Traumatic Asphyxia Research Articles

A forensic overview of deaths in mountainous terrain.

Deaths at high altitudes may arise from a range of quite disparate entities including trauma (e.g. falls), environmental factors (e.g. hypothermia and hypoxia), and pre-existing medical conditions (e.g. coronary artery disease). Unique conditions include high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) which may contribute to lethal mechanisms or precipitate a traumatic event. Forensic issues that may arise in these cases are logistical problems due to remote locations, sometimes with failure to find a body, delay in discovery and/or repatriation, prior local autopsies being performed with embalming, and the non-specificity of pathology markers. Traumatic deaths involve blunt force impacts, falls, suffocation, crush asphyxia and hypothermia. The assessment of cases requires careful integration of the autopsy findings with the medical history of the decedent and an accurate description of their behaviour in the hours leading up to death.

Positional Asphyxia: Remains Hard to Diagnose?

Positional asphyxia is a type of asphyxia where the position of an individual compromises the ability to breathe. It is commonly caused by accidents due to alcohol or drug intoxication, diseases, and/or being in a confined space. In this study, the authors reviewed autopsy cases at their institute over the past 5 years where positional asphyxia is suspected as a contributing factor or cause of death. The autopsy cases (n=24) were divided into three groups: positional asphyxia was the cause of death (n=15); unknown cause of death but positional asphyxia was considered (n=4); and positional asphyxia was suspected to be a contributing factor (n=5). All cases of group A included postures that could interfere with breathing, but the typical jackknife or head-down postures were seen in approximately half of the cases; “classic signs of asphyxia” were also observed in approximately half of the cases. They shared features such as high blood alcohol concentration, therapeutic levels of drugs, various disease, minor head trauma, and morbid obesity; however, no definite diagnostic criteria have been established for forensic practice. Positional asphyxia is a form of mechanical asphyxia which must be differentiated from traumatic asphyxia. In addition to a complete autopsy, thorough laboratory tests and understanding of the circumstances of the case and the situation at the death scene are required for diagnosis. Special attention is required for the diagnosis of special types of positional asphyxia such as death during institutional restraint or prone restraint.

TRENDS OF ASPHYXIAL DEATHS AND ITS ASSOCIATION WITH VARIOUS DEMOGRAPHIC FACTORS REPORTED TO FORENSIC MEDICINE DEPARTMENT PESHAWAR; AN AUTOPSY-BASED RETROSPECTIVE STUDY

Objectives: To find the frequency of reported asphyxial deaths to gender and pattern of injury reported. This study also intended to identify the causes and the association between age, area, and gender of the deceased with sexual assault-related asphyxial deaths. Methods: A retrospective chart review was conducted at the Department of Forensic Medicine and Toxicology Khyber Medical College Peshawar from 1st July 2018 to 30th June 2023 (5 years data). All the subjects who died due to asphyxia and were presented for autopsy at the department were included in the study. Cases with incomplete documentation and those referred from other districts were excluded from the study. Results: Of the total 187 subjects, 66.8% (n=125) were males and 33.2% (n=62) were females with male to female ratio of 2:1. In the data, 57.2% (n=107) belonged to urban areas and 42.8% (n=80) were of rural areas. In total subjects, 88.8% (n=166) had immediate deaths, 6.4% (n=12) had delayed ones, and 4.8% (n=9) were undetermined. The most prevalent type of asphyxia was mechanical 113 (60.4%). The most common cause of asphyxia death was found to be hanging at 34.22%. However, of the 187 subjects, 5.3% (n=10) had intoxications, of which 1.6% (n=3) had tetrahydrocannabinol (THC), carbon monoxide (CO) and morphine poisoning each and 0.5% (n=1) had methamphetamine poisoning. Conclusion: Our study concluded that asphyxial deaths were more prevalent in males in the middle-aged group. Asphyxial deaths were found more in urban areas than in rural areas. Mechanical asphyxia was the most common type of asphyxia while hanging was the most common pattern. Key words: asphyxia, tetrahydrocannabinol, mechanical, traumatic, sexual, iatrogenic, and chemical asphyxia.

TRAUMA AND HANGING- AN UNUSUAL CASE OF COMPLICATED SUICIDE

Suicidal deaths are very frequently encountered by forensic experts in day-to-day practice. Here, we shed light on an unusual complicated suicide case, with features of hanging, head trauma and traumatic asphyxia. Allegedly, a dead body of a 65 years old man was found stuck in a shaft between the elevator and a wall, in a multistorey building, with ligature material placed around his neck. The ligature material was torn in two parts and the other part was found tied over the railing upstairs, in proximity to the elevator shaft, in front of his room. Suicide notes were found with the body. During the autopsy, two loops of faint ligature marks were present on the neck and on further exploration, extravasation of blood was present over the strap muscles of neck and carotid sheath. Upper part of the body was congested and there was a clear line of demarcation. Head injury was also present with skull fractures and cerebral haemorrhages. Signs of asphyxia were seen on the internal organs. This case, illustrating a peculiar pattern of injuries is reported for future reference of pathologists to help in identifying and anticipating such injuries in similar cases of suicide.

Dilemma of the General Surgeon in a Medico-Legal Autopsy of a Case of Traumatic Asphyxia: A Unique Case Report

The ability to perform medicolegal autopsy does not necessarily give a registered medical practitioner the expertise over it which is a major setback in solving medicolegal cases. Manner of death is very much important to decide as like cause of death and time since death for the proper disposal of justice to the dead. Traumatic asphyxia is a type of mechanical asphyxia, where respiration is prevented by external pressure on the body, at the same time inhibiting respiratory movements and compromising venous return from the head. Here we present a case of traumatic asphyxia where a general surgeon who conducted the autopsy could not be convinced by the police investigation that tractor accident was the cause for which the deceased succumb to death without any external & internal injuries and meanwhile got confused with the findings in the body suspecting it to strangulation death which was finally resolved by the opinion of the subject expert.

Thoracic trauma in children.

Isolated thoracic trauma is rare in children. Because of their small body size, the trauma often also affects other spaces, such as the abdomen and head, and these coexistences significantly increase the rate of mortality. However, in isolated thoracic traumas, the children can quickly recover if they can survive the initial period of trauma. Pediatric thoracic trauma cases can have a different clinical course compared to adults due to the unique anatomic and physiologic properties of children's thoracic cages. Their ribs are nonossified and are very elastic, and therefore, as their ribs can sustain significant deformation without breaking, some significant intrathoracic injuries can be overlooked. In this review, the most common thoracic injuries, including pulmonary contusion, hemopneumothorax, pulmonary laceration, rib fractures, flail chest, tracheobronchial injuries, traumatic asphyxia, and other less common mediastinal injuries are discussed in detail in regard of clinical presentation and management.

TEN YEARS RETROSPECTIVE AUTOPSY STUDY OF THROTTLING AND TRAUMATIC ASPHYXIA

Objectives: The objectives of the study were to assess the characteristics of wounds on the body if present and to study the effect of constriction externally as well as internally on the underlying structures of the neck in throttling and traumatic asphyxia. Methods: Collection of data was done from the record of the autopsies conducted of cases of traumatic asphyxia and throttling among the violent asphyxial deaths in the mortuary associated with the Department of Forensic Medicine and Toxicology, Government Medical College, Amritsar, during the past 10 years from January 1, 2006, to December 31, 2015. Results: Among the violent asphyxial deaths studied, 5 (1.23%) cases studied were of throttling, 4 (0.98%) cases were of suffocation, and the least common was traumatic asphyxia for which only 3 (0.74%) cases were studied. Out of 5 cases of throttling, mechanical injuries were present in 4 (80%) cases, out of which bruises were seen in 1 (20%) case, while abrasions in combination with bruises were seen in 3 (60%) cases. Among the 3 (100%) cases of traumatic asphyxia, contusion of strap muscles, contusion of sternocleidomastoid, and contusion of subcutaneous tissue of the neck were present in all 3 (100%) cases. Regarding the time since death, the majority of cases of throttling and traumatic asphyxia 4 (50%) cases have 12 to 24 h, followed by two each (25%) have 24 to 36 h and 3 to 7 days. Conclusion: Knowledge of these structures is necessary for the consistent diagnostic challenges associated with throttling, strangulation, and other forms of neck compression.

Traumatic asphyxia in the young: report of two cases and literature review

BackgroundTraumatic asphyxia, also called masque ecchymotique, Ollivier’s syndrome, and Perthes syndrome, is a rare but serious form of chest trauma described for the first time by Ollivier in 1837. The purpose of this study is to report our experience with two cases of traumatic asphyxia and discuss their management in view of the relevant literature.ResultsDuring a 6-year period, the author treated 2 cases of traumatic (crush) asphyxia in a local teaching hospital. The two patients were males, aged 20 and 30 years and were crushed beneath their vehicles. The presenting symptoms and signs were irritability, dyspnea, cervicofacial cyanosis, petechiae, and sub-conjunctival hemorrhages. The second patient suffered multiple rib fractures, hemopneumothorax, pulmonary contusion, vertebral fracture, and paraplegia. Negative surgical exploration for suspected cardiac tamponade was performed in the first case, while the second was managed conservatively.The first patient survived whereas the second succumbed because of the associated injuries.ConclusionsDue to its widespread lesions, traumatic asphyxia should be looked upon as a systemic syndrome. Timely accurate diagnosis and supportive treatment save the majority of patients with traumatic asphyxia. In this rare syndrome, death may result from asphyxia secondary to thoracic compression or from the associated injuries.

Severely Elevated Intraocular Pressure Following Traumatic Asphyxia: A Case Report

BackgroundTraumatic asphyxia is a syndrome caused by a sudden pressure rise in the chest caused by crushing injury of the thorax or upper abdomen. It is associated with a variety of thoracic injuries, neurological symptoms, and ocular complications. Case ReportWe report an unusual case of traumatic asphyxia complicated by severe, sight-threatening, elevation in intraocular pressure. Why Should an Emergency Physician Be Aware of This?After initial stabilization, the treatment of patients with traumatic asphyxia is supportive and is mainly directed toward the accompanying injuries and complications. A complete and prompt ophthalmologic examination, including tonometry, should be an integral part of the secondary survey. This is particularly important in patients who cannot report visual impairment, such as children or unconscious patients.

An epidemiological retrospective profile of medico-legal autopsy cases reported at a tertiary care center in Dhulikhel, Nepal

Autopsy is a systematic scientific examination of dead body that helps in manifesting the information about the cause of death in case of an unnatural death. Medico legal autopsy profiling helps to understand the nature of casualties, it helps to assess the social and economic profile for understanding the nature of crime in particular area, helps to address the demographic needs according to the mortality statistics specific to that region and helpful to identify the need necessary to take preventive measures to stop the crime or unnatural deaths by means of spreading awareness and psychological course. This study aims to analyses the pattern of autopsy cases with manner and various causes of death which was conducted in a tertiary level hospital. This is a retrospective study conducted over a period of one year (Oct 2020 to Oct 2021) at Dhulikhel hospital, Nepal. During the study period on one year, a total of 258 cases of medicolegal autopsies were performed at Department of Forensic Medicine and Toxicology. Out of the 258 cases analyzed maximum incidence of the postmortems were reported in the age group of 43.80% was reported from 20 to 39 years aged group which are the most productive years in one’s life. The maximum incidence of the postmortems was reported in the male population of 70.54% compared to the female population (29.46%). Our strongest conclusion is that male/female differences in medicolegal autopsies are highly dependent on historical time and geographic location. The maximum incidence 32.56% was reported within 6 – 12 hours’ time group and minimum incidence 12.02% was reported within 0 – 6 hours’ time group. The maximum incidence 48.06% was reported from Suicide group and minimum incidence 6.20% was reported from Homicide group. The maximum incidence 33.72% was reported by Hanging group and minimum incidence 0.39% were reported from Choking and Traumatic Asphyxia groups during the medicolegal autopsies, , , , ,

A retrospective study of 51 pediatric cases of traumatic asphyxia

BackgroundTraumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.MethodsScanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.ResultsThe average age of patients was 5.3 ± 2.9 (1.3–13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0–100.0%), 25 (49.0%, CI 34.8–63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8–70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6–20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4–88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.ConclusionTA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.

Gua Sha, An Asian Traditional Therapy That Could Mimic Physical Injury

Gua Sha is a traditional Asian medicine with different names in many Asian countries. It is a treatment to scrape the petechiae of the skin with ointment. It has generally been administered to patients with upper respiratory infections, heat syndrome, and pain. Herein, we report the case of a 31-year-old Cambodian man who was found dead at a farm accommodation. During the autopsy, multiple linear intradermal hemorrhages without subcutaneous damage were observed in the upper chest and both shoulders. The cause of death was sudden unexpected nocturnal death syndrome because he was a young Asian man who died while sleeping without specific findings. Since it is an unfamiliar traditional medicine in Korea compared to other Asian countries, forensic officers without background knowledge about Gua Sha initially suspected that he was severely assaulted or pressed against a particular object enough to cause crush asphyxia. Because of the difficulty of going to the hospital during the coronavirus disease 2019 pandemic, Gua Sha was used to treat headaches and mild fever. Therefore, this case shows that understanding the culture of other countries could be helpful for investigations especially with the increase of multicultural families in Korea.

Deaths due to suffocation in an oxygen deprived environment onboard a marine vessel – A case report

Suffocation deaths may be due to mechanical obstruction of the airways such as smothering and choking, restriction of respiration from traumatic and positional asphyxia, or from a lack of environmental oxygen. The latter may be due to entrapment in a nearly or completely air-tight container, or from consumption or replacement of the environmental oxygen by other means. Enclosed spaces onboard marine vessels are potential workplace hazards due to consumption of oxygen from rusting of the walls. Autopsy findings are typically non-specific.

A Case of Fatal Asphyxia by a Barbell during a Bench Press

The bench press is a widespread form of weight training with few scientific reports on its associated fatalities. We herein report a case of an individual performing bench press training who was found deceased in a supine position on the bench with the shaft of the barbell resting on his neck. The bench press safety bars were set at bench height. On the basis of the postmortem computed tomography imaging and the autopsy, the cause of death was determined to be fatal traumatic asphyxia caused by a cervical compression. We wish to highlight the importance of correctly using safety devices during weight training as well as the need for developing and disseminating safe equipment that is not dependent on the manner of use. We also wish to highlight the need for a form of legal regulation on the design of devices.

Brachial plexus paralysis associated with traumatic asphyxia

Traumatic injuries are the most common cause of brachial plexus lesions in children and adults. There are many causes of brachial plexus injuries such as accidents, falls and prolonged pressure. Traumatic asphyxia (TA) is a rare but serious clinical syndrome. Rarely, brachial plexus lesion may develop after TA and it is extremely rare in children. The cause of brachial plexus injury in patients without posttraumatic nerve root avulsion has not yet been fully explained. In this case report, we present the case of a child with neurological damage following TA which is very rare in the literature.

Accidental Deaths Involving Trees: Professional and Nonprofessional Woodcutting and Tree Failures With Autopsy Findings.

We examined all deaths in Connecticut involving tree mishaps (struck by a tree/tree limb, injuries associated with tree removal operations). Records of the Connecticut Office of the Chief Medical Examiner including autopsy, toxicology, and investigators' reports of deaths from 2004 to 2019 were reviewed. All underwent autopsy examination.There were 64 fatalities, with ages ranging from 4 to 90 years (mean, 50 years). The causes of death involved the following: 56 blunt injury (primary site: 25 head, 13 multiple locations, 11 torso, and 7 neck), 5 traumatic asphyxia, 2 electrocution, and 1 chainsaw injury. Deaths were classified into 3 groups: 21 nonprofessional woodcutters, 19 professional woodcutters, and 24 tree failures. Among all woodcutters (100% men), impact by a falling tree/limb (78%) was the most common fatal event, and the most common lethal injury site was the head (45%). For tree failures, 58% involved storm/high-wind events, whereas 42% were spontaneous. Of the tree failure events, 58% involved motor vehicles, with most (86%) occurring while driving. Ethanol was detected in 6 decedents with blood concentrations ranging from 0.02 to 0.19 gm%, of which 4 were nonprofessional and 2 were professional woodcutters. There were some seasonal differences among the 3 groups.Overall, fatalities of nonprofessional woodcutters, compared with professionals, were more likely to involve an older man (58 vs 40 years), working alone (67% vs 11%), and under the influence of ethanol (19% vs 11%) in late summer-autumn who dies of blunt head trauma from a falling tree or tree limb. Aggressive tree control management along highways has been used to attempt to decrease storm-related fatalities.

Perthes Syndrome after Roll-Over Trauma

Roll-over trauma and associated traumatic entrapments frequently result in serious polytraumatisation. In rare cases, severe extrathoracic compressions and a protracted entrapment period can lead to Perthes syndrome, also known as traumatic asphyxia. The Perthes syndrome manifests itself by a triad of craniocervical cyanosis, facial petechiae and subconjunctival haemorrhages, enabling a rapid diagnosis based on these typical clinical features. In addition, a contusion of the heart, lungs or even the liver may occur as well as neurological and other ophthalmological complications. An early identification of this condition, the elevation of the upper body to allow adequate venous drainage in addition to ensuring sufficient oxygenation are essential for optimal therapy. In general, no long-term complications are to be expected for Perthes syndrome. The stasis usually disappears completely within a few months.

Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia: A Preliminary Study.

Muscular hemorrhages around the scapula that are caused by upper extremity motion are rarely reported in cases other than drowning. We examined differences in the frequency of muscular hemorrhages around the scapula and stratified them by the cause of death. Muscular hemorrhages were mostly noted in cases of drowning (118/185, 63.8%), followed by cases of asphyxia (23/44, 52.3%). In addition, muscular hemorrhages around the scapula were found in cases of ligature strangulation (8/11, 72.7%), manual strangulation (2/3, 66.7%), choking (11/14, 78.6%), and traumatic asphyxia (2/2, 100%). Muscular hemorrhages were not found in cases of hanging or environmental suffocation, possibly because of the short time interval preceding the loss of consciousness. The distribution of muscular hemorrhages was similar in choking and drowning cases. Muscular hemorrhages due to strangulation were mainly unilateral, whereas those due to choking and drowning were mainly bilateral. During all types of asphyxia, muscular hemorrhages around the scapula were considered to be the result of conscious, active upper extremity motion. Because the frequency and laterality of muscular hemorrhages around the scapula differed based on the type of asphyxia, our findings provide insights into the manner of asphyxia that could be used to aid in the identification of homicidal hangings.

Study of external and internal injuries to the neck structure in cases of hanging

Introduction: Asphyxia could occur in various situations like: Traumatic asphyxia, Hanging, Choking, Smothering, Strangulation, poisoning, etc. There are both external and internal general features to diagnose fatal asphyxia macroscopically such as: a) External (i) ligature mark (ii) congestion, cyanosis & petechial hemorrhages. b) Internal – fluidity of blood, dilatation of right chamber of heart and visceral congestion. Materials and Methods: An observational Cross sectional study was carried out in Department of Forensic Medicine & Toxicology, Santosh Medical College, Ghaziabad. A total 58 cases of fatal neck compression were included in this study during. All the cases with alleged history of fatal neck compression were included in the study, except where the dead body was severely decomposed, that would effect the observation of findings. In study the aim was to find out the different associated lesions, injuries / fracture of the organo-complex of the larynx, bleeds in the tongue, hemorrhage in the tonsils and tonsilar beds. Results: Majority cases of hanging were seen in young adult age group of 20 ± 30 years. The overall male : female ratio in cases of hanging was 11:1. Majority cases of hanging were suicidal. Neck compression and hanging were seen between time interval of 6 + AM to 12 noon. Congestion of the face was observed in 60.86%. Hemorrhage in Sub-conjunctiva, strap muscle, tongue, epiglottis and tonsil were seen in 13%, 23.91%, 13.04%, 20% and 15.21% cases respectively. Hyoid bone fracture was present in 13.04% while thyroid cartilage fracture was present in 4.34%. Conclusion: According to the present study hanging is more common in young adults mostly suicidal in nature. congestion of face is most significant external feature in hanging while tonsillar heamorrage is significant internal feature. Keywords: Hanging, Asphaxia, External neck injury, Internal neck injury, Ligature mark.

Traumatic asphyxia successfully treated with jidabokuippo

ABSTRACTCaseA 29‐year‐old man presented with traumatic asphyxia associated with symptoms of ecchymosis over the face, conjunctival hyperemia, and a blood‐red puffy face. Jidabokuippo (JDI), a traditional Japanese Kampo medicine to alleviate static blood™1 was administered. The blood‐red puffy face improved dramatically.OutcomeSymptoms improved after treatment with JDI.ConclusionJDI can be used for the management of ecchymosis and swelling following traumatic asphyxia.