ORIGINAL ARTICLE Medico Legal Autopsies of Mechanical Asphyxial Deaths Carried Out in Allama Iqbal Medical College Lahore during the Year 2013: A Retrospective Study FARHAT SULTANA1, SAEED AHMAD MALIK2, SOBIA AMIR3, MOHAMMAD MOHSIN KHAN4, IRFAN QADIR5 KAMRAN ISHAQ6 ABSTRACT Background: This study was on all mechanical asphyxias deaths whish were received for autopsies in Allam Iqbal Medical College Lahore during the year 2013.The objective was to be carried out a retrospective analysis of 32 autopsies on mechanical asphyxias deaths. The relationship of age and gender was focused. Methods: Total medico legal autopsies which were carried out at Forensic Medicine Department at AIMC Lahore were 221 during the year of 2013. Out of these, 32 were the cases of mechanical asphyxias deaths which were selected for this study. The documents scrutinized for this purpose were autopsies reports , police papers and hospital history charts. Results: Out of 221 autopsies cases, 32 cases were of mechanical asphyxias deaths. 22 deaths were strangulated (Homicidal), hanging one, drowning nine and traumatic were found zero. Conclusion: Out of 221 autopsies cases, 32 cases were of mechanical asphyxias deaths. Asphyxias deaths were mostly homicidal and male & female were equally suffered. Keywords: Allama Iqbal Medical College (AIMC), Asphyxia, Homicidal INTRODUCTION No specific autopsy findings; may see signs of Choking caused by a mechanism that prevents lung struggle (contusions/abrasions on face and mouth) in ventilation. This mechanism can be internal (by adult victims foreign bodies or by drowning) or external (hanging, Choking: blockage of internal airways strangulation, crushing, facial flushing, burial). Accidental: large food bolus in airway, usually General: Asphyxia is the lack of oxygen supply to intoxicated adults, elderly with neurodegenerative tissues/organs disorders, young children Types of asphyxia include suffocation, strangulation Homicidal: gag placed in oropharynx. Must find food / hanging, positional / mechanical / traumatic bolus or other item in airway, or have report of its Suffocation: Failure of oxygen to reach the blood. prior removal, to confirm choking. Environmental: Smothering: obstruction of nose and mouth inadequate oxygen in atmosphere; also called Accidental: infant wedged between mattress and entrapment. Due to oxygen displacement by other wall gases (in silo), lack of oxygen in small enclosed Suicidal: placing plastic bag over one's head and space (child trapped in refrigerator). No specific tightening around neck autopsy findings Homicidal: duct tape across nose and mouth, Strangulation / hanging: External pressure on neck covering face with pillow, closing off nose and mouth resulting in compression of blood vessels and of young child with hand occasionally airway Overlay: infant death due to parent onto child in bed; Strangulation: neck compression due to something involves smothering and mechanical asphyxia other than the victim’s body weight, such as manual ----------------------------------------------------------------------- 1 compression or ligature tightened by assailant; Assistant Professor Forensic Medicine, Allama Iqbal usually homicidal Medical College Lahore. 2 Ligature strangulation: the ligature mark on the Professor Forensic Medicine, Amna Inayat Medical College Lahore. neck is usually horizontal. If homicidal (most 3Assistant Professor Forensic Medicine, Amna Inayat common), may be signs of struggle (abrasions / Medical College Lahore. lacerations and fingernail marks on neck) Suicidal 4Professor Community Medicine, Amna Inayat Medical strangulations can occur if individual ties cord or College Lahore. other ligature around neck with some sort of locking 5 Professor Anatomy Amna Inayat Medical College Lahore device. Accidental strangulations can occur if scarf or 6Assistant Professor Sociology, BZU, Multan Correspondence to Dr. Farhat Sultana 392 P J M H S Vol. 10, NO. 2, APR – JUN 2016 Farhat Sultana, Saeed Ahmad Malik, Sobia Amir et al necktie becomes trapped in doorway or other breathing for an extended period of time. Asphyxia mechanical device can cause coma or death. Hanging: Neck compression due to ligature around In 2013 about 1.6 million cases of unintentional neck, with at least a portion of body weight being suffocation occurred1. The word asphyxia is used to tighten ligature. Usually suicidal; can be from Ancient Greek α-"without" and sphyxis, accidental (child trapped in cord) or homicidal. "squeeze" (throb of heart)2 Ligature mark on neck is oblique, with highest point Causes: Situations that can cause asphyxia include usually at back of head, where ligature knot is tied. but are not limited to: the constriction or obstruction This is in contrast to strangulation (usually homicide), of airways, such as from asthma, laryngospasm, or where ligature mark is usually horizontal around simple blockage from the presence of foreign neck. Ligature mark may be absent if soft fabric (i.e., materials; from being in environments where oxygen bed sheet) used as ligature. May see pattern is not readily accessible: such as underwater, in a markings in ligature mark that correspond to patterns low oxygen atmosphere, or in a vacuum; on ligature (i.e., weaved fabric, metal chain). 4 environments where sufficiently oxygenated air is pounds of pressure required to occlude jugular veins present, but cannot be adequately breathed because (preventing venous drainage of head) and 5-11 of air contamination such as excessive smoke. pounds to occlude carotid arteries. Loss of Other causes of oxygen deficiency include but are consciousness occurs in 10-15 seconds; death within not limited to: 3-5 minutes. Fractures of hyoid bone, tracheal Acute respiratory distress syndrome: Carbon cartilage, cervical vertebrae are rare; hemorrhage in monoxide inhalation, such as that from a car neck muscles also rare. Hyoid fractures are more exhaust and the smoke's emission from a lighted common in older victims, because hyoid bone is cigarette: carbon monoxide has a higher affinity than cartilaginous and incompletely ossified in children oxygen to the hemoglobin in the blood's red blood and young adults. Injuries are more common if corpuscles, bonding with it tenaciously, and, in the struggle between decedent and assailant. In hanging, process, displacing oxygen and preventing the blood where body is completely suspended, autopsy may from transporting oxygen around the body show congestion and petechiae of lower legs due to Contact with certain chemicals, including blood pooling. May have no specific findings at pulmonary agents (such as phosgene) and blood autopsy agents (such as hydrogen cyanide) Positional / mechanical / traumatic asphyxia: Drowning Position of body or external pressure on chest Drug overdose prevent respiration Exposure to extreme low pressure or vacuum to Positional asphyxia: body is positioned in a way the pattern that restricts airflow Hanging, specifically suspension or short drop Twisting or compression of neck resulting in hanging. occlusion of oropharynx or trachea seen in Self-induced hypocapnia by hyperventilation, as intoxicated individuals or elderly persons who in shallow water or deep water blackout and the become trapped choking game Mechanical/traumatic asphyxia: External Ondine's curse, central alveolar hypoventilation compression of chest, preventing normal respiration. syndrome, or primary alveolar hypoventilation, a Example: vehicle collapsing on individual working disorder of the autonomic nervous system in under car. May have petechiae, face and upper chest which a patient must consciously breathe; congestion at autopsy although it is often said that persons with this Chemical asphyxia: gases that prevent oxygen disease will die if they fall asleep, this is not utilization at cellular level. Carbon monoxide, usually the case hydrogen sulfide, cyanide Respiratory diseases Sexual Asphyxia or autoerotic asphyxia: Sleep apnea Asphyxia or asphyxiation is a condition of severely A seizure which stops breathing activity deficient supply of oxygen to the body that arises from abnormal breathing. An example of asphyxia is Strangling choking. Asphyxia causes generalized hypoxia, Breaking the wind pipe. which affects primarily the tissues and organs. There Smothering: "Smother" redirects here. For other are many circumstances that can induce asphyxia, all uses, see Smother (disambiguation). Smothering is of which are characterized by an inability of an the mechanical obstruction of the flow of air from the individual to acquire sufficient oxygen through environment into the mouth and/or nostrils, for instance, by covering the mouth and nose with a P J M H S Vol. 10, NO. 2, APR – JUN 2016 393 Medico Legal Autopsies of Mechanical Asphyxial Deaths Carried Out in AIMC Lahore hand, pillow, or a plastic bag3. Smothering can be weight or force. An example of traumatic asphyxia either partial or complete, where partial indicates that includes cases where an individual has been using a the person being smothered is able to inhale some car-jack to repair a car from below, and is crushed air, although less than required. In a normal situation, under the weight of the vehicle4. Pythons, smothering requires at least partial obstruction of anacondas, and other constrictor snakes kill through both the nasal cavities and the mouth to lead to compressive asphyxia. In cases of co-sleeping asphyxia. Smothering with the hands or chest is used ("overlay"), the weight of an adult or large child may in