Traumatic and sexual asphyxia Forensic Medicine

Ppt on sexual asphyxia

1. Traumatic Asphyxia and Sexual Asphyxia 7/5/2024 1

2. Causes Stampede (riot crush or human pile death) Crushing by fall of earth or stone Victim pressed to the ground by a heavy object Assault Industrial disasters, earthquakes, landslides Jack knife position (knees driven against chest) 7/5/2024 2

3. Postmortem appearance Intense congestion, petechial and confluent hemorrhages and cyanosis of deep purple or purple red colour of head, neck, upper chest above the level of compression. Purple red colour due to hemorrhage into tissues around dilated blood vessels. Below this level skin is pale or mildly cyanosed . Areas of pallor seen at the level of collar of shirt, folds or creases in garments, buttons, braces etc. 7/5/2024 3

4. Face, lips and scalp may be swollen, congested and dotted with petechiae and ecchymoses. Fracture of ribs and other bones If patient recovers, purple colour gradually disappears in 10-14 days without the colour changes seen in bruises. Heavy pressure on chest primarily compresses the thinner right side of the heart, but left side continues to pump blood for some time. 7/5/2024 4

5. Retrograde displacement of blood from SVC into subclavian veins & veins of head and neck results from sudden compression of chest/abdomen. Spread of hydrostatic force to the veins of upperlimb prevented by valves of subclavian vein. The displacement of blood in valveless veins of head and neck causes rupture of distal venules and capillaries. Conjunctivae and sclerae are grossly congested and hemorrhagic. 7/5/2024 5

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7. Burking Homicidal smothering and traumatic asphyxia. William Burke and William Hare Dr Robert Knox Hare turned approver 7/5/2024 7

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9. Postural or Positional Asphyxia When an individual acquires a certain body position in which his breathing is impaired, often because of neck twisting with kinking or compression of the trachea and/or elevation of the tongue into the posterior hypopharynx. Normal venous return to heart may be impaired . Body is typically inverted and the weight of abdominal contents press against diaphragm pushing it upwards, thus compressing thoracic organs which combined with respiratory movements lead to cardiorespiratory failure and death. 7/5/2024 9

10. Always accidental . Causes Violent or physically aggressive person is physically or mechanically restrained on their stomach, face down or prone position. Falls in a well or wedged between walls. Intoxicated person sliding out of bed. Forcible flexion of neck on chest. Jack knife position. 7/5/2024 10

11. Characteristics Marked congestion Cyanosis Petechiae in face and neck Diagnosis Body position must obstruct normal gas exchange Must not be possible to move to another position Other causes of death must be excluded. 7/5/2024 11

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13. Environmental Suffocation Hypoxic hypoxia due to breathing in a vitiated atmosphere which is deficient in oxygen from atmosphere by displacement of oxygen from atmosphere by inert gases or by gases generated in the atmosphere. CO, CO 2 , CH 4 , H 2 S, SO 2 , N 2 O, Cl and COCl 2 . CO displaces oxygen from atmosphere and sulphur dioxide prevents hemoglobin from combining with oxygen. 7/5/2024 13

14. Deaths are almost always accidental. An oxygen concentration of 16% or less is dangerous and with 5% concentration, consciousness is lost rapidly and death occurs within a few minutes. CO 2 and CH 4 are most commonly encountered suffocating gases. In hypoxic deaths, petechial hemorrhages are absent. Congestion and cyanosis may or may not be present. 7/5/2024 14

15. Gagging Variety of suffocation Fabric or adhesive tape occludes the mouth to prevent speaking or shouting. While the nasal passages remain patent, air can enter, but later blockage by mucus or edema may lead to death. Congestion of face and fine petechiae of face, sclerae and conjunctivae. 7/5/2024 15

16. Almost always homicidal if victim is an infant. Can be accidental also Sudden death due to reflex vagal inhibition may occur. Gag should be examined for buccal epithelial cells. 7/5/2024 16

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18. Overlaying Compression suffocation Compression of chest so as to prevent breathing Occurs when mother or other person shares bed with an infant During sleep older person rolls on to and crushes the infant. Flattening of nose and face may or may not be seen. 7/5/2024 18

19. Pale Nostrils often filled with froth which may be blood stained and may stain pillow or garment. 7/5/2024 19

20. Choking Refers to blockage of the upper airways by some foreign body. Usually between pharynx and bifurcation of trachea. Develops a sore throat, hoarseness, respiratory difficulty and suddenly collapses. Choking from objects being lodged in the posterior hypopharynx, blocking glottis and oesophagus is commonly seen in young/elderly/psychiatric patients particularly where the ability to swallow or masticate is severely impaired. 7/5/2024 20

21. If there is struggle to breathe and attempts to remove the occluding object are unsuccessful, asphyxial changes are well marked. Autopsy Thickening of epiglottis and epiglottic folds by jelly like oedema and inflammatory tissue will be found occluding entrance to larynx. Mucus may be found at the back of the mouth and throat Microscopically lungs show intense interalveolar oedema and congestion, hemorrhages of varying sizes and collection of desquamated respiratory epithelium. 7/5/2024 21

22. Diphtheria, IMN, H. influenzae infection in children. Suicidal choking rare Homicidal choking used as a mode of infanticide. 7/5/2024 22

23. Café Coronary Healthy but grossly intoxicated person who begins a meal , suddenly turns blue, coughs violently, then collapses and dies, without much fuss. Death appears to be due to sudden heart attack. At autopsy a large piece of poorly chewed food (bolus or a piece of meat) may be found obstructing the larynx. Clinical signs of choking are absent, because of high alcohol content which anaesthetises the gag reflex. 7/5/2024 23

24. Treatment A blow on the back or on sternum may cause coughing and expel the foreign body. Heimlich manoeuvre Application of pressure on the abdomen by a person standing behind and using hands with fingers interlinked and exerting pressure in the region of pit of stomach If not successful, foreign body removed from hypopharynx by using middle and index finger or by a forceps. 7/5/2024 24

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26. Autopsy Foreign body When food or vomited matter is inhaled, particles of food may be observed embedded in thick mucus in the trachea and bronchi and particles may be drawn into bronchioles which distinguishes the condition from those conditions in which food is forced up the oesophagus and falls into larynx after death. 7/5/2024 26

27. Sexual Asphyxia Autoerotic asphyxia or asphyxiophilia Partial asphyxia caused by pressure on carotid vessels, or partial obstruction of airways causes cerebral disturbances and may lead to hallucinations of an erotic nature in some men. Usually degree of asphyxia is controlled but death occurs in some cases. Associated with some form of abnormal sexual behaviour usually masochism and transvestism. 7/5/2024 27

28. Victims are almost always males and usually young . Scene is usually victim’s own house, bedroom or bathroom etc. and door may be locked from inside. 7/5/2024 28

29. Methods Hanging most frequent method Neck is protected by a padding between neck and ligature. The ligature is passed around the neck in the form of running noose and free end may be tied to a limb thereby controlling the pressure. Noose can be tightened by extending/flexing the limb. 7/5/2024 29

30. When consciousness is lost, the relaxation of limb releases pressure. Such persons are usually found naked, partly naked or wearing women’s dress 7/5/2024 30

31. There may be padding of bra to simulate breasts, female undergarments, wigs and make-up may be worn. Electrical stimulation Can give sexual gratification Covering head in a plastic or some impervious bag Carbon tetrachloride, trichloroethylene etc. are inhaled Less commonly death may occur from rectal hemorrhage following some foreign body insertion 7/5/2024 31

32. Scene of crime Evidence of abnormal sexual behaviour Evidence that act had been practised previously Evidence of attempts to conceal the act by some method to prevent a ligature from leaving marks around neck Look for any other causes. 7/5/2024 32

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