د/ عبد المنعم جودة مدبولى بسم الله الرحمن الرحيم Asphyxia د/ عبد المنعم جودة مدبولى دكتوراة الطب الشرعي و السموم الإكلينيكية, مدرس الطب الشرعي و السموم الإكلينيكية, استشاري علاج التسمم

Classical signs of asphyxia (A) External signs: 1- Congestion of face. 2- Edema of the face. 3- Cyanosis of the skin. 4- Petechial hges. 5- Prominent eye ball. 6- Hypostasis: well developed & dark blue. 7- Bloody forth: rupture of capillaries in air passage. (B) Internal Signs: 1- Visceral congestion. 2- Pulmonary edema & pulmonary hge. 3- Petechial hges: on pleura, epicardium, thymus in children (true Tardieu spots). 4- Silvery spots: shining grey spots under pleura seen by a hand lens.

لا نعتمد فقط على ال classical signs To diagnose asphyxia لا نعتمد فقط على ال classical signs Circumstances & scene of crime External exam: 1- Local signs ……. 2- Classical signs …….. 3-PM changes …. Internal exam: 1-Local signs 2- Classical signs ……… ± 3- Toxic. Lab.

Types of asphyxia تذكر أسباب الوفاة «3» Violent (Mechanical) (true) = Trauma الأختناق I. Suffocation الخنق II. Fatal pressure on neck الغرق III. Drowning Pathological (Medical) = Disease diphtheria, tumors, edema of the glottis, Anemia, lung & heart disease and poliomyelitis. Toxicological (chemical) = Poison morphine, CO, HCN, and H2S مجازا» « = forms of anoxia or hypoxia

True asphyxia (Violent = Mechanical) Mechanisms of death of True asphyxia (Violent = Mechanical) (+/- Obstruction of air passage +/- Pressure) (a) Air access to lung (Hypoxia) (b) Blood supply to neck (Ischemia) (c) Sudden cardiac arrest (vagal inhibition) ص 137 رقم 3

P.M. picture of Hanging Vs Ligature strangulation DD Hanging Ligature External classical signs No classical signs (face is usually pale) EXCEPT in incomplete suspension ص 150 External classical signs of asphyxia except nerve mech. ص 154 External exam. Head: bent opposite to the knot. Tongue is swollen, black due to drying. Excessive salivation an indicator of ante-mortem hanging. Blood tinged fluid or bloody froth is sometimes seen in the nostril due to congestion in the lungs and pulmonary edema. Hypostasis: marked in the dependent parts (arms, legs) No external evidence of violence on the body except .... Signs of violence and struggles in case of homicide

If a simple slipknot : groove is completely encircles the neck. DD Hanging Ligature Local Findings (ligature mark): If fixed knot: does not completely encircle the neck, but slants upwards, an inverted V- shaped with the apex at knot. If a simple slipknot : groove is completely encircles the neck. Position of ligature mark: In 80% of cases, it is present above the thyroid cartilage, in 15% at the level and in 5% is present below the thyroid cartilage. Appearance of the groove: may be pale, yellowish or yellow brown and look like parchment. A thin line of congestion or haemorrhage will be seen above and below the groove at some areas. The width of the groove is about or slightly less than the width of the ligature material. A definite pattern of the ligature may be seen. Completely encircle neck, at level of thyroid cartilage or below. Incomplete if cloths. - It is horizontal but may be oblique.

1- Internal classical signs of asphyxia. DD Hanging Ligature Internal findings Tissues under the ligature mark: dry, white and glistening. Laceration, ecchymosis and rupture of the neck structures. Fractures of the hyoid bone and thyroid cartilage are rare (15-20%) below the age of 40 years due to elasticity and the mobility of the joints. If the fracture occurs, it usually found at the greater horn (outward fracture) due to backward compression of the bone against the vertebrae. - Fracture dislocation of upper cervical vertebrae with transaction of spinal cord in judicial hanging 1- Internal classical signs of asphyxia. 2- Internal signs on the neck: Haemorrhages in the muscles and soft tissues. - Fracture of hyoid bone, not common. (inward fracture).

Medicolegal importance of Hyoid bone Age and sex determination. Denotes the cause of death: inward fracture → throttling and strangulation due to force of compression . Outward fracture → hanging due to traction force DD :from joint fracture, edges are irregular ,bleeding at site of fracture. Diagnosis of heavy metal intoxication (Pb ,As, Sb).