.

(2). Closure of the external respiratory orifices, as in case of smothering.

(3). Occlusion of the respiratory passage from inside, as in cases of drowning, choking and gagging.

(4). Restriction of the respiratory movement caused due to compression over the chest, as in cases of traumatic asphyxia and overlying.

2).Toxic

(1). Poisons which depress the respiratory centers, like – opium,barbiturate, CO2, H2S,chloroform, bromides etc.

(2). Respiratory tract irritants, like – irritant volatile poisons or irritant vapors, e.g., chlorine gas, SO2, vapors of HNO3, HCL, ammonia gas etc.

(3). Poisons which affect the pickup,carriage, and diffusion of oxygen at the tissue level, like, phosgene, CO,

(4). Lack of oxygen in the inhaled air.

(5). Poisons which causes paralysis of the respiratory muscle like, muscle relaxants, cobra snake venom.

3).Traumatic
(1). Injury to both lungs.  (2). Pulmonary embolism – Fat and air emboli may be of traumatic origin.

4).Pathological causes

Infective conditions and new growth of the lungs or in the respiratory tract.

2. Stages of asphyxia

1). State of dyspnoea . Initially, increased CO2 level in the blood causes respiratory stimulation and the rate and depth of the respiration is increased. There is breathlessness, feeling of oppression in the chest and raised blood pressure. Mild degree cyanosis may be noticed.

2). State of convulsion: The level of CO2 in the blood is further increased. The pulse rate and the blood pressure are still high. The neck veins are engorged. There is marked cyanosis. Expiratory effort is more prominent. There is convulsion.

3). Stage of respiratory exhaustion:
The respiratory center is depressed. There is gasping respiration, the rate is much diminished. Muscles are relaxed, reflexes are lost or very sluggish.

There are deep cyanosis, widely dilated pupils. There is fall of blood pressure, pulse is feeble and slow. Involuntary passage of stool and urine may occur. There is failure of the vital centers and death.

3. Pathogenesis

In acute cases, the process of asphyxia progresses very rapidly. The increased CO2 tension in the blood causes capillary dilatation and loss of tonicity of the vascular wall. This leads to stasis of blood.

On one hand, the organs are congested and on the other, increased permeability of the capillary wall due to asphyxia causes oedema of the organs.

The sum effect of capillary dilatation, stasis and congestion is low venous return. This further aggravates the lack of oxygen and increase of CO2 on the blood which in turn exerts its effects as

Hence, the progress towards the final stage is very rapid, if the primary cause of the asphyxia continues.

Stasis of blood and distension of capillaries cause their rupture and leakage of blood in the tissue. High CO2 tension also increases the capillary permeability and leakage of whole

Thus, minute haemorrhagic spots appear in the tissue spaces which are known as petechial haemorrhagic spots or Tardieu’s spots.

These are pinhead size or slightly larger haemorrhagic spots, more conspicuous at the under surface of pleura, pericardium and epidermis.

3. Postmortem features

1). External features: (1). The postmortem staining is bluish and prominent.

(2). Cyanosis is evident at the fingertips, nail-beds, ear lobules and lips.

(3). Face may be congested.

There will be presence of Tardieu’s spots over the forehead, eyelids and conjunctiva in some cases of violent
(4).

In some cases, depending on the mode and process of asphyxiation, there may be protrusion of the eyeballs and the tongue and in some cases, there is seminal discharge.
(5).

Evidence of mode of asphyxiation may be present in some cases.
(6).

a. Presence of ligature marks in strangulation and hanging.  b. Dribbling of saliva in hanging.

c. Abrasions and bruises around the mouth and nose in case of smothering.

d. Abrasions and bruises on the neck in case of throttling.

2). Internal findings

(1). The organs are in general congested. Congestion is more marked in deaths due to asphyxia.

(2). The lungs are congested, oedmatous with presence of Tardieu’s spots at the undersurfaces of lobes.

(3). Tardieu’s spots are also present at the undersurfaces of the pericardium and in the brain and meninges.

(4). Vessels contain dark fluid blood.

(5). According to the specific causes of asphyxia, there will be presence of specific signs in different organs like lungs, trachea and larynx as in cases of death due to drowning and strangulations.

(6). Similarly, there will be additional findings in the structures of the neck, inside the mouth cavity and the chest wall, in cases of compression of neck, smothering and traumatic asphyxia respectively.