OUTLINE

DEFINISI

ETIOLOGI &TANDA KLASIK

SEBAB MATI YANG BERHUBUNGAN

DGN ASFIKSIA:
1. Sufokasi & Smothering
2. Gagging & chocking
3. Strangulasi
4. Asfiksia Traumatik
• Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Mun’im A, Sidhi,
Hertian S, et al. Ilmu kedokteran forensik. First Edition. Jakarta:

REFERENCES
Bagian Kedokteran Forensik Fakultas Kedokteran Universitas
Indonesia; 1997.

• Shepherd R. Simpson’s forensic medicine. Twelfth Edition. Great

Britain: Arnold; 2003.

• Knight B. Forensic pathology. Second Edition. Great Britain: Arnold;

2004.

• Di Maio VJ, Di Maio D. Forensic pathology. Second Edition. USA: CRC

Press; 2001.
 Definition

• Greek : breathlessness
• The lack of oxygen in the blood or
failure of cell to utilize oxygen and
a failure of the body to eliminate
carbon dioxide.
• Pulselessness
• Lack of oxygen : partial (hypoxia)
and complete (anoxia)
Saveral condition which connected
to asphyxia
– Hypoksia
– Anoxic anoxia
– Anemic anoxia
– Stagnant anoxia
– Histotoxic anoxia
 MANNER & ETIOLOGY
1. Natural
• Lung disease: pneumonia, pulmonary
oedema, etc, may lead to hypoxia 
not forensic concern
2. Un Natural
1. Mechanical :
• Forensic concern : suffocation,
smothering, gagging, choking, throttling,
hanging, strangulation, mugging, etc
2. Chemical :
• Toxins : Carbonmonoxide, cyanide, etc
THE CLASSIC SIGN OF
ASPHYXIA

• Cyanosis of skin and face

• Face congestion
• Face edema
• Petechial in face, eyes and organs
 LIP CYANOSIS

UNDIP Collection
 Face
Congestion

Dolinak D, Matshes E, Lew E. Forensic pathology principles and practice. Elsevier academic
press. Amsterdam. 2005
 PETECHIAE

Gresham GA. A colour atlas of forensic pathology. Wolfe Medical Books. London. 1975
TARDIEU Petechiae in
SPOTS pericardium

UNDIP’s Collection
LUNG EDEMA
STAGE OF ASPHYXIA
1. Dyspnoe : increase effort to breath,
facial congestion and the onset of
cyanosis
2. Deep, laboured respiration or attempts
at respiration with a heaving chest 
the apparance of petechiae
3. Loss of consciousness and possible
convulsions
4. Reduction in the depth and frequency
respiration, irreversible brain damage
 death
 Asphyxial condition
Underlying cause of death Name

Lack of oxygen in the inspired

Suffocation
air

Blockage of external orifices Suffocation/Smothering

Blockage of internal airways by

Gagging/Choking
obstruction

Blockage of internal airways by

Strangulation/Hanging
external pressure

Restriction of chest movement Traumatic Asphyxia

Failure of oxygen transport CO poisoning

Failure of oxygen utilization Cyanide poisoning

 Definition of term
• Suffocation :
– Inadequate oxygen in the environment
– Entrapment, decompression, physical
replacement by other gases,
smothering, gaging and choking
• Smothering :
– Mechanical occlusion of mouth and
nose
– Death may occur by pressing the
occluding substance into the facial
orifices
Smothering and Suffocation

Dix J. Color atlas of forensic pathology. CRC press. Florida. 2000

• Gagging :
– The air passages may obstructed
when cloth or soft object is pushed
into the mouth or placed across the
mouth.
– The victim can breathe with the nose,
then nasal mucus and edema close
posterior nares

• Choking :
– Blockage of the internal airways
usually between pharynx and
bifurcation of the trachea by :
foreign body, dentures, haemorrhage
 CHOKING

Looks turkey clog Turkey meat

laryngeal successfully taken

Dix J. Color atlas of forensic pathology. CRC press. Florida. 2000

 GAGGING

DiMaio VJ, DiMaio D. Forensic Pathology.2nd ed. CRC Press. London. 2001
 TRAUMATIC ASPHYXIA

– The point is fixation of the thorax

by external pressure that prevent
respiratoric movement.
– The chest and abdomen are
compressed by an unyielding object.
– Crushing in crowds
– Chest crushing arise from trapping
between a vehicle and wall or between
the buffers of two truck whilst
uncoupling or coupling the rolling
stock.
Dolinak D, Matshes E, Lew E. Forensic pathology principles and practice.
Elsevier academic press. Amsterdam. 2005
 FATAL PRESSURE
ON THE NECK

– It may arise form manual

stangulation, ligature strangulation,
hanging, arm lock and mugging.

– Mechanism of death :
• Airway occlusion
• Occlusion of the neck veins
• Compression of the carotid artery
• Nerve effect
1. MANUAL STRANGULATION
• Produced by pressure of hand, forearm, or
other limbs against neck, compressing the
internal structures of neck.
• A common method of homicide
• Bruises are mainly discoid marks, caused by
fingertip
• Caused by fingernails marks and scratches
on sides of neck
• Bruising in the tissue of the neck, platysma
muscle
• Run vertically along larynx may show patchy
bleeding
• Fracture of superior horns of thyroid
cartilage, greater horns of hyoid bone; on
one or both side.
• Classic signs of venosus obstruction will be
seen
Manual Strangulation

UI’s collection
2. STRANGULATION BY LIGATURE

• Pressure on neck is applied by a

constrictingband that is tightened
by a force other than the body
weight
• A common methode of homicide
• Encircles the neck in a horizontal
plane often overlying the larynx or
upper trachea
• U shaped ligature
 Strangulation by ligature

Gresham GA. A colour atlas of forensic pathology. Wolfe Medical Books. London. 1975
3. HANGING

• Pressure on neck is applied by a

constricting band that is tightened by
gravitional drag of the weight of body or
part of the body.
• A common method of suicide
• Accidental hanging are uncommon and
homicidal hanging very rare
• Not completely encircles the neck in but
rather slants upward toward the knot,
fading out at the point of suspension the
knot
• There may be either complete or
incomplete hanging; typical or atypical
hanging
Complete hanging Incomplete hanging

Dix J. Color atlas of forensic pathology. CRC press. Florida. 2000

 UI’s collection

Typical hanging
ATYPICAL HANGING

UNUD’s collection Gresham GA. A colour atlas of forensic pathology. Wolfe

Medical Books. London. 1975
ACCIDENTAL HANGING IN
AUTOEROTIC HANGING

Dix J. Color atlas of forensic pathology. CRC press. Florida. 2000

Knight B, Saukko P . Knight’S forensic pathology. 3th Hodder Arnold. UK. 2004
DROWNING
 OUTLINE
KONDISI YANG BERHUBUNGAN

TANDA KONTAK DENGAN AIR

TIPE TENGGELAM

PEMERIKSAAN JENAZAH

PEMERIKSAAN TAMBAHAN
Getah paru, Diatom, kimia darah
• Bodies that recovered from water probably:
• Died of natural diseases
• Died from exposure and hypotermia in the
water
• Died of injuries before entering the water
• Died of injuries after entering the water
• Died from drowning  process of change in
the respiratory tract due to ingress of liquids
• Do not need the whole body into the water
• Quite the mouth and nose
SIGNS OF CONTACT WITH
WATER

• Washer Woman hand (cold water

slower than hot water)
• Cutis anserina (cold water faster
than hot water)
• Slower decomposition (2 times)
than at room temperature.
• Mud and other water bodies may
exist.
 TYPES OF DROWNING
IN BERNARD KNIGHT
• In fresh water :
– Water enters the airways  alveolus
 absorbed by the blood vessels 
hemodilution (in 3 minutes 70%) 
anemia relative, overloading of
cardiac capacity  miocardial
hypoxia.
– Hemodilution  swelling red cells 
potassium realese  myocardial toxin
in dog  ventricular fibrilation
– Time survival 4-5 minutes
• Sea water/salt water
– Salt water entering the airways
 alveolus  plasma out of the
blood vessels  enter
interstitial ( oedem pulmonum),
plasma sodium concentration 
deleterious the heart function.
– Time survival 8-12 minutes
POSTMORTEM EXAMINATION

• Froth exuding from mouth or nose

WASHER WOMAN HAND CUTIS ANSERINA
 THE FINDINGS OF THE
INTERNAL ORGANS
•Smooth froth mixed
water bodies in the
airways.
•Weed or sand on
trachea
•Pulmonary Aquaeus in
salt water but
relatively normal in
fresh water
•stomach contains
water, sand or weed.
SUPPORTING INVESTIGATION

Gum Lung Test

Destruction test/diatome test:
Lungs
Brain
Kidney
Bone Marrow
Blood chemistry tests
 GUM LUNG TEST
When the lungs are still there in the
chest cavity
With gloves and a new scalpel, make
a shallow incision in the anterior
surface of the lung depth of ± 0.5
cm, 2-3 cm long.
Squeeze the lung fluid by using the
tip of a scalpel, drops on glass
objects
Remade in several places
TESTS DIATOMACEOUS

• Diatomaceous is grit algae, walled

silicate, looks as algae with double
wall insulated.
Basic: water + drowning  alveoli 
circulation diatomaceous deposits
in the kidneys, brain, bone marrow
etc.
Knight B, Saukko P . Knight’S forensic pathology. 3th Hodder Arnold. UK. 2004
DIATOMACEOUS IMAGES
ON THE TISSUE
 BLOOD CHEMISTRY
TESTS
• The aim is to distinguish the case of
fresh water or salt water.
• Blood samples from the right ventricle
and the left heart. Which examined
electrolytes Na, Cl, Mg.
• Fresh water Na right> left.
Salt water Na right <left
• Results strongly influenced by the
decomposition and change after death.