Positional Asphyxia Research Articles

Organ distribution of diclazepam, pyrazolam and 3-fluorophenmetrazine

The organ distribution of 3-fluorophenmetrazine (3-FPM), pyrazolam, diclazepam as well as its main metabolites delorazepam, lormetazepam and lorazepam, was investigated. A solid phase extraction (SPE) and a QuEChERS (acronym for quick, easy, cheap, effective, rugged and safe) - approach were used for the extraction of the analytes from human tissues, body fluids and stomach contents. The detection was performed on a liquid chromatography–tandem mass spectrometry system (LCMS/MS). The analytes of interest were detected in all body fluids and tissues. Results showed femoral blood concentrations of 10 μg/L for 3-FPM, 28 μg/L for pyrazolam, 1 μg/L for diclazepam, 100 μg/L for delorazepam, 6 μg/L for lormetazepam, and 22 μg/L for lorazepam. Tissues (muscle, kidney and liver) and bile exhibited higher concentrations of the mentioned analytes than in blood. Additional positive findings in femoral blood were for 2-fluoroamphetamine (2-FA, approx. 89 μg/L), 2-flourometamphetamine (2-FMA, hint), methiopropamine (approx. 2.2 μg/L), amphetamine (approx. 21 μg/L) and caffeine (positive). Delorazepam showed the highest ratio of heart (C) and femoral blood (P) concentration (C/P ratio = 2.5), supported by the concentrations detected in psoas muscle (430 μg/kg) and stomach content (approx. 210 μg/L, absolute 84 μg). The C/P ratio indicates that delorazepam displays susceptibility for post-mortem redistribution (PMR), supported by the findings in muscle tissue. 3-FPM, pyrazolam, diclazepam, lorazepam and lormetazepam did apparently not exhibit any PMR. The cause of death, in conjunction with autopsy findings was concluded as a positional asphyxia promoted by poly-drug intoxication by arising from designer benzodiazepines and the presence of synthetic stimulants.

Positional Asphyxia after Falling to Backward in a Drunken State

Positional Asphyxia after Falling to Backward in a Drunken State

Traumatic asphyxia: A case report and literature review

Perthe's syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Crush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in literature, reporting usually poor outcomes. We reported a case of a 29-year-old male who sustained a severe crush injury to the chest due to fall of a heavy object.

Death due to knee-elbow position in a restricted area: positional - traumatic asphyxia? case report

Positional asphyxia which evolves out of a bodyÂ’s staying in an unusual posture, is a kind of hypoxia and anoxia that occurs as a result of -partially or completely- narrowing of respiratory passage. Crime scene investigation provides significant evidences and clues to enlighten on positional asphyxial deaths. This study aims to discuss the cause of death for the case which was found stuck in knee-elbow position in a restricted area due to external factor exposure. The victim was a 37-year-old male worker. It was thought that he had left on the slaughter house at the end of the shift in the evening but he was found in the following morning as restricted in a cattle knocking box. In the examination of the case, there was no traumatic or pathologic findings to explain the cause of death, except for the apparent finding of asphyxia. It was considered that the death in the case occurred due to positional asphyxia caused by external factor exposure related to restriction in knee-elbow position. As a conclusion, in order to elucidate the death reason and the manner of death, in addition to the findings of internal and external medical examination, evaluation of crime scene investigation and history are also important.

Positional asphyxia, the rare but fatal complication of nocturnal hypokinesia: A case report

Positional asphyxia, the rare but fatal complication of nocturnal hypokinesia: A case report

Forensic investigation of atypical asphysia

Smothering, choking, confined spaces, traumatic asphyxia, positional asphyxia, and other kinds of atypical mechanical asphyxia are not rare in forensic practice. However, these are not commonly well demonstrated in forensic monographs worldwide. The authors researched related works and literatures and summarized these with a view to contribute to the existing teaching resources and provide help to forensic practitioners who are involved in scene investigation and identification of such deaths.

Common Findings and Predictive Measures of Opioid Overdoses.

This research examines autopsy findings from fatal opiate/opioid intoxications in New Hampshire for cerebral edema, pulmonary edema, and urinary bladder distension in the interest of finding predictability of such cases. Autopsy reports of 150 decedents, between 20 and 40 years old, were reviewed. Subjects were divided into three groups as follows: 50 whose cause of death was opioid intoxication excluding fentanyl, 50 who died from fentanyl, and 50 who, lacking intoxication, died from cardiac issues, seizure disorders, or positional asphyxia as the control group. Autopsy reports were reviewed for cerebral edema, pulmonary edema, and urinary bladder distension. Pulmonary edema was present in 96% of those who died of fentanyl alone and in 94% of those who died of opioids excluding fentanyl. Cerebral edema occurred in 54% of decedents who died of opiates/opioids excluding fentanyl and 8% in those who died solely of fentanyl. Thirty-four percent of the fatal intoxications excluding fentanyl had bladder distension while only 16% of those who died of fentanyl intoxication. The control group found 30% had pulmonary edema, 2% had cerebral edema, and none had bladder distension. The triad occurred in 8% of intoxications and never in the control group. The results validated correlation between opioid intoxication and pulmonary edema, cerebral edema, and bladder distension. Cerebral edema and bladder distension suggest opioid intoxication, but arise less frequently in fentanyl intoxication. We hypothesize that fentanyl causes death more rapidly than other opioids leading to these results. Given the variations, we do not recommend reliance on postmortem computed tomography in lieu of autopsy to evaluate potential fatal intoxications.

A case of Positional asphyxia - The importance of Livor Mortis -

Positional(postural) asphyxia has been defined as asphyxia caused by unusual position of the body, leading to the inability toexpand the chest wall, which interferes with pulmonary ventilation, hence leading to respiratory failure. The diagnosis is usuallybased on circumstantial evidence in conjunction with excluding other significant underlying causes of death. In absence of thescene information, the diagnostic difficulties are evident because in the majority of such cases, the autopsy gives only negativeresults or reveals only slight signs of generic, nonspecific asphyxiation that are compatible with other, even natural, causes ofdeath. The characteristic distribution of postmortem hypostasis, and the stiffening of the body in that position were additionalconfirmatory evidence to that fact. The importance of this case report is attributed to the availability of hypostasis fixed in theundisturbed decedent that is extremely helpful in illustrating the cause and the manner of death.

Death due to Positional Asphyxia – a Case Report

Background : Positional asphyxia is virtually always an accident and is associated with alcohol or drug intoxication. In positional asphyxia individuals do get trapped in restricted spaces. Case Report: We are presenting a case of 26-years old young adult male, who was intoxicated with alcohol, positioned himself in such a way that it led to his death due to positional asphyxia. Conclusion: The positional asphyxia has been defined as asphyxia caused due to unusual position of the body which interferes with the breathing and thus pulmonary ventilation The cases of positional asphyxia are difficult to diagnose because of the absence of any specific external findings.

Sudden Infant Death

The association between Long QT syndrome (LQTS) and sudden infant death syndrome (SIDS) remains highly topical and even polarizing.1 Because the landmark Italian study of the QT interval and SIDS2 triggered extensive controversy,3,4 there has been a substantial and commendable effort to establish LQTS as one of the true causes of SIDS.5 The motivation underlying this effort is based on the fact that true LQTS is a potentially preventable cause of sudden death. Many questions, however, remain.6 Where and how does LQTS fit into the spectrum of SIDS? Have we reached the stage where we can describe a typical phenotype for SIDS because of LQTS? Is it conceivable that some SIDS victims die with contribution from a channelopathy genetic variant, rather than because of it in isolation? After SIDS, can we identify those cases that are more likely to have been LQTS and, therefore, warrant genetic testing? When should family clinical screening be undertaken?7 To facilitate clarity of academic discussion, research and clinical care, we suggest a paradigm shift in how to analytically view the LQTS–SIDS association. Over the years there have been multiple working definitions of SIDS including many contradictions.8–10 The definition includes the sudden unexpected death of an infant <1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history. In the most widely accepted definition, there is a graded classification based predominantly on the thoroughness of the autopsy investigation in excluding potential causes, and the possibility of positional asphyxia.10,11 Type 1 occurs between the ages of 21 days and 9 months in otherwise healthy, normal infants, …

Study of Violent Asphyxial Deaths in and around Warangal Region

A two year retrospective study was conducted by evaluating a total of 32 deaths due to mechanical asphyxia from 01-01-2013 to 31-12-2014, autopsied at MGM Hospital, Warangal. Analysis of the recorded data related to autopsy examination along with age, sex of the deceased, season and manner of death was done. Asphyxial deaths were 10.50% of total autopsies and number of males (67.96%) was more than females in a ratio of 3: 1. In our study commonest method of asphyxial death was hanging (80.60%), followed by drowning (8.3%), ligature strangulation (5.5%) and each case of Traumatic asphyxia (2.8%) and Postural asphyxia (2.8%). 21–30 years age group were more prone to violent asphyxial deaths (38.88%) and more cases were noticed in summer season (50.0%) constituting majority of suicidal cases (83.30%).

Iatrogenic Foreign Body in the Heart in Relation to Possible Malpractice and Its Consequences a Case Report

The paper presents the case of a 55-year-old man whose body was found at home at the foot of the stairs. The inspection of the body at the scene showed that the probable cause of the man’s death was positional asphyxia after falling down the stairs. The forensic autopsy revealed a 10-cm-long tip of a nephrostomy catheter. To determine the time and circumstances of the foreign body’s entry into the heart and its possible impact on the man’s death, the medical history was analyzed. It indicated that the piece of the catheter entered the circulatory system during surgery performed few years before man’s death. The results of the postmortem examination, taking into consideration the obtained medical information, excluded the foreign body in the right ventricle of the heart as a contributory cause of the man’s death.

Alterations of Ca(v)1.2 and 5-hydroxytryptamine in rat hearts after positional asphyxia

We investigated alterations of cardiac Ca(v)1.2 and 5-hydroxytryptamine (5-HT) associated with positional asphyxia. Male rats were divided into five groups: a control group with no restraint, group 1 restrained for 1 h, group 2 restrained for 2 h, group 3 restrained for 4 h, and group 4 restrained for 8 h. The rats that were restrained for 8 h ultimately suffered fatal asphyxia. After the restraint periods, the rats were sacrificed and immunohistochemistry was performed to evaluate the expressions of Ca(v)1.2 and 5-HT in the heart. Sections were analyzed by digital image analysis. Cardiac expression of Ca(v)1.2 and 5-HT proteins were significantly decreased by positional asphyxia in the rat, shown by integrated optical density (IOD) compared to controls. Our findings indicate that Ca(v)1.2 and 5-HT alterations could cause abnormal cardiac function, and the proteins investigated here may be useful for investigating the mechanisms underlying positional asphyxia.

Seats are not for sleeping

It is undisputed that car seats save lives. Like any other consumer item, however, they are only safe when used as directed. There have been recent disturbing reports of infants dying in car seats or other carrying devices. The current issue of The Journal contains an important report from Batra et al, which analyzes data from the Consumer Product Safety Commission. They identified 47 deaths of children < 2 years of age during a 4-year period. The deaths occurred while children were placed outside a car in a car seat (n = 31) or other infant sitting/carrying device (eg, strollers, bouncers). The analysis showed that more than one-half of the deaths were from strangulation because of straps not being secured appropriately. The others were from unrecognized positional asphyxia. The authors provide very specific, actionable advice that pediatricians should share with all their patients' parents. The advice boils down to: “Properly used car seats save thousands of infant lives. However, these and similar devices are not designed for unsupervised infant sleep!” Article page 183▶ Hazards Associated with Sitting and Carrying Devices for Children Two Years and YoungerThe Journal of PediatricsVol. 167Issue 1PreviewTo analyze reported mechanisms of injury and characterize risk factors for infants and young children ≤2 years of age who died in sitting and carrying devices. Full-Text PDF

Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger

To analyze reported mechanisms of injury and characterize risk factors for infants and young children ≤ 2 years of age who died in sitting and carrying devices. A retrospective review of deaths involving sitting and carrying devices (car seats, bouncers, swings, strollers, and slings) reported to the US Consumer Product Safety Commission between 2004 and 2008. Of the 47 deaths analyzed, 31 occurred in car seats, 5 in slings, 4 each in swings and bouncers, and 3 in strollers. The reported elapsed time between the last time a child was seen by a caregiver and found deceased varied greatly, with a mean of 26 minutes in slings; 32 minutes in strollers; 140 minutes in car seats; 150 minutes in bouncers; and 300 minutes in swings. The cause of death was asphyxiation in all cases except one. Fifty-two percent of deaths in car seats were attributed to strangulation from straps; the others were attributed to positional asphyxia. Infants and children 2 years of age and younger should be properly restrained and not be left unsupervised in sitting and carrying devices. Car seats should not be used as sleeping areas outside of the vehicle, and children should never be in a car seat with unbuckled or partially buckled straps. Infants in slings should have their faces visible and above the edge of the sling, should not have their faces covered by fabric, and their chins should not be compressed into their chests.

An Epidemiological Study of Suffocation Deaths In Twin Cities of South India

In spite of advancement in medical facilities, the end of life is inevitable. Suffocation deaths have increased over the years and are becoming a large group in medico legal autopsies. In such deaths, a detailed and meticulous autopsy plays a major role to solve the case, while the scene visit and collection of samples have their own significance. To analyse the recent trends such as manner, methods, motive etc., in suffocation deaths, a prospective study was conducted for two years period. 34 suffocation deaths were studied, which comprised 0.18% of all Forensic autopsies; 38.23% of the cases were aged between 21–30 years. Males constituted 67.63% of all the cases. The most frequent method of suffocation death was smothering (35.29%) followed by environmental and traumatic asphyxia (20.58%), choking (17.64%) and positional asphyxia (5.88%). The most common manner of suffocation was found to be accidental (67.64%). But in homicidal cases (29%), the common motive was domestic disputes. Only 30% of suffocation victims were found positive for blood alcohol.

Homicides due to positional asphyxia: two case reports

Homicides by positional asphyxia do not come up very often within forensic literature in contrast to other ways of asphyxia have been frequently described. This article describes two cases in which the autopsy findings of the external and internal examination, may suggest patterns for future studies and/or reference points for studying this kind of death. In addition, it could open discussion about an unfrequented topic in forensics. The analysis of this case report aims to understand positional asphyxia as a homicide method in order to shed light on such a complex and rare kind of death.

A case of complex mechanical asphyxia due to physical restraint and gagging in an obese man

Death from positional asphyxia by physical restraint takes place when the abnormal position of the victim's body compromises the process of respiration. Dying in a supine restraint position is rare. The term ''gagging'' describes the blockage of the internal airways by ramming certain objects into the mouth. Here, we report the case of a 47-year-old obese man who had been kidnapped and was found dead in a supine position with limbs bound together in the back and the mouth gagged with stick. Apart from a very low level of the drug estazolam, and mild trauma on the body surface, autopsy findings were unremarkable. There were no injuries or pathological findings to account for his death. The cause of death was certified as mechanical asphyxia following gagging and restraint in a supine position. The victim's obesity is a co-factor in hastening his death.

Deaths during apprehensions of agitated persons. A review of proposed pathophysiological theories

Abstract The pathophysiology of sudden death during apprehension remains largely unclear. The most frequently discussed mechanisms are excited delirium, positional asphyxia, metabolic acidosis, acute and chronic drug abuse, and autonomic instability. As in most areas of forensic medicine, much of the knowledge comes from case reports, which are of little use in understanding causality. Experimental studies of some aspects have been performed, and they show somewhat divergent results and interpretations. The aim of this review is to summarize the different proposed theories, and to point out important issues for further research.

Infant Deaths and Injuries Associated with Wearable Blankets, Swaddle Wraps, and Swaddling

To assess risks involved in using wearable blankets, swaddle wraps, and swaddling. This was a retrospective review of incidents reported to the Consumer Product Safety Commission between 2004 and 2012. A total of 36 incidents involving wearable blankets and swaddle wraps were reviewed, including 10 deaths, 2 injuries, and 12 incidents without injury. The median age at death was 3.5 months; 80% of the deaths were attributed to positional asphyxia related to prone sleeping, and 70% involved additional risk factors, usually soft bedding. Two injuries involved tooth extraction from the zipper. The 12 incidents without injury reported concern for strangulation/suffocation when the swaddle wrap became wrapped around the face/neck, and a potential choking hazard when the zipper detached. All 12 incidents involving swaddling in ordinary blankets resulted in death. The median age at death was 2 months; 58% of deaths were attributed to positional asphyxia related to prone sleeping, and 92% involved additional risk factors, most commonly soft bedding. Reports of sudden unexpected death in swaddled infants are rare. Risks can be reduced by placing infants supine and discontinuing swaddling as soon as an infant's earliest attempts to roll are observed. Risks can be further reduced by removing soft bedding and bumper pads from the sleep environment. When using commercial swaddle wraps, fasteners must be securely attached.