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Asphyxia can literally be translated from the Greek as meaning

'absence of pulse', but is usually the term given to deaths due


to 'anoxia' or 'hypoxia'.
The term 'asphyxia' is thought by some forensic pathologists to be a
vague and confusing term. In its broadest sense it refers to a state in
which the body becomes deprived of oxygen while in excess of carbon
dioxide (ie. hypoxia and hypercapnoea). This results in a loss of
consciousness and/or death. However, prior to any death the body
usually reaches a low oxygen-high carbon dioxide state, and so an
'asphyxial' death is therefore one in which the oxygen deprived state
has been achieved unnaturally.
Categorising asphyxial deaths
Neck Compression
Chest Compression
Postural/ Positional Asphyxia
Airway Obstruction
Exhaustion or Displacement of Environmental Oxygen
Neck Compression
Mechanisms of Death
mechanical constriction/ squeezing of the soft tissues of the
neck - the most common mechanism is that of compression of the
jugular veins, with or without that of the carotid arteries, leads to
reduced oxygen reaching the brain, loss of consciousness, and if
sustained for a sufficient interval (minutes) death. The time interval
of compression to loss of consciousness is approx. 10 secs if both
carotid arteries are compressed and a minute if only the jugulars are
compressed. The time interval from loss of consciousness to death is
said to be in the region of minutes.

airway obstruction - this is a contributory factor in some hangings,


where the hyoid bone and tongue are pushed upwards and
backwards against the laryngo-pharynx. This type of obstruction
produces 'air hunger', which is a frightening sensation and which is
not a feature of vascular compression in the neck.

cardiac arrhythmia - this is a controversial postulated mechanism


whereby pressure over the carotid artery at the carotid sinus
provokes a reflex slowing of the heart (bradycardia), which may
provoke a fatal arrythmia (particularly in the elderly or those with
underlying cardiac disease). This mechanism is unlikely to be
responsible where there are petechiae or congestion which would
suggest that the heart had been beating for a more lengthy period
than this mechanism would support.

Classic signs of asphyxia ...


congestion of the face - due to venous congestion (venous return to
the heart is prevented)
facial oedema - increased venous pressure causes tissue fluid
transudation (remember those Starling forces !)
cyanosis - excess de-oxygenated haemoglobin in the venous blood
petechial haemorrhages in the skin and eyes (particularly the
eyelids, conjunctiva, sclera, face, lips and behind the ears) - due to
raised venous pressure

Petechial Haemorrhages
Unfortunately the presence of petechial haemorrhages does not
automatically point to asphyxia as a cause of death. They are fairly
non-specific in that they can be produced whenever there is a marked
or sudden increase in vascular congestion of the head that causes
rupture of capillaries.
The areas of the head that are most characteristically involved are
those that have little surrounding soft tissue support, such as the
conjunctiva, eyelids, lining of the mouth/ larynx etc. Petechiae can
therefore be produced not only during vascular compression of the
neck, but also where valsalva manouvres operate, such as during
labour, straining at stool, coughing (eg in asthma), sneezing, vomiting
etc.

Other examples include chest compression, where the right heart is


compressed, but the left heart is still capable of pumping (and acute
right heart failure due to disease). In these circumstances, the level of
congestion would be just above the heart on the chest wall.
Where bodies are found lying prone with the head at a lower level than
the rest of the body, there may be coarse petechiae present in the
areas of intense congestion.
Traumatic Asphyxiation
This is the term given to the condition most often seen after mass
disasters, such as the Hillsborough football stadium disaster, or where
people have been crushed by collapsing trenches, or by the weight of
grain etc in silos.
The thorax is transfixed, preventing respiratory movements. There are
classic signs of congestion, cyanosis and petechiae, but there may be
no other signs of injury on the body. The florid signs of congestion
usually finish at the level of the clavicles.
Postural asphyxia is a related condition, recently coming to the fore
due to interest in deaths in police custardy etc, and may involve
splinting of the diaphragm during restraint, coupled with the additional
requirements for oxygen during a struggle. Research into this aspect is
ongoing.

Obstruction of the airway


When oxygen is not able to reach the lungs because of external
occlusion of the mouth and/ or nose, or the airway at the level of the
larynx is obstructed (eg by a bolus of food), the cause of the asphyxial
death is 'obstruction of the airways'. There are no specific autopsy
findings that would support the main types of airway obstruction
deaths, and circumstantial evidence, physical evidence (eg plastic bags
used by the deceased) and the scene of death would be relied on to
support the diagnosis.
smothering - the covering of the mouth or nose (or external
occlusion) eg by a plastic bag or in overlay deaths (may see
abrasions etc in a homicidal smothering if the victim could put up a
struggle)

gagging - the tongue is pushed backwards and upwards, and the gag
becomes saturated with saliva and mucus causing further
obstruction.
foreign body obstruction (those at risk being children/ infants, the
intoxicated and those with neurological difficulties with swallowing
etc)
swelling of the airway lining (anaphylactic hypersensitivity reactions,
or thermal/ heat injury.

Exhaustion or Displacement of Environmental Oxygen


(Suffocation)
This may occur in tight or confined spaces, where toxic fumes are
released from bedding etc in cots, or in drowning (the inhaled water
displaces the oxygen).
This is 'pure' asphyxia and results in a fairly rapid, painless loss of
consciousness, followed by death if not discovered. There are no
diagnostic autopsy findings.