Legal Medicine - Asphyxia(1)
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Transcript of Legal Medicine - Asphyxia(1)
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asphyxiaThe general term applied to all forms of violent death which results from the interference with the process of respiration.
The condition in which the supply of oxygen to the blood or to the tissues has been reduced below normal level.
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TYPES OF ASPHYXIAL DEATH:Anoxic Death: failure of the arterial blood to become normally saturated with oxygen
Anemic-Anoxic Death: due to decreased capacity of the heart to carry oxygen
Stagnant Anoxic Death: brought about by the failure of circulation
Histotoxic Anoxic Death: failure of the cellular oxidative process
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anesthesiapulmonary edemaAlcohol CyanideDrowningand ChokingHeart Failure, Shock, A-V mal, embolismHigh altitudePatent foramen ovaleHemorrhage, Foreign body impactionTraumatic crush asphyxiaVaricose veinsTorniquet useSmothering and overlayingCarbon monoxide poisoningPneumonia, Asthma, Emphysemahemoglobinemia
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Classification of Asphyxia
hangingstrangulationsuffocationdrowningtraumatic crush asphyxiainhalation of irrespirable gases
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HANGING
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classification of hanging:
As to the location of the ligature and knot:
- typical- atypical
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As to the amount of constricting force:
- complete- partial
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As to symmetry:
symmetricalassymetrical
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post-mortem findings in hanging:
Neck elongated and stretched with the head inclined on the side opposite the knotLividity or pallor of the face with swollen and protruded tongueEyes closed or partly opened with pupils dilated on one side and small on the otherBlue lips with frothy saliva droolingState of erection or semi-erection of the penis with some seminal fluid on the meatusLividity or ecchymosis on the legs
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mechanism of death in hanging:
Tracheal obstructionCarotid compressionVagal stimulationAtlanto-axial dislocation
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strangulation by Ligature
RARELY suicidal
Usually homicidal and accompanied by evidence of struggle or marks of violence
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other forms of strangulation:
Manual Strangulation or ThrottlingPalmar StrangulationGarrotingMugging or Strangle-holdStick Compression
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manual strangulation
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COMPARO: HANGING vs. STRANGULATION
Frequently above the Adams apple
Ligature mark is inverted V-shape, the apex is on the site of the knot
Ligature groove is deepest at the site opposite the knot
Usually below the Adams apple
Ligature mark is usually horizontal, knot is on the same horizontal plane
Ligature groove is uniform in depth in its whole course
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Asphyxia by SuffocationMECHANISM: Closure of air opening or obstruction of the air passageway
Types:- Smothering- Choking- Burking
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types of smothering:
Overlaying
GaggingPlastic bag SuffocationAccidental Smothering of Epileptic
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Choking- impaction of foreign body in the respiratory passage such as:
1. Vomitus2. Regurgitation from the stomach3. Bolus of food (caf coronary)4. False teeth5. Blood in oral operations6. Tuberculosis
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asphyxiabydrowning
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Asphyxia by DrowningSUBMERSIONNostrils and mouth are submerged in water for some time to prevent the free entrance of air into the air passage and the lungs
It is not necessary for the whole body to be submerged
Children drown in shallow pools or ponds
Drunks may drown in shallow creeks
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Phases of Drowning:1.Respiracion de Surprise2.Phase of resistance(first apnea)3.Dyspneic phase4.Another apnea5.Terminal respiration
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Causes of Death in Drowning:TYPICAL - cause of death is asphyxiaATYPICAL- cardiac inhibition due to vagal stimulation - laryngeal spasm - submersion when unconscious
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Time factor in drowning:1 min. , considered fatal4 min. , possibility of revival23 min., average time for death
N.B. the length of time for survival in drowning is proportional to the amount of froth in the respiratory tract
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Post-mortem findings:Wet clothes, pale face with foreign bodies clinging on skin surfaceCutis anserina or goose skin or goose fleshFirmly clenched hands with objects, weeds or stones
Mouth closed or half-open with tongue protrudingPhysical injuries due to struggle
Penis and scrotum are retractedWasherwomans hands and feetLivid eyes, conjuctival injection and dilated pupils
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Internal findings in DrowningEmphysema aquosumEdema aquosumChampignon d ocume
Tracheo-bronchial congestionFluid with bloody frothRight side of the heart is usually distended
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conclusive findings in drowning:
Foreign bodies in hands; cadaveric spasmEmphysema Aquosum Edema AquosumStomach contents: water or fluid, corresponding to the medium where body was submergedFroth, foam or foreign body in the air passage consistent with the mediumWater in the middle ear
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floatingNaked body floats after 24 hrs.Those with clothes or apparels take more time
TETE DE NEGRI
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Compression AsphyxiaTraumaticor Crush Asphyxia
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Causes:LandslideAndMasonry accidents
Highwayaccidents
Rubble of collapsed buildings
Mine Collapse and Stampede
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Burking
BURKE and HARE
Murderer sits or kneels on the chest with one hand covering the mouth and nostrils of the victim.
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Inhalation of IrrespirableGases
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carbon monoxideCARBONIC OXIDESILENT KILLER
From incomplete combustion of carbon fuel as in burning of wood, oil, coal, kerosene, gasoline and charcoal
Limits oxygen carrying capacity of the blood due to its 250 X more affinity to hemoglobin.
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carbon dioxide
Product of respiration, complete combustion and fermentation or decomposition of organic matters
Found also in drainage pipes, deep wells, sewage tanks
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hydrogen sulfide
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hydrogen cyanide
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the war gases:
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LACRIMATOR or Tear Gas
ChloracetophenoneBromobenzyl CyanideEthyl IodoacetateVESICANT or Blistering GasMustard GasLewisite
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STERNUTATOR or Vomiting Gas
Diphenyl ChlorarsineDiphenyl CyanarsineDipenylamine Chlorarsine
ASPHYXIANT or Choking Gas
ChlorinePhosgeneChloropicrineDiphosgene
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BLOOD POISONS
Hydrocyanic AcidHydrogen SulfideCarbon MonoxidePARALYSANTS or Nerve GasAnti-cholinesterase
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From the lost sea He rises,Creating armies in every shore,Turning men against their brothers,Till Man exists no more.
- NOSTRADAMUS