SUFFOCATION

MEDICO LEGAL ASPECT OF SUFFOCATION

1. SUFFOCATION By: Pragati Msc part 1

2. SUFFOCATION Suffocation is caused by deprivation of oxygen either due to lack of oxygen in environment or from obstruction of air passages. In general it indicates asphyxia.

3. Homicidal suffocation It happens usually when a person is either weak on unconcious due to drug or in sleep and his/her mouth and nose is pressed with a cloth or a pillow.

4. Suicidal suffocation It is impossible to commit a suicide through suffocation. But it is possible by burying the face again the bed clothing, mostly seen in mental patients. Sometimes cut throat wounds can also lead to the obstruction due to soft part choking the throat. It can also be done by covering face by plastic bag.

5. Accidental suffocation It is the most common suffocation. At times infants gets suffocated with the weight of bed cloths or due to the weight on their mother’s hand while sleeping. A child may get suffocated while playing with bags. A person might fall in mud and get suffocated.

6. Suffocation smothering gagging choking Traumatic suffocation overlying burking Due to irrespirable gases

7. SMOTHERING Smothering refers to death resulting from mechanical occlusion of the mouth and nose that prevents breathing. The smothering agent is usually a fabric, an impervious sheet or a hand, though occasionally a mobile solid such as sand, mud , grain or flour may be responsible for blocking the air-passages.

8. Post mortem findings There are scratch abrasions, finger nail marks, laceration of soft parts of victim’s face. There may be bruising and laceration of lips, gums and tongue. Face is pale and white.

9. Medico- legal aspects Suicidal smothering can occur in mental patients or prisoners. Suicide is practicable merely by burying the face in a flock mattress or even it would appear by lying against the bed clothing to obstruct the nose and mouth, especially when drunk. The death by cutthroat may occasionally terminate by smothering. The circumstances of accidental smothering vary according to the age of the victim. The bedclothes covering the nostrils and mouth of the infant infants during first month of life especially premature.

10. Homicidal smothering of an adult by smothering is possible when there is a gross disparity between the assailant and the victim or else when the victim is helpless by virtue of his age, ill health or incapacity from drink or drugs or when stunned by a blow. It is a common mode of infanticide. Usually the assailant uses far more force than is necessary to kill and consequently finger-marks in the form of scratches and bruises are found over the victim’s face.

11. Gagging Mechanical obstruction of oral cavity is termed as gagging. It is usually resorted to prevent the victim from shouting for help & death is usually not intended. At times, it may be homicidal, particularly when victims are infants or in individuals incapacitated by alcohol or drugs, old, infirms . initially the gag only blocks the mouth and permits air entry through nostrils. Later the gag becomes progressively soaked with saliva &/or mucus, becomes impervious and gets sucked in with inspiratory gasps. Finally it obstructs the nasopharynx leading to complete obstruction of airways & may cause unforeseen death. The sequence of physiological events is bradycardia , decrease in respiration, eventual cessation of respiration, slowing and finally flattening of EEG.

12. In case of gagging, gag should be examined for saliva , mucous and blood. Sometimes Sudden death due to vegal inhibition also occurs . Sruggle marks can also be seen in various cases.

13. Overlying It is seen most commonly when an infant is put to bed with one or more adults. During the night, one of the adult inadvertently rolls on to or otherwise crushes and asphyxiates the infant by compressing the chest thus preventing respiratory movement and occluding the nose and mouth with bedding or the body of the adult. Later on the adult rolls off the child. The next morning the child is found dead without any evidence of trauma.

14. Post mortem findings Presence of petechial haemorrhages beneath the conjunctiva, epicardium and pleura. Evidence of contact flattening of face and nose may or may not be there. This is suggestive of infant being laid on the face at the time of or after death. Blood tinged froth from mouth and nostrils that may stain the bed clothing. Absence of injury marks over the body.

15. Burking Burking is a form of traumatic asphyxia plus smothering that is homicidal in nature. It was named after criminals named Burke and Hare during 1820s. External sign of suffocation is absent in this case.

16. Choking It is a form of asphyxia caused by an obstruction within the air passage. It is almost always accidental and is usually due to inhalation of a foreign body, but it can be caused by the inhalation of the products of disease or by anatomical changes due to disease. The usual mechanism of asphyxia in choking is simple mechanical obstruction.

17. Café coronary One of the commonest causes of choking is the entry of food into the air passages. If food enters the larynx during swallowing, it usually causes gross choking symptoms of coughing, distress and cyanosis, which can be fatal unless the obstruction is cleared by coughing or some rapid treatment is offered. However, if the piece of food is large enough to occlude the larynx completely, it will prevent not only breathing but also speech and coughing. The individual may die silently and quickly, the cause of death remaining hidden until the autopsy. This is the so-called café coronary

18. Causes of choking Inhalation of foreign body into the glottis such as bolus of meat, potato, button, coins, marbles, corns, fish, screws, pins or artificial dentures. Inhalation of vomited material in an unconscious, when intoxicated, during anaesthesia or epileptic fits. Belching out of milk by infants and young children may be aspirated into the air passages. Inhalation of products of disease or violence such as blood or pus while haemoptysis in Tuberculosis, rupture of an aortic aneurysm in air passages, or due to flooding of air passages with pus and necrotic debris in a lung abscess. Anatomical changes due to disease such as a bronchial growth, laryngeal oedema and tumours , pharyngeal abscess, angioneurotic oedema . In conditions such as poliomyelitis or bulbar palsy, accidental inhalation of food occurs due to disturbance in swallowing mechanism.

19. Post mortem finding Presence of impacted foreign body in the air passages. Regurgitated food particles such as vomitus , milk etc may be found mixed with mucus in trachea, bronchi and lower bronchioles. All organs are congested.

20. Traumatic asphyxia Asphyxia caused due to mechanical fixation of the chest so that normal movements of chest wall are prevented. This occurs when a large weight falls onto or presses down on an individual’s chest or upper abdomen. The most common form of traumatic asphyxia encountered is while repairing a car the jack slips and the vehicles falls on top of the individual.

21. POST MORTEM FINDING Black blue discoloration of the skin of head, neck and upper trunk numerous petechiae , conjunctiva and retinal haemorrhages intense cyanosis of deep purple or purple-red colour cyanosis above the level of compression usually to the level of third rib. Haemorrhage is seen in the tissues around the site of compression whereas below the level of compression, skin is pale and mild cyanosis may be seen. Areas of pallor are seen at the level of collar of the shirt, folds or creases of garments. Internally, there is often no evidence of trauma in spite of the heavy weight on the chest. In addition, fracture of ribs may be present.

22. Asphyxia due to irrespirable gases Deaths from suffocating gases are not due to the toxic nature of the gases, but rather to displacement of oxygen from the atmosphere. Carbon dioxide and methane are two most commonly encountered suffocating gases. Both are essentially nontoxic and odorless and are found in sewers and mines. The cause of death can be determined from the circumstantial evidences as there are no specific autopsy findings. If death is prolonged, the individuals appear cyanotic with petechial haemorrhages of the epicardium and visceral pleura.

23. Common Signs of suffocation: Cyanosis Lips, gums and tongue is swollen Petechial haemorrge in internal organs Blood stained froath can be seen in nostrils. Swollen face. Oedma in organs. Right side of the heart becomes congested in various cases of burking and traumatic asphyxia.

24. References: Simpson's Forensic Medicine 13th ed. - J. Payne-James, et. al., ( Hodder -Arnold, 2011) BBS. Textbook of Forensic Medicine and Toxicology, Fifth Edition - Krishan Vij . Forensic-Medicine; Dikshit Google images

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