Hanging, strangulation, Asphyxial death

Hanging, strangulation, Asphyxial death

1. Hanging
ATUL ABHISHEK
(Galgotias university, Greater Noida)

2. Asphyxial death Asphyxial death Asphyxial death Asphyxial death
Asphyxia is a condition of the body in which the su pply of 02 to the blood and tissues 
has been reduced appreciably below minimum critical  level for maintenance of vital 
functions of the body by any mechanical interferenc e with respiration, causing first 
unconsciousness or then death. If a person died due  to asphyxia, such death is known 
as asphyxia death.
A
The normal levels of oxygen in the arterial blood ( pO2) with a 95% saturation of 
hemoglobin ranges from 90 to 100 mm Hg in a healthy  young adult. The same is 65–
80mmHg in above 60 years of age. 
A
Hypoxia occurs when PO2 is less than 60 mmHg even t hough the 
hemoglobin 
is 
A
Hypoxia occurs when PO2 is less than 60 mmHg even t hough the 
hemoglobin 
is 
90% saturated. Severe hypoxia occurs when PO2 is 40  mmHg.
A
Death occurs when PO2 is less than 20 mmHg.
Axphyxialphenomenon  A
Reduction in O2 tension                Capillary dil atation             Capillary stasis              
Capillary engorgement                Stasis of bloo d in organs            Diminished venous 
return to heart              Reduced pulmonary flow                          Deficient 
oxygenation in lungs                  
Asphyxia

3. Types of Asphyxia
1.
MECHANICAL------Air passages blocked mechanically
H
Hanging
H
Strangulation
H
Suffocation
H
Entrapment
H
Smothering
H
Gagging
H
Gagging
H
Choking
H
Burking
H
Overlaying
H
Traumatic asphyxia
H
Environmental
H
Postural or positional
H
Drowning

4. 2.
PATHOLOGICAL------Entry of oxygen in lungs decreased
due to disease of upper respiratory tract or lung. E.g.
bronchitis, acute edema of glottis, laryngeal spasm.
3.
TOXIC------Poisonous substances preventing use of oxygen.
Carbon monoxide poisoning, paralysis of respiratory centre by
opium, barbiturates, strychnine etc.
4.
ENVIRONMENTAL--------Insufficient oxygen in inspired
air. e.g. enclosed spaces, irrespirable gas in environment as in
sewer gas, high altitude etc. sewer gas, high altitude etc.
5.
TRAUMATIC-------Bilateral Pneumothorax, pulmonary fat
embolism from fracture of long bones, pulmonary thrombo-
embolism due to injury of lower limb etc.
6.
POSTURAL-------in unconscious or stuporousperson, where
upper half of body lower than remainder.
7.
IATROGENIC--------anesthetic deaths.

5. Hanging
Hanging  is a suspension of a person’s body by liga ture around the neck. A
cause of death-Asphyxia & venous congestion
A
Purpose of hanging can be suicidal, homicide, judici al & Accidental
The four types of hanging:- 1)
Complete hanging 
–
complete hanging in which no body part is 
1)
Complete hanging 
–
complete hanging in which no body part is 
touching the ground.
A
Whole body weight suspended
A
Trachea is always compressed 
A
“asphyxia” –person will die from it 
A
Cyanosis, congestion & petechiae (ccp-+nt) are pres ent in a 
complete hanging.

6. 2)  
Partial hanging –partial hanging in which some part  of the body is 
touching the ground. A
Only head weight suspended
A
Patient will die from “venous congestion”
A
In this condition cyanosis, congestion & petechiae  are absent (ccp-
absent)
3)  
Typical hanging
A
Knot is at -occipital (most common)
4)  
Atypical hanging
A
Knot is at -any other side

7. Post-mortem changes in complete hanging 1.
“V” shape ligature mark
2.
Cyanosis , congestion & petechiae - present( asphyxi al),   
absent(venous congestion)
3.
“ Tardieu’s spot”-venous congestion
4.
Hyoid bone fracture-10% cases
5.
Protrusion of tongue
6.
Semen discharge
7.
Eye open→pupil dilated  →same side of the knot  →La facie 
sympathetiqueknot
8.
Dribbling of saliva  →opposite side of the knot 

9. Judicial hanging
A
Perfect method of death. Complete, Atypical, sudden  drop
A
Knot  at –angle of mandible
A
C2 –C3 or C3 –C4 cervicaldamage  →respiratory arrest
A
Carotid artery damage (very common)
↓↓
known as a “ Amussat’s sign”

10. Point of comparison COMPLETE HANGING INCOMPLETE HANGING
Other name High point hanging Low point hanging
Touching the ground Negative Positive
Circumstances Presence of a near-by table
or chair
Negative
Main cause of death Cerebral ischemia Asphyxia
Face Less congested, sometimes
pale
Markedly congested
Hypostasis
Lower
half of the
body
According to the
part
Hypostasis
Lower
half of the
body
According to the
part
touching the ground
Type of knot Fixed knot or running noose Always runningnoose
Rope marks -Incomplete with fixed knot
-Above thyroid cartilage
-Oblique
-Deep and fades gradually
towards suspension point
-Complete
-Below thyroid cartilage
-Transverse
-Deep all through
Dribbling of saliva Positive Negative
Tear in carotid intima Positive Negative
Hyoid bone If fractured: outwards If fractured: inwards

13. Humanexperiment
H
Acute obliteration of neck circulation with
600mmHg cuff
a
Blurring of vision
a
Constriction of visual fields
a
Loss of conscious (6-6.5 sec)
a
Hypoxic convulsion
a
Hypoxic convulsion
a
EKG minimal change
H
Prolonged occlusion of cerebral circulation up to
100 sec.
a
Convulsion, Cyanosis, Involuntary urination, Involuntary
defection, a
Bradycardiaand dilation of pupils occurred after loss of
consciousness

14. Postmortem appearance Postmortem appearance Postmortem appearance Postmortem appearance
1.
External appearance.
2.
Internal appearance.
External appearance
-
Above the ligature.
-
Above the ligature.
-Beneath the ligature.
-Below the ligature. 

15. Above the ligature mark
2
Tilt of the head.
2
Protrusion of tongue.
2
Dribbling of saliva.
2
Le FaciaSympathique.
2
Tardieu spots.
2
Congestion (excessive accumulation of blood/ body fl uid) of the face.
2
Congestion (excessive accumulation of blood/ body fl uid) of the face.
2
Petechealhemorrhages.
2
Middle ear hemorrhages.
(petechiae hemorrhages-petechiae are tiny purple, r ed, or brown spots on 
the skin. Petechiae are formed when tiny blood vess els called capillaries 
break open. when these blood vessels break ,blood l eaks into the skin.)

16. Beneath the ligature
2
Fixed or running noose.
2
Position of the knot.
2
Course of the ligature.
2
Width and multiplicity.
2
Point of suspension.
2
Slipping of ligature.
2
Weight of the body.
Below the ligature
2
Postmortem lividity (Glove and Stocking)
2
Relaxation of sphincters.
2
Injury to legs.(partial hanging)

17. Internal appearance 2
Hemorrhages in the neck.
2
Dry, white and glistening.
2
Rupture of platysmaand sternomastoid.
2
Transverse tear in the intimaof carotid artery.
2
Fracture of 
hyoid,cricoid
and thyroid cartilages.
2
Fracture of 
hyoid,cricoid
and thyroid cartilages.
2
Congestion of organs.
2
Petechialhemorrhages. 

18. Differential characteristics between Homicide and
Suicide by Hanging
There are five important features to consider to di fferentiate a 
murder of a suicide by hanging:
1. Furrow or groove with Ecchymosis, or so called l igature mark, 
which is caused by the pressure of the constrictor  agent (rope, 
cable, etc.) in the skin. In the hanging will find  it incomplete, and  cable, etc.) in the skin. In the hanging will find  it incomplete, and  in the murder by constriction will find it complete .
2. Commonly blood appears in the hanged with the as phyxia own 
characteristics, which will look like this: blackis h, fluid and little 
clotted.

19. 3. In a suicide, can occasionally see the retro-pro pulsion of the 
tongue, when this is out of the mouth, caused by pr essure that 
makes the hyoid bone in the neck, and instinctively  by the body to 
take air. Therefore, when hung a body previously mu rdered, the 
tongue out of the mouth we will not see.
4. It is possible case of homicide when the body sh ows signs of 
struggle or recent injuries in other body parts. struggle or recent injuries in other body parts.
5. When the person died on the floor, and then the  body was hung by 
another person pretending suicide, can be found mor tem lividity 
(when blood settles by gravity into the lower regio n of the body), 
either in the back or in the abdomen, it will not m atch with the 
gravity and location of hanged.

20. Medical effects
A
People who survive hanging report seeing flashing   lights and hearing 
ringing sounds. A
The neck of people who are hanged are usually marke d with furrows 
where the ligature had constricted the neck. An inv erted V mark is also 
often seen.
A
Because of the pressure on the jaw, the tongue is s ometimes protruding,   causing  it  to dry. causing  it  to dry.
A
Depending on  the  circumstances, petechiae may be  present on  the 
eyes,  face,  legs,  and  feet. A
Cervical  spine  fractures  are  rare  unless  the   hanging  is  a  drop 
hanging, which  usually  causes  an  injury  known   as  hangman's  
fracture.
A
Suspension  hanging usually  results  in  cerebral   hypoxia  and  
decreased muscle  tone  around  the  neck. Accordin g  to Aufderheideet 
al., the most common cause of death of hangings is  cerebral hypoxia.

21. Treatment 
A
Most people who are hanged die before they are foun d; the term "near 
hanging" refers to those who survive  (at  least  f or  a  while—for  
example,  until  they  reach  hospital).
A
Initial  treatment  of survivors follows the "usual  priorities of airway, 
breathing, and circulation (ABC)". Treatment should  be "directed at  breathing, and circulation (ABC)". Treatment should  be "directed at  airway control with endotrachealintubation, ventila tion using positive 
end expiratory pressure  (PEEP),  and  hyperventilati on  with  
supplemental  oxygen  to  control  intracranial pre ssure".
A
One study of people who experienced near-hanging wh o were treated 
appropriately at hospital found that 77 percent of  them survived.

22. Types of strangulation
STRANGULATION
H
Application of external pressure on the neck eitherby ba re
hands, or by a ligature, or by any othermaterial.
H
It is a form of asphyxia caused by constriction ofthe neck WITHOUT
suspending thebody.
H
THROTTLING: when constriction is produced by the
pressure of the fingers and thepalms H
GARROTING: loop of thin string thrown from back and
tightened H
BANSDOLA: neck compressed between two bamboo
sticks H
MUGGING: pressure upon neck by arm around the
throat

23. Sr.
No.
Trait Hanging Strangulation 1 Ligaturemark Oblique,incomplete,
high in theneck
Transverse,
complete, mid
level or below
thyroidcartilage
2 Base Pale, hard,
parchment
like
Contused
parchment
like
3 Abrasion,
contusion&
Echymosis
Lessprominent Moreprominent
4 Hyoidfracture Morecommon Lesscommon
5 Thyroidcartilage Lesscommon Morecommon

24. Sr.
No.
Trait Hanging Strangulation 6 Carotid Intimaltear Notseen
7 Signs ofasphyxia Lessmarked Moremarked
8 Dribbling ofsaliva Often Rare
9
Bleeding
from
nose,
Rare
Often
9
Bleeding
from
nose,
mouth &ears
Rare
Often
10 Involuntary
discharge
Occasional Frequent
11 Manner Suicidal Homicidal
12 Injuries onother
bodyparts
Rare Common