DEATH BY

ASPHYXIA

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ASPHYXIA
Asphyxia is the general term applied to
all forms of violent death which result
primarily from the interference with the
process of respiration or the condition in
which the supply of oxygen to the blood
or to the tissue or both has been reduced
below normal level.

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TYPES OF ASPHYXIA:
1. Anoxic Death
2. Anemic Death
3. Stagnant Anoxic death
4. Histotoxic Anoxic Death

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I. ANOXIC ASPHYXIA
This is associated with the failure of the arterial
blood to become normally saturated with
oxygen.
 Arterial blood is the oxygenated blood in the
circulatory system found in the lungs, the left
chambers of the heart, and in the arteries
It may be due to:
a. Breathing in the atmosphere without or with
insufficient oxygen as in high altitude
b. Obstruction of the air passage due to
pressure from the outside, as in traumatic
crush asphyxia

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ANOXIC ASPHYXIA
c. Paralysis of the respiratory center due to
poisoning, injury or aesthetic, etc.
d. Mechanical interference with the passage of
air into or down the respiratory tract due to:
 Closure of the external respiratory orifice, like
in smothering(suffocate) and overlaying
 Obstruction of air passage, as in drowning,
choking with foreign body impact, etc.
 Respiratory abnormality, like pneumonia,
asthma, emphysema and pulmonary edema

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d. Shutting of blood from the right side of the heart
to the left without passage through the lungs as in
congenital anomalies like potent foramen ovale

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II. ANEMIC ANOXIC DEATH

 This is due to a decreased capacity of the blood

to carry oxygen. This condition may be due to:
 Severe hemorrhage
 Poisoning, like carbon monoxide
 Low hemoglobin level in the blood
III. STAGNANT ANOXIC DEATH

 This is brought about the failure of circulation.

This is due to:
 Heart Failure
 Shock
 Arterial and venous obstruction, incident to
embolism, vascular spasm, varicose veins, or the

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use of tourniquet
IV. HISTOTOXIC ANOXIC DEATH

 This is due to the failure of the cellular oxidative

process, although the oxygen is delivered to the
tissues, it cannot be utilized properly.
 Cyanide and alcohol are common agents
responsible for histotoxic anoxic death

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PHASES OF ASPHYXIA

1. Hanging
2. Strangulations:
a) Strangulation by ligature
b) Manual strangulation or throttling
c) Special forms of strangulation:
1. Plamar strangulation
2. Garroting
3. Mugging or yoking
4. Compression of the neck

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3. Suffocation
a. Smothering or closing of the mouth
and nostril by solid objects
b. Choking or closing of the air passage
by obstruction of its lumen
4. Asphyxia by submersion or drowning
5. Asphyxia by pressure on the chest
(traumatic crush asphyxia)
6. Asphyxia by irrespirable gases

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PHASES OF ASPHYXIAL DEATH
1. DYSPNEIC PHASE
 Due to lack of oxygen and the
retention of carbon dioxide in the body
tissue.
 The breathing becomes rapid and
deep, the pulse rate increases and
rise ion blood pressure.
 The face , hands and fingernails
become blush esp.in the case of
infants

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PHASES OF ASPHYXIAL DEATH
2. CONVULSIVE PHASE
 Due to stimulation of the central
nervous system by carbon dioxide.
 Cyanosis becomes more pronounced
and the eyes becomes staring and
pupils dilated.

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Causes of asphyxiation:
Gagging
 Usually results
from forcing a cloth into
the mouth or the closure
of the mouth and nose
by a cloth or similar
material
 Usually homicidal
 A gag pushed sufficiently deep
inside the mouth will cause
asphyxia.
 Initially, airway is patent thru the
nose but collections of saliva,
excessive mucus with edema of the
pharynx and nasal mucosa will
eventually lead to complete
obstruction of airways.
 Gagging is usually resorted to in
order to prevent a victim from
shouting for help and death is
usually unintentional
• Choking
 Occurs due to obstruction within
the air passages
Almost always accidental
 Usually occurs
during a meal due
to impaction of
large, solid bodies
such as a bolus of
food, piece of meat,
etc…
•Suffocation
 General term to indicate that form of
asphyxia which is due to deprivation
of oxygen
 May be due to lack of O2 in the
environment or due to obstruction of
air passages
•Environmental Suffocation
 Due to insufficient O2 in the
environment
 May be due to chemical or smoke
inhalation
 Smoke inhalation is
the no. 1 cause of
death in fires
 May be accidental,
suicidal or homicidal
 CO, HCN, H2S are
chemicals produced
by fire that can
cause chemical
asphyxia
 Suicidal smothering is almost
impossible
 Accidental smothering frequently
occurs e.g. infants lying-in with
parents, children playing with plastic
bags, mental patients, etc…
 Homicidal smothering – difficult to
detect at autopsy. History, crime
scene processing and circumstances
surrounding death must be known
•Asphyxia by Strangulation:
Asphyxia by HANGING
 Asphyxiation by
strangulation using
a rope, cord or any
similar material to
work against the
weight of the body
 ASPHYXIA BY HANGING
CLASSIFICATION OF ASPHYXIA BY HANGING:
1. As To The Location Of The Ligature And Knot
a. Typical – when the ligature runs from the midline
above the thyroid cartilage symmetrically
encircling the neck on both sides to the occipital
region.

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 b. Atypical – when the
ligature is tied or noosed
and present on one side of
the neck, in front or behind
the ear, or on the chin,

2. As To The Amount Of
Constricting Force
a. Complete – when the
body is completely
suspended and the
constricting force is the
whole weight

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• b. Partial – when the body is partially
suspended as when the victim is sitting ,
kneeling, reclining, prone or any other position.

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Death may come by any of 4 means:
1. Occlusion of carotids and
vertebral arteries
2. Base of the tongue is pushed
backwards and upwards inside
the neck thereby occluding the
nasopharynx
3. Direct laryngeal or tracheal
damage and occlusion
4. Cervical Fracture (Judicial or
Drop Hanging) causing damage
to the brainstem
Note: A person
does not have
to be fully
suspended to
hang
 When a victim is
found bound or
hung, the
bindings should
not be untied
Bindings should
not be cut so
knots can be
preserved
 A common outward sign of all the
forms of asphyxia by strangulation and
hanging is the presence of petechial
hemorrhages (Tardieu’s Spots)

They are typically found in and around

the eyes and cheeks
 They are pinpoint capillary ruptures
visible on the skin and in the eyes

 They are caused by a build-up of

pressure as a result of
asphyxiation or strangulation and
hanging
Tardieu’s Spots
TIME REQUIRED IN THE PROCESS OF DEATH
1. Severity of the constricting force
 If constricting force is only sufficient to occlude
the windpipe, death may be delayed;
 But if the pressure is sufficient to occlude the
carotid arteries, jugular veins and vagus nerve,
then unconcious develops immediately and
death is accelerated.

Jugular vein

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TIME REQUIRED IN THE PROCESS OF DEATH

2. Point of Application of the

Ligature:
 But when applied above
the larynx, death may
occur for 3 to 5 minutes.

 When the ligature is

made below the larynx,
death is almost
instantaneous

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• Hanging with the knot situated on one
side of the neck may delay death
because the closure of the cerebral
vessels cannot be completely
maintained.
• If the knot just below the jaw, maximum
pressure is at the back of the neck
causing merely partial occlusion of the
windpipe and blood vessels of the neck,
thereby delaying death

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Determination Whether Hanging Is Ante-mortem Or
Post-mortem
Findings Show That Hanging Is Ante-mortem:
1. Redness or ecchymosis at the site of ligature
2. Ecchymosis of the pharyx and epiglottis (escape of
blood into the tissues from ruptured blood vessels)
3. Line of redness or rupture of the intima of the
carotid artery
4. Sub pleural, subepicardial punctiform hemorrhages
It is advisable to look for other injuries which are
capable of producing death to eliminate the possibility
of hanging as the cause of death.

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DETERMINATION WHETHER HANGING IS
ACCIDENTAL, HOMICIDAL OR SUICIDAL

1. Evidence In support of homicidal hanging

a. Nature of the windows and doors – see
whether the entrance was forcibly opened or
have been used as an escape by the
offender in homicidal case.
b. Presence of sings of struggle in the clothing,
furniture and beddings – if it is disturbed
c. Presence of stains, bodily injuries in the
body of the victim
d. Presence of defense wounds in the body of
the victim

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2. Evidence in support of suicidal hanging:
a. Findings at the place where the dead body
was found is compatible with self-suspension
Ex. A chair may be found where he can stand to
tie the rope at a higher level.
A hammer to fix the nail may be found near
the place where the body when found
b. Unusual position of the body when found:
Ex. The feet or the knees may be found
partially touching the floor if the body was found in
a reclining position to make part of the body weight
as the constricting force on the neck.

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c. Absence of signs of struggle
d. Presence of suicide note
e. Sings of ineffective suicide attempt.
f. the history of reverses in life, like financial
loss, love, studies, etc. his mental condition
g. No disturbance in place where death took
place

3. Accidental hanging is very rare.

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POST-MORTEM FINDINGS IN
DEATH BY HANGING
1. General external appearance:
 Eyes closed or partially opened with pupils dilated
 Lividity or pallor of the face with swelling and
protrusion of the tongue
 Hands are clenched firmly and purpled colored
fingernails
 Saliva dribbled from the mouth with froth
 State of erection or semi-erection of the penis with
seminal fluid in the meatus
 Post-mortem lividity with ecchymosis are mostly
marked at the legs.
 Urination or defecation due to loss of power of the

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sphincter muscles
2.Internal findings:
 Engorgement of the lungs
 Venous system contains dark-colored fluid blood
 Blood vessels of the brain is generally congested
 Kidneys are congested
 Tardieu spots
3. Finding in the neck:
 Neck is flexed opposite side where the knot is
located.
 The course of ligature is inverted v-shaped with the
apex of the “V” at the site of the knot.
 Ecchymosis of the neck depends upon the width and
softness of the ligature
 Fracture of the hyoid bone of tracheal rings
 Lining membrane of the blood vessels may be
lacerated.
 Contusion of the inner wall of the trachea

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II. ASPHYXIA BY STRANGULATION
 Strangulation by ligature is produced by
compression of the neck by means of a
ligature which is tightened by a force other
then the weight of the body.

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 DISTINCTIONS IN THE POST-MORTEM FINDINGS IN THE NECK BETWEEN
DEATH BY HANGING AND DEATH BY STRANGULATION WITH LIGATURE:

HANGING STRANGULATION WITH

LIGATURE

1. Hyoid bone is frequently 1. Hyoid bone in frequently

injured spared.

2. Direction of the ligature 2. Ligature mark is usually

mark is inverted V-shape
with the apex as the site of
the knot.
3. Ligature is usually at the
level of the hyoid bone.
4. Ligature groove is
deepest opposite the site
of the knot
5. Vertebral injury is
horizontal and knot is on the
same horizontal plane.
3. Ligature is usually below the
larynx
4. Ligature groove is
uniform in depth in its
whole course
5. Vertebral injury is not

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frequently observed observed
CAUSE OF DEATH IN STRANGULATION BY LIGATURE

1. Asphyxia due to the occlusion of the

windpipe
2. Coma due to arrest of cerebral
circulation
3. Shock or syncope
4. Inhibition of the respiratory center due to
the pressure on the vagus and
sympathetic nerves.

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MANUAL STRANGULATION
OR THROTTLING

 This is a form of asphyxial death whereby

the constricting force applied in the neck
is the hand.
 METHODS OF THROTTLING:
a. Using one hand
b. Using both hand with assailant in front
c. Using both hands with the assailant at
the back.

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 SPECIAL FORM OF STRANGULATION:

A. PALMAR STRANGULATION
 The palm of the hand of the
offender is pressed in front of the
neck without employing the fingers.
B. GARROTING
 A ligature, a metal collar or a
bowstring is place around the neck
and tightened at the back.
.

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C. MUGGING (Strangle-hold)
 A form of strangulation with the assailant
standing at the back and the forearm is
applied in front of the neck.
 The pressure on the neck is brought about by
the pressure of the flexed elbow.
D. COMPRESSION OF THE NECK WITH A
STICK
 The victim may be forced to place his back
behind a post. The assailant with a piece of
stick placed in front of the neck pulls with two
hands passing on both side of the post
backwards with sufficient strength to occlude
the trachea.

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POST-MORTEM FINDINGS IN
DEATH BY STRANGULATION
1. External examination:
 Face is livid and swollen
 Eyes are wide open, congested and pupils
are dilated
 Tongue swollen, dark colored and protruded
 Bloody froth may escape from the mouth and
nostrils
 Tardiue”s spot are found beneath the
conjunctivae, face, neck, chest and lungs

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POST-MORTEM FINDINGS IN
DEATH BY STRANGULATION

2. Internal Examination:
 Intense venous congestion of both the
lungs with numerous petechial
hemorrhages
 Blood -stained

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 Ligature mark around the neck is
usually horizontal in direction

 Hyoid bone may be fractured

 Must be presumed to be
homicidal unless proven otherwise
ASPHYXIA BY DROWNING OR
SUBMERSION

DROWNING is asphyxiation from liquid or water

being inhaled into airways, blocking passage of
air into lungs
As a person chokes and tries to breath, frothy
foam forms in the airway
This foam may be white or white with pink
coloration
This foam coming from the mouth and nose is an
outward sign of pulmonary edema
 Time required for death in drowning:
 Submersion for 1 ½ minutes is considered fatal.
 The average time required for death in drowning is 2 to 5
minutes.
FINDINGS CONCLUSIVE THAT THE PERSON DIED OF
DROWNING:
1. Presence of materials or foreign bodies in the hands of the
victims.
 Clenching of the hands is a manifestation of cadaveric
spasm in the effort of the victim to save himself from
drowning.
2. Increase volume and edema of the lungs
3. Presence of water and fluid in the stomach contents
4. Presence of froth, foam, or foreign bodies in the air
passage
5. Presence of water in the middle ear.

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 Determination whether drowning is suicidal,
homicidal or accidental
1. SUICIDAL DROWNING:
o Heavy articles or weight may be found in the
pocket of clothing.
o Presence of a suicidal note
o Determination of the strong reason for him to
commit suicide.
o Mentality of the person
o Study of the character and manner of the
person previous to the commission of suicide.
o History of previous attempt to commit suicide

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Determination whether drowning is suicidal,
homicidal or accidental

2. HOMICIDAL DROWNING:
o Evidence of struggle like physical
injuries and destruction of clothing
o Articles belonging to the assailant
may be found near the place where
the deceased was recovered.

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 Determination whether drowning is suicidal,
homicidal or accidental

o Presence of motive for the killing

o Presence of ligature on the hands or legs
which could not possibly be applied by
the victim himself.
o Presence of physical injuries which could
not have been self-inflicted, like gunshot
wounds , severe injuries in the head, etc.
o Testimony of witnesses.
.

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 Determination whether drowning is suicidal,
homicidal or accidental

3. ACCIDENTAL DROWNING:
o Absence of mark of violence on the body
surface.
o Testimony of a witness or witnesses who
saw the incident happened.
o Condition and situation of the victim
immediately before death which may
make one inclined to believed that it is
accidental.

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Electrocution
 Another form of death by
asphyxiation
 Shock may stop the heart or cause
ventricular arrythmia and oxygen will
cease to reach the brain
 Respiratory paralysis
 CNS damage / Brain Stem paralysis
 Burns
 Hemorrhage
 Electric current needed to cause
death depends on the quantity and
length of exposure as well as the part
of body affected
• Electrical
shocks may or
may not leave
marks on the
body (High
Voltage vs Low
Voltage)
 Lightning is a type of High Voltage
electrocution
 Death may result even without a
“direct hit”
 “Fern-like” or “Fan-like” arborescent
markings may be observed
 Injuries may be similar to those
found in blasting incidents
MECHANISM
 Direct effect of current to the heart, causing heart
fibrillation (muscular twitching involving muscle
fibers acting without coordination)
 Direct effect of current on the respiratory muscles
causing respiratory paralysis
 Effects of current on brainstem respiratory center
ELECTROCUTION