power point forensik hanging

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HangingHanging

By internBy intern 朱智邦朱智邦



IntroductionIntroduction

• About 3500 people die each year inAbout 3500 people die each year in

the United States form suicidalthe United States form suicidal

hanging or strangulation.hanging or strangulation.• Its the 3rd common form of suicide.Its the 3rd common form of suicide.

• Hanging is the most common choiceHanging is the most common choice

for people !ho suicide successfully infor people !ho suicide successfully inrecent "0 years in #ai!an.recent "0 years in #ai!an.



IntroductionIntroduction

• $udicial hanging $udicial hanging

% Since Biblical timeSince Biblical time

% Slo! strangulation !ith &ictim '(ancing)Slo! strangulation !ith &ictim '(ancing)% ''*lean and instantaneous)*lean and instantaneous)

• #hic+ness of rope #hic+ness of rope

•,osition of the +not,osition of the +not

•-ength of drop-ength of drop

% ot performed in ma/ority of countries no!ot performed in ma/ority of countries no!



*lassication of hanging*lassication of hanging

• on1/udicial &s $udicialon1/udicial &s $udicial

• Suicide2 homicide and accidentalSuicide2 homicide and accidental

% Suicidal 4ost common2 4aleemale63"Suicidal 4ost common2 4aleemale63"% Homicide 7areHomicide 7are

% Accidental4ost common in childhoodAccidental4ost common in childhood•Autoerotic hangingAutoerotic hanging

• *omplete &s Incomplete*omplete &s Incomplete

• #ypical &s atypical #ypical &s atypical



*linical eature of Hanging*linical eature of Hanging

• *linical feature*linical feature

% Hemorrhage in area of ligatureHemorrhage in area of ligature

% Bro!nish groo&e in the nec+Bro!nish groo&e in the nec+% Hoarseness and stridorHoarseness and stridor

% ,ain on s!allo!ing,ain on s!allo!ing

% Subcon/uncti&al hemorrhageSubcon/uncti&al hemorrhage% #ardieus spot #ardieus spot



#he mechanism of hanging #he mechanism of hanging

deathdeath

• Air!ay compression8Air!ay compression8

% Ho! about &ictim !ith tracheostomyHo! about &ictim !ith tracheostomy

% 9omitus in the air!ay of hanging &ictim9omitus in the air!ay of hanging &ictim• *er&ical fracture !ith spinal cord*er&ical fracture !ith spinal cord

transection8transection8

% Belie&ed to be the main reason of /udicialBelie&ed to be the main reason of /udicial

hanging.hanging.% e! &ictim has cer&ical fracture in autopsye! &ictim has cer&ical fracture in autopsy

% Hanging on the bed8Hanging on the bed8




deathdeath

• (ecapitation(ecapitation

% *ases reported in e:treme situation*ases reported in e:treme situation

hea&y body2 inelastic;thin rope2 fall fromhea&y body2 inelastic;thin rope2 fall fromgreat distance.great distance.

• Hyperacti&eHyperacti&e

parasympathetic;sympathetic ner&eparasympathetic;sympathetic ner&eby carotid compression8by carotid compression8

% Hypothesis that has been proposedHypothesis that has been proposed




deathdeath

• 9ascular compression !ith brain9ascular compression !ith brainasphy:iaasphy:ia

•Belie&ed to be the main mechanismBelie&ed to be the main mechanism

% 9essels9essels•Internal /ugular &ein<=+g>Internal /ugular &ein<=+g>

•*ommon carotid artery<5+g>*ommon carotid artery<5+g>•9ertebral artery<30+g>9ertebral artery<30+g>

•*ollateral circulation*ollateral circulation

•<#rachea "5+g><#rachea "5+g>



7elated Anatomy of7elated Anatomy of

HangingHanging• <past the atlas><past the atlas>



Human e:perimentHuman e:periment

• Acute obliteration of nec+ circulationAcute obliteration of nec+ circulation

!ith ?00mmHg cu@ <part I>!ith ?00mmHg cu@ <part I>

% Blurring of &isionBlurring of &ision% *onstriction of &isual elds*onstriction of &isual elds

% -oss of conscious <?1?.5 sec>-oss of conscious <?1?.5 sec>

% Hypo:ic con&ulsionHypo:ic con&ulsion% C minimal changeC minimal change



Human e:perimentHuman e:periment

• ,rolonged occlusion of cerebral,rolonged occlusion of cerebral

circulation up to "00 sec.circulation up to "00 sec.

% *on&ulsion2*yanosis2 In&oluntary*on&ulsion2*yanosis2 In&oluntaryurination2 In&oluntary defection2urination2 In&oluntary defection2

% Bradycardia and dilation of pupilsBradycardia and dilation of pupils

occurred after loss of consciousnessoccurred after loss of consciousness



,athophysiology of Hanging,athophysiology of Hanging

ec+ pressureec+ pressure

⇓⇓

9enous obstruction<stasis hypo:ia>9enous obstruction<stasis hypo:ia>

*ommon carotid artery obstruction8*ommon carotid artery obstruction8⇓⇓

-oss of consciousness-oss of consciousness

⇓⇓

(ecreased nec+ muscle tone(ecreased nec+ muscle tone

⇓⇓9etebral and common carotid artery obstruction9etebral and common carotid artery obstruction

⇓⇓

(A#H(A#H



*omplication of hanging*omplication of hanging

patientpatient• -aryngeal-aryngeal

% racture of laryn:<DE>racture of laryn:<DE>

% Soft tissue edemaSoft tissue edema

• Stridor2 hoaresness2 dysphagiaStridor2 hoaresness2 dysphagia

• ,ulmonary,ulmonary

% BronchopneumoniaBronchopneumonia% -ung edema-ung edema

% A7(SA7(S



*omplication of hanging*omplication of hanging

patientpatient• eurologicaleurological

% (elayed neurological damage8(elayed neurological damage8

• Bilateral basal ganglia damageBilateral basal ganglia damage%

7eperfusion in/ury87eperfusion in/ury8

% :cessi&e catecholamine or amino acid8:cessi&e catecholamine or amino acid8

% *alcium8*alcium8

% orsa+o@ syndrome2 progressi&e dementiaorsa+o@ syndrome2 progressi&e dementia

% AmnesiaAmnesia

% Accessory ner&e in/uryAccessory ner&e in/ury

• FthersFthers% #hrombosis of cer&ical artery8 #hrombosis of cer&ical artery8

• intimal and media in/ury in nec+ artery has been reportedintimal and media in/ury in nec+ artery has been reported



,rognosis,rognosis

• UnpredictableGGGGGUnpredictableGGGGG

% 7is+ factors identied in pediatric study7is+ factors identied in pediatric study

•ailed to resume heartbeat an drespirationailed to resume heartbeat an drespiration!ith administration of rst aid!ith administration of rst aid

•Apneic or had agonal respiration in 7Apneic or had agonal respiration in 7

• Initial pH less than .=Initial pH less than .=

•7euired &entilator7euired &entilator



4anagement4anagement

• AB*AB*% Aggressi&e air!ay management is essentialAggressi&e air!ay management is essential

• 4ost delayed mortality result from pulmonary4ost delayed mortality result from pulmonary

complicationGGGcomplicationGGG% Sympathomimetics and /udicious use of Juid forSympathomimetics and /udicious use of Juid for

hypotensionhypotension

% *ardiac arrhythmia be identied and treated*ardiac arrhythmia be identied and treated

% #reat II*, #reat II*,

• Fther in&estigationFther in&estigation% K1ray of nec+K1ray of nec+

• Fbser&e in hospital at least =L hoursFbser&e in hospital at least =L hours



4anagement4anagement

• ,otential useful drug,otential useful drug

% ,henytoin8,henytoin8

• 7educe the chance of seiMure7educe the chance of seiMure

• Has been sho!n helpful in arresting the de&elopmentHas been sho!n helpful in arresting the de&elopment

of centroneurogenic A7(Sof centroneurogenic A7(S

% alo:onealo:one

• 7e&erse the signs of cerebro&ascular ischemia in7e&erse the signs of cerebro&ascular ischemia in

animal modelanimal model

% *alcium channel bloc+er*alcium channel bloc+er

% Barbiturate and steroid contro&ersialBarbiturate and steroid contro&ersial



#han+ for your attention #han+ for your attention



7eference7eference

• Strangulation A 7e&ie! of ligature2 4anual andStrangulation A 7e&ie! of ligature2 4anual and

,ostural ec+ *ompression In/uries1,ostural ec+ *ompression In/uries1 Annals of mergencyAnnals of mergency

4edicine 4arch "DNLO"3"D1"N54edicine 4arch "DNLO"3"D1"N5

• Hanging and Strangulation In/uries1Hanging and Strangulation In/uries1 #he *linical ,ractice of #he *linical ,ractice ofmergency 4edicine2=nd edition by Har!ood1uss etc. 5??15?mergency 4edicine2=nd edition by Har!ood1uss etc. 5??15?

• Asphy:ia1Asphy:ia1 orensic ,athology2 =nd edition by (i4aio etc.==D1=orensic ,athology2 =nd edition by (i4aio etc.==D1=

• (elayed death after attempted suicide by hanging1(elayed death after attempted suicide by hanging1Int. $. -egal 4ed."DDO""0"?L1??Int. $. -egal 4ed."DDO""0"?L1??

• #he neuropsychological seuelae of attempted #he neuropsychological seuelae of attemptedhanging1$. of eurology2 eurosurgery and ,sychiatry."DD"O5L5L?1NNhanging1$. of eurology2 eurosurgery and ,sychiatry."DD"O5L5L?1NN

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