1

Forensic medicine
Mechanical asphyxia

Name:G.Lohith Raj
Roll no:21
Regd no:20M102011028
 2
Competencies
 FM 2.20: MECHANICAL ASPHYXIA: define, classify and describe
asphyxia and medico-legal interpretation of postmortem findings in
asphyxial deaths.
 FM 2.21: MECHANICAL ASPHYXIA: describe and discuss different
types of hanging and strangulation including clinical findings, causes of
death, postmortem findings and medico-legal aspects of death due to
hanging and strangulation including examination, preservation and dispatch
of ligature material.
 FM 2.22: MECHANICAL ASPHYXIA: describe and discuss
pathophysiology, clinical features, postmortem findings and medico- legal
aspects of traumatic asphyxia, obstruction of nose and mouth, suffocation
and sexual asphyxia.
3
ASPHYXIA

 Definition: Asphyxia (Greek, ‘pulselessness’ or ‘absence of pulse’)

is the condition caused by interference with the exchange of oxygen
and carbon dioxide in the body.
 Asphyxia literally means ‘defective aeration of blood’ due to any
cause.
4
Classification of asphyxia
• Mechanical interference to the passage of
Mechanical asphyxia air into the respiratory tract, e.g. hanging,
smothering.
• Entry of oxygen to the lungs is prevented
by disease of the upper respiratory tract or
Pathological asphyxia lungs e.g., laryngeal edema, spasm, tumors
or abscess.
Environmental asphyxia • Breathing in vitiated atmosphere, as in high
altitude or inhalation of CO, sewer gas.
• Cessation of the respiratory movements due
to paralysis of the respiratory center and
Toxic asphyxia poisoning with morphine, barbiturates or
strychine.
5
Pathophysiology of asphyxia
asphyxia

Deficient Decreased oxygenation

oxygenation
In lungs

Decreased
pulmonary blood Capillary dilatation
flow

Decreased venous
engorgement
return
Stasis of
blood
6
Clinical effects of asphyxia
Decreased O2
asphyxia tension and cyanosis
reduced Hb

Petechial
Capillary Increased
haemorrha
asphyxia endothelium capillary
ge/tardieu’s
damage permeability
spots

Venous Venous
asphyxia obstructi return is Congestion of visceral
on halted organs
7
Triad of asphysia
 Cyanosis
 Petechial haemorrhages
(tardieu spots) { regions
involved are : conjunctiva,
mucous membranes,
epiglottis}
 Visceral congestion
O Others features
 Pronounced lividity
 Fluid blood
 Right heart enlargement
8
Mechanical asphyxia
 Definition: mechanical interference to the passage of air into the
respiratory tract. This condition is known as mechanical asphyxia.
 CAUSES:
 Closure of the air passages by external pressure on the neck, e.g.
hanging, strangulation, throttling.
 Occlusion of the respiratory tract and lungs by fluid. e.g.
Drowning
 Closure of the external respiratory orifices by closing the nose and
the mouth, e.g. smothering.
 Occlusion of the respiratory tract by foreign bodies, e.g. Gagging,
choking.
 Pressure on the chest leading to failure of expansion of chest, e.g.
9
10 HANGING
 Definition : It is a type of violent mechanical asphyxia which is produced
by suspending the body with a ligature encircling the neck wherein the
constricting force being the weight of the body.
 Hanging should always raise the presumption of suicide, while strangulation
must always be considered homicidal, unless proved otherwise.
 In India, hanging is among the top 5 methods of choice for committing
suicide, the other preferred methods being poisoning, drowning, burning and
jumping from a tall structure or in front of a train.
 Classification of hanging
11
 Based on position of the knot
1)Typical hanging: knot is at nape of neck on the back.
2) atypical hanging: knot is anywhere other than on occiput.
 Based on degree of suspension
1) Complete hanging: body is fully suspended. Constricting force is weight of the body.
2) Incomplete/ partial hanging: lower part of the body (toes/ feet) is touching the
ground, in sitting, kneeling or prone position. Constricting force is weight of the head.
 On the basis of manner of death
1) suicidal hanging 3) accidental handling
2) homicidal hacking 4) autoerotic hanging
 Others
1) judicial hanging
2) lynching: form of homicidal hanging
3) near hanging
12
13
Causes
 Asphyxia: Constricting force of ligature causes compressive narrowing of
laryngeal and tracheal lumina, leading to asphyxia.
 Venous congestion: Jugular veins are blocked by the ligature, which results
in stoppage of cerebral circulation; occurs if ligature is made-up of broad
and soft material.
 Combined asphyxia and venous congestion.
 Cerebral ischemia: it occurs when the ligature is made of thin cord.
 Reflex vagal inhibition leading to sudden cardiac arrest.
 Fracture/dislocation of cervical vertebrae : seen in judicial hanging.
14
Ligature material

 Depending on the availability, any material can be taken as a ligature.

eg: life, rope, cable, sorry, dhoti, dupatta etcetera.
 The ligature material should be strong enough to hold the weight of
the person.
 While examining the ligature material, we have to check if there is
any specific pattern,
This pattern is correlated with the ligature mark
 Soft ligature or causes wide/faint ligature mark.
 Narrow wire causes deep ligature mark.
15
KNOT
 Mainly 2 types of knot are seen
1.fixed knot
 it produces oblique ligature mark
 Part of the knot isn’t touching the skin
 Thus, incomplete ligature mark is seen
 Oblique & incomplete ligature mark seen with fixed
knot.
2.Slip knot
 Slip knot produces running noose
 It completely encircles the neck & constricts it.
 Even the knot compresses the skin.
16 Contd.
3) Reef knot
 It is a flat knot used in tying reef –points consisting of
two loops passing symmetrically through each other that
will not slip.
4) Granny knot
 It is knot like reef knot, but asymmetrical, apt to slip or
jam.
17
Preservation of ligature material
 Ligature material should be
removed and preserved properly.
 Noose should be preserved and this
is done by cutting the ligature away
from the knot and then securing the
ends with thread.
18
postmortem findings
 External findings
Face
1. Swollen, cyanosed face due to impaired venous
return and accumulation of blood.
2. Prominent eyeballs.
3. Protrusion of tongue which is usually swollen and
blue.
4. Dilated pupils.
5. If the knot presses on cervical sympathetic, eyelid
of the same side may remain open and pupil is
dilated (la facies sympathtique)- sign of
antemortem hanging
6. Subconjunctival hemorrhages.
19 Contd..
7. Bleeding from nose/ears due to impaired venous
return and increase in pressure
8. Dribbling of saliva--surest sign of antemortem
hanging
 Neck findings
1. Ligature mark (furrow)
Site: Usually above the hyoid bone.
Direction: Oblique, backwards, upwards and towards
the point of suspension.
Mark is non-continuous; usually inverted ‘V’ shaped
Skin at the site: Usually depressed/grooved, pale in
color, becomes brown, dry, hard and parchment like
20
Contd..
2. Dimension of neck: Due to prolonged suspension, the neck becomes slender
and increases in length.
3. Bending of neck: Neck gets flexed to the side opposite to the knot.
 Other parts of the body
1. Tardieu's spots may be present on forehead, eyelids, conjunctiva and temple.
2. Cyanosis of fingernails.
3. Purple colored PM staining in the lower limbs and lower regions of upper
limbs (hands/forearms)-glove and stocking PM staining.
4. Signs of asphyxia may be lacking in case of instantaneous death due to vagal
stimulation.
5. Florid asphyxial changes can be seen in cases where a fixed knot was used or
in incomplete hanging.