Dr.I.B.GD Surya Putra P, SpFDepartment of Forensic MedicineFaculty of Medicine, Gadjah Mada University

Definition of asphyxiaCauses of asphyxiaPhase of asphyxiaAppearence /clasiccal signs of autopsyTypes of asphyxia

Term asphyxia mean lack of oxygenEtymologically the word means absence of pulsationA condition where the cells or organs did not receive oxygen.The condition can be partial (hypoxia) or total (anoxia).

There are three causes of asphyxia :Natural diseaseTrauma (mechanical)Toxic conditions

DyspneuConvulsionApneuParalyseALL PHASE NEED 45 MINUTE

1. CYANOSIS2. PETECHIAE HAEMORRHAGES3. VISCERAL CONGESTION4. FLUIDITY OF BLOOD

Mean dark blueThe colour of soft tissue or skin change to blue or purple. And usually we look In the lip and under the nail.However becomes observable until at least 5 g of reduced hemoglobin per 100 ml.

Pinpoint hemorrhages produced by ruptured of small vessels, predominantly small venules.Size from a tent of millimetre to about two millimetre. Rupture is caused by sudden over distention or increases in intravascular pressure.It is classically seen in the conjunctivae and sclerae (strangulation).It often known as tardiev spot

It is due to obstructed venous return and capillovenous congestion.There is dilatation of the vessels and stasis of blood.

It is due to increased activity of fibrinolysin.

Can be group into three categories:SuffocationStrangulationChemical asphyxia

There are six general forms :Entrapment/environmental suffocationSmothering (pembekapan)ChokingMechanical asphyxiaMechanical asphyxia combined with smotheringSuffocating gases

It is caused by inadequate or gross deficiency of oxygen in the environment.But it is not due to by suffocating gases.In this case volume of oxygen was 9.6%It caused by fungus-like organisms ( for enviromental)These death are almost accidental in nature.

It is caused by the mechanical obstruction or occlusion of the external airways, i.e., the nose and mouth.These death are usually either homicide or suicide, very rarely accident.

It is caused by obstruction within the air passages.The manner of death can be natural, homicide, or accident.The diagnosis of choking death is made at autopsy when the airways is found occluded (adanya saluran napas yang tertutup).If the material in oro-pharynx is choking, if laryngo-pharyngx is called Gagging.

This condition, if there is pressure on the outside of the body prevents respiration.Divided into three types :Traumatic asphyxiaPositional asphyxiaRiot-crush or human pile death

Traumatic asphyxia:It occurs when a heavy weight press down on individuals chest or upper abdomen.Positional asphyxia :It occurs when the position of the bodies trapped(terperangkap) in restricted space. (uu ranga tagepe)Riot-crush :It occurs in riots, when the chest is compressed by stampeding people piling on top each other.

It is a combination of both these entities.An accidental form is overlay, where an infant is placed in bed for the night with either an adult or a larger child.

This condition is caused by inert gases such as carbon dioxide and methane.The gases makes reduction of atmospheric oxygen.

It is characterized by closure of the blood vessel and air passages of the neck as a result of external pressure on the neck.They are three forms :HangingLigature strangulationManual strangulation

In hanging, there is compression or constriction of the neck structure by noose or other constricting band tightened by the weight of the body. There may be either complete or incomplete suspension of the body.Commonly, hanging is suicide. Accidental hanging is uncommon and homicidal hanging very rare.

HOMICIDE :Complete supension : the distance between foot an floor is farVictim : there is another woundsScene : UntidySUICIDE :The distance between foot and floor is nearVictim : just one wound in the neckScene: Tidy

The pressure on the neck is applied by a constricting band that tightened by a force other than the body weight.All cases are homicides.

It is produced by pressure of the hand, forearm, or other limb against the neck, compressing the internal structures of the neck.All cases are homicide.

Principally caused by hangingTransitory anoxia is intentionally induced to enhance sexual arousement produced by masturbation.Loss of control, and accidental death occur.Such deaths are rare, with the victim always a male, only a few cases involving female.Typically found in a private area, sometimes wearing female clothing, erotic literature, sexual paraphernalia, and mirror

This condition occur due to chemical substance.In chemical asphyxiants, the most common encountered by medical examiner is carbon monoxide, and cyanide.

The example of signs of asphyxia

Ptechie

Cyanosis

Congestion in the face

Congestion in the brain

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