Asphyxial Deaths and Hanging Mechanisms

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Questions and Answers

What characterizes a complete hanging as opposed to an incomplete hanging?

The feet do not touch the ground. (correct)

The victim is in a standing position.

The point of suspension is located higher than the neck.

The ligature runs asymmetrically on one side of the neck.

Which type of asphyxia is caused by a foreign body obstructing the lower respiratory passages?

Choking (correct)

Traumatic asphyxia

Suffocation

Strangulation

In the classification of mechanical/violent asphyxial deaths, which scenario falls under 'upper respiratory passage' issues?

Smothering by hands

Hanging

Gagging with a cloth (correct)

Overlaying by heavy objects

What is the description of 'traumatic asphyxia'?

Asphyxia resulting from an external constricting force applied to the chest. Signup and view all the answers

What distinguishes an atypical hanging from a typical hanging?

The ligature position is asymmetrical. Signup and view all the answers

What condition is characterized by the immediate survival after asphyxia due to submersion?

Secondary drowning syndrome Signup and view all the answers

Which symptom is NOT typically associated with acute poisoning from D.D.T., aldrin, dieldrin, or lindane?

Severe chest pain Signup and view all the answers

Which of the following is NOT a characteristic feature of cadaveric spasm?

Puckered skin with hair standing out Signup and view all the answers

What is the mechanism behind 'Washer Woman feet' found during post-mortem examinations of drowning victims?

Action of water on thickened epidermis Signup and view all the answers

What is the most likely outcome of D.D.T. accumulation in the body over time?

Gradual decline in concentration over months Signup and view all the answers

Which treatment is NOT recommended for D.D.T. poisoning?

Administration of adrenaline Signup and view all the answers

Which sign is considered one of the surest indications of death due to drowning?

Cadaveric spasm with clenched objects Signup and view all the answers

What type of froth is typically produced in the lungs of drowning victims?

Whitish or pinkish fine froth Signup and view all the answers

Which symptom represents a chronic effect of D.D.T. poisoning?

Tinnitus Signup and view all the answers

During a post-mortem examination, which external change occurs twice as fast as the environment?

Cooling Signup and view all the answers

What dietary advice is given for individuals suffering from chronic D.D.T. poisoning?

Balanced diet with carbohydrates and protein Signup and view all the answers

Which of the following is a postmortem finding associated with D.D.T. poisoning?

Congested lungs with fluid buildup Signup and view all the answers

Which statement about hypostasis in drowning cases is accurate?

It depends upon whether the water is running or stagnant. Signup and view all the answers

What result can occur 24 hours after a drowning incident, known as post immersion syndrome?

Brain damage and hypoxemia Signup and view all the answers

Which of these treatments is specifically used to control muscular twitching and convulsions in D.D.T. poisoning?

Phenobarbital sodium Signup and view all the answers

What is a potential consequence of D.D.T. transfer through breastfeeding?

Poisoning of the infant Signup and view all the answers

Which of the following symptoms is NOT typically associated with cholinergic toxidrome?

Hypotension Signup and view all the answers

What is the primary cause of death in acute cholinesterase inhibitor poisoning?

Paralysis of musculature Signup and view all the answers

Which laboratory test is considered more reliable in diagnosing cholinesterase activity in acute poisoning?

RBC cholinesterase test Signup and view all the answers

In cholinergic toxidrome, which of the following signs is indicative of a severe reaction?

Bronchospasm Signup and view all the answers

Which of the following is a common central nervous system symptom of cholinergic toxicity?

Delirium Signup and view all the answers

What characteristic odor may be associated with skin exposure to certain organophosphates?

Garlic or kerosene-like odor Signup and view all the answers

Which symptom is part of the mnemonic DUMBELS related to cholinergic toxidrome?

Emesis Signup and view all the answers

Which condition would be diagnosed using the P-nitrophenol test?

Parathion poisoning Signup and view all the answers

What is a common finding associated with severe intoxication of barbiturates?

Absence of corneal reflex Signup and view all the answers

What is the mode of action of barbiturates?

Depressant effect on the central nervous system Signup and view all the answers

Which condition is contraindicated in patients taking barbiturates?

Impairment of liver function Signup and view all the answers

During moderate intoxication, what reflexes are typically observed?

Normal corneal reflexes Signup and view all the answers

What respiratory condition may be present in severe intoxication from barbiturates?

Irregular and slow respiration Signup and view all the answers

What is the typical duration of action for long acting barbiturates?

Around 8-10 hours Signup and view all the answers

Which symptom indicates mild intoxication from barbiturates?

Drowsy but arousable state Signup and view all the answers

What finding is NOT typically associated with delayed paralysis from poisoning by parathion and malathion?

Pulmonary edema Signup and view all the answers

Study Notes

Mechanical/Violent Asphyxial Deaths

Classification: External opening, Upper respiratory passage, Larynx/Trachea, Lower respiratory passage, Chest wall
External opening: Suffocation, Gagging, Smothering, Overlaying
Upper respiratory passage: Glottis choking
Larynx/Trachea: Hanging, Strangulation (garotting/throttling)
Lower respiratory passage: Foreign body impaction
Chest wall: Traumatic asphyxia

Hanging/Suspension

Death caused by suspension of a body by a ligature encircling the neck
Types: Complete, Incomplete

Complete Hanging

Feet doesn't touch the ground.
Weight of the whole body act as constricting force.

Incomplete Hanging

All other situations where feet touch the ground.
Examples: kneeling position, reclining position

Typical Hanging

Point of suspension is placed centrally over occipital.

Atypical Hanging

Point of suspension is placed on another position on the neck/scalp.

Submersion of Unconscious

Victim may be unconscious due to epilepsy, pre-existing cardiac disease, dizziness due to essential hypertension or being drunk.

Secondary Drowning Syndrome

Immediate survival after asphyxia due to submersion.

Post Immersion Syndrome

Resuscitated after drowning and survives for 24 hours.
May develop hypoxemia resulting in brain damage, cerebral edema, pulmonary edema, pneumonitis, myocardial anoxia, cardiac arrhythmias, electrolyte imbalance, metabolic acidosis, hemoglobinuria, fever and sepsis.

Autopsy Findings

General Changes Occuring After Death:
- Cooling: Rate twice that of the environment. Usually cool when recovered.
- Hypostasis: Depends upon the state of water whether running or stagnant.
  - In stagnant water: Distribution - Head, neck & chest area, legs. Color - Pink
- Rigor Mortis: Sets early due to struggling and muscular exhaustion.
- Putrefaction: Sets early and is usually advanced.
Due to Contact with Water:
- Body wet.
- Clothes wet (findings of medium).
- Goose flesh (cutis anserina).
- Washer Woman feet.

Goose Flesh (Cutis Anserina)

Feature: Skin appears granular puckered with hair standing out (pimpling of skin).
Mechanism: Spasm of erector pilae muscles due to exposure to cold water.
Value: Not a sure sign of death due to drowning.

Washer Woman Feet

Feature: Skin of palms and soles, sodden, wrinkled and bleached.
Mechanism: Action of water on thickened epidermis, loss of skin tone & vascular contraction.
Value: Not a sure sign of death due to drowning.

Cadaveric Spasm

Features: Aquatic vegetation, contents of water or floating objects are tightly clenched in the hands.
Mechanism: Person may make terminal attempts to grasp the things for support. Usual objects: weeds, grass.
Value: One of the surest sign of death due to drowning.

Due to Inhalation of Water

Oro-nasal fine froth (Foam):
- Color: Whitish or Pinkish (Blood tinged).
- Quality: Fine, tenacious, persistent.
- Quantity: Abundant, if wiped away, reappears.
- Shape: Small balloon, mushroom like, sometimes resembling a protruded tongue.
- Mechanism: Fluid entering the air passages provokes the lining membrane to produce mucus. The mucous + surfactant + water vigorously produces fine froth.

DDT (Dichloro Diphenyl Trichloroethane) Poisoning

Signs and Symptoms:
- Acute Poisoning:
  - Apprehension, hyper excitability, restlessness, Nervousness
  - Tinnitus and vertigo
  - Blurred vision with twitching of eyelids followed by tremors
  - Tonic Clonic convulsion
  - Generalized epileptiform convulsions
  - Muscular weakness, ataxia, incoordination, numbness, and paralysis
- Chronic Poisoning:
  - Anorexia, nausea and vomiting
  - Cachexia, loss of weight, anemia
  - Anxiety, headache, hyperirritability
  - Blurred vision
  - Tremors, convulsion and coma
  - Liver is moderately enlarged
Treatment:
- Immediate gastric lavage with 2% potassium permanganate
- Emetics should be given
- There is no known antidote of DDT
- Cathartic fats, or oils should be avoided as they promote absorption.
- Atropine sulfate, should be administered
- Oxygen inhalation and artificial respiration is given
- Thiopentone sodium 100-250 mg IV. followed by I.M. injection of 100 mg of Phenobarbital sodium, also Diazepam and barbiturates to control muscular twitching, tremors and convulsion.
- Calcium gluconate 10 ml of 10% with glucose IV and calcium lactate orally are beneficial
- Adrenaline, epinephrine should not be used; they induce ventricular fibrillation. Morphine is also avoided
- For skin contamination, washing with soap and water
- In chronic poisonings, the patient should be removed from the site of exposure and given a low fat, high protein and carbohydrate diet. The treatment is symptomatic.
Postmortem findings:
- Stomach contents may smell of kerosene and are bloodstained
- Mucosa of stomach and intestines is congested and petechial hemorrhagic, fatty changes in heart
- Liver is enlarged with fatty degeneration
- Lungs are congested and edematous
- Spleen, brain and kidneys are congested
Medico legal importance: Used for suicidal purpose

Cholinergic Toxidrome

Mnemonic: DUMBELS
- D: Diarrhea
- U: Urination
- M: Miosis, Muscle fasciculations and weakness
- B: Bronchospasm, Bronchorrhea, Bradycardia , Blurring of vision (d/t miosis)
- E: Emesis
- L: Lacrimation (red tears)
- S: Salivation, Sweating
Nicotine like effects:
- Striated Muscles' Weakness, twitching/ fasciculation and cramps
- Cardiovascular effect:
  - Mydriasis (Dilated pupils)
  - Tachycardia (Increased heart rate)
  - Hypertension (Increased blood pressure)
  - Bradycardia (Decreased heart rate)
  - Weakness of Muscles, HyperTension, Fasiculations
- Eyes: Mydriasis (Dilated pupils) and miosis (Constricted pupils), muscarinic effect more pronounced.
Other: Diaphragmatic failure, paralysis, areflexia and respiratory failure.

Central Nervous System Side Effects

Irritability, drowsiness, confusion, tremors of hands, lips, face or tongue, slurred speech, ataxia, generalized weakness

Severe Poisoning

Cheyne-Stokes respiration, delirium, Areflexia, coma, convulsions, respiratory and circulatory depression, psychosis and death

Diagnostic Findings

Garlic or kerosene like odor
Skin becomes red and blistered

Lab Diagnosis

Depression of CHOLINESTERASE ACTIVITY:
- In acute poisoning, signs and symptoms occur when > 50% of cholinesterase is inhibited.
- RBC cholinesterase is considered true while plasma one is called pseudo cholinesterase.
- RBC cholinesterase is more accurate as Plasma cholinesterase declines more rapidly.
P-nitrophenol test: More helpful in parathion poisoning.
- P-nitrophenol is a metabolite of some OPCs and is excreted in the urine. It can also be performed on vomitus or gastric contents.

Therapeutic Poisons 1 (Barbiturates, Diazepam, and Tranquilizers)

Barbiturates: Used as sedatives, hypnotics, anticonvulsants, anesthetics and tranquilizers.
Barbituric acid (Malonyl Urea): A combination of Urea and Malonic acid.
Mode of action: Depressant effect on the C.N.S.and affect the Cardiac and Respiratory centers. Death usually occurs due to respiratory failure.

Routes of Excretion

Detoxicated and excreted by the LIVER.
Excreted by the KIDNEYS.
Contraindicated in cases of impairment of Liver or Kidneys.

Mild Intoxication - Grade I

Patient is drowsy or asleep, readily aroused by calling his name loudly or by shaking him.
Slow thinking, mild disorientation, variation of mood, impairment of judgment, slurred speech, ataxic gait and Nystagmus.
Reflex activity and vital signs are not affected.

Moderate Intoxication - Grade II

Follows 5-10 times the oral hypnotic dose.
State of consciousness is more severely depressed, with depressed or absent deep reflexes and slow but not shallow respiration.
Corneal reflexes are retained with occasional exceptions.
Patients can be aroused by vigorous manual stimulation, when awakened, he is confused and dysarthric and after a few moments he drifts back into unconsciousness.

Severe Intoxication - Grade III

Ocрurs with ingestion of 15-20 times the oral hypnotic dose.
Patient can not be roused by any means.
Respiration is slow and shallow or irregular and pulmonary edema and cyanosis may be present.
The deep tendon reflexes are absent.
Usually patients show no response to plantar stimulation.
Corneal reflex is absent, unless the patient is severely asphyxiated
In early hours of Coma, there may be a phase of rigidity of limbs, hyperactive reflexes, ankle clonus extensor plantar signs, the temperature is subnormal the pulse thready and rapid and blood pressure at shock levels i.e.decreased.

Long Acting Barbiturates

Effect lasts from 1 to 8-10 hours.
F.D. 2-4 GMS.

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Description

This quiz explores the various types of mechanical asphyxial deaths, including suffocation and hanging. It covers key concepts such as the differences between complete and incomplete hanging, along with typical and atypical hanging scenarios. Understanding these classifications is essential for a comprehensive study of asphyxial deaths.