This document provides information on various types of asphyxia including mechanical, pathological, toxic, environmental, and miscellaneous causes. Mechanical asphyxia includes suffocation, hanging, strangulation, throttling, choking, and drowning. Hanging can be classified based on knot position and degree of suspension. Strangulation involves ligature or manual compression of the neck. Choking involves aspiration of a foreign body in the airway. Positional asphyxia involves abnormal body positioning preventing respiration. Drowning involves submersion in liquid leading to respiratory impairment. Autopsy findings for different types of asphyxia include petechiae, ligature marks, bone fractures, and fluid/bolus in airways.
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
FORENSIC MEDICINE BOOKS OF
REDDY
GOUTAM BISWAS
MAGENDRAN
OTHERS
TOPICS :-
COLD INJURY
HEAT INJURY
BURN INJURY
SCALDS
ELECTROCUTION
LIGHTENING INJURY
THIS IS ONE OF MY BEST AND FAVORITE PRESENTATIONS. IT WILL SURELY HELP YOU A LOT DURING YOUR EXAMS (PROF/OTHERS). IF YOU FIND IT HELPFUL THEN LIKE IT. MY EMAIL ID IS GIVEN ON THE 2ND PAGE OF THIS PRESENTATION, IF YOU WANT PRESENTATIONS ON OTHER TOPICS (ANY MEDICAL SUBJECTS) THEN MAIL ME. I WILL WORK ON IT LOT AND WILL BE TRYING TO SHARE WITH YOU GUYS...
THANK YOU
An account of strangulation, its types, mechanism, causes of death, post-mortom signs of death due to strangulation, fracture of thyroid cartilage and hyoid bone, medico-legal aspects of strangulation
A POWER POINT PRESENTATION BY DR. SANGEETA CHOWDHRY AND DR. SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
We saw the infamous 26/11 at Mumbai, India. We lost some brave-hearts. Hence, we look into the forensics behind firearm injuries. We shall also discuss the JFK assassination case in brief. I would recommend downloading the presentation and view it in power point 2010 or above to see all the effects flawlessly.
Thanatology
Types of transplants
Cause, Mechanism of Death
Manner of death
Anoxia
Signs of Death
Immediate Changes (Somatic Death)
Early Changes (Molecular Death)
Algor Mortis ......
Reference
FORENSIC MEDICINE BOOKS OF
REDDY
GOUTAM BISWAS
MAGENDRAN
OTHERS
TOPICS :-
COLD INJURY
HEAT INJURY
BURN INJURY
SCALDS
ELECTROCUTION
LIGHTENING INJURY
THIS IS ONE OF MY BEST AND FAVORITE PRESENTATIONS. IT WILL SURELY HELP YOU A LOT DURING YOUR EXAMS (PROF/OTHERS). IF YOU FIND IT HELPFUL THEN LIKE IT. MY EMAIL ID IS GIVEN ON THE 2ND PAGE OF THIS PRESENTATION, IF YOU WANT PRESENTATIONS ON OTHER TOPICS (ANY MEDICAL SUBJECTS) THEN MAIL ME. I WILL WORK ON IT LOT AND WILL BE TRYING TO SHARE WITH YOU GUYS...
THANK YOU
An account of strangulation, its types, mechanism, causes of death, post-mortom signs of death due to strangulation, fracture of thyroid cartilage and hyoid bone, medico-legal aspects of strangulation
A POWER POINT PRESENTATION BY DR. SANGEETA CHOWDHRY AND DR. SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
We saw the infamous 26/11 at Mumbai, India. We lost some brave-hearts. Hence, we look into the forensics behind firearm injuries. We shall also discuss the JFK assassination case in brief. I would recommend downloading the presentation and view it in power point 2010 or above to see all the effects flawlessly.
Thanatology
Types of transplants
Cause, Mechanism of Death
Manner of death
Anoxia
Signs of Death
Immediate Changes (Somatic Death)
Early Changes (Molecular Death)
Algor Mortis ......
Reference
this is a short and informative presentation on asphyxia death which my teacher liked a lot.
He appreciated me a lot.
I hope whoever get this presentation find this very useful for your class.
# ppt
# asphyxia
THANK YOU
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Asphyxia which means "Pulselessness" and is cause due to absence of oxygen amount in a body. The death cause by asphyxia is known as asphyxial deaths. They are Hanging, Strangulation, Suffocation and Drowning.
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
What is the LPR
Esophageal anatomy
Pathophysiology
Risk factors
CLINICAL MANIFESTATIONS
Reinke’s edema
Patterns and Mechanism of LPR and GERD
DIAGNOSIS
Symptom Questionnaire:
Laryngoscopic Findings
Therapeutic Trial for LPR
Ambulatory PH Monitoring
Treatment
Lifestyle modifications
Dietary modification
PHARMACOLOGICAL
Drug therapy
Surgery
Cardiac Surgery
Internal thoracic ( mammary ) artery
ORIGIN and Course Of IMA
BRANCHES
Thymic Artery
The Xiphoid branch
The sternal branches
The Pericardiacophrenic branch
Anterior intercostal branches
Perforating branches
Musculophrenic artery
Superior Epigastric Artery
Clinical significance
Introduction
Natural conception
Epidemiologic figures
Factors affect the natural conception rate
Causes of subfertility
Female causes of subfertility
ovulation
Ovarian problems
Marker of ovarian reserve
Tubal blockage
Endometrial factors
Uterine factors
Cervical factors
History and PE
Investigations
Treatment
Male subfertility
Hypothalamic-pituitary disease
Obesity
Primary hypogonadism
Sperm transport disorders
Defective ejaculation
History and PE
Investigations
Surgical sperm retrieval
Cryopreservation of gametes
Introduction
What is definition and law of supply
Factors determine supply for health care services
Factors determine price & quantity of health care
What is the production function for health
Market equilibrium
Investing in the healthcare sector
Cost production in healthcare
Different healthcare system
Models of non-profit agencies
References
Supply of health and medical care
Definition and Law of Supply.
The health care production function.
Cost production in health care.
Factors determine price and quantity of health care.
Factors affecting Supply.
Investment on healthcare.
Health insurance and supply in healthcare.
Market Equilibrium.
References
Questions
Helicobacter pylori and Peptic Ulcer diseaseDiaa Srahin
Case Study
Clinical Case Summary
History
Helicobacter pylori
Biochemical characteristics
Transmission
Epidemiology
Global incidence of H. pylori infection
risk factors for acquisition of H.pylori
Immune responses
Pathogenesis
Helicobacter pylori Virulence Factors
Clinical Presentation
Complications
Peptic Ulcer
Diagnosis
Treatment
Prevention
Introduction
Disease
Important Properties
Transmission & Epidemiology
Risk factor of reactivation
Pathogenesis
Clinical Findings
Laboratory Diagnosis
Approaches to the diagnosis of latent infections
Treatment
Prevention
The benefits of the mediterranean diet pattern for adultsDiaa Srahin
Clinical Nutrition
Introduction
What is Mediterranean Diet
How to Follow the Mediterranean Diet
Mediterranean Diet Pyramid
Health Benefits of the Mediterranean Diet in Adults
Mediterranean Diet and Possible Health Concerns
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. Classification of Asphyxia
1- Mechanical/Violent
2- Pathological
3- Toxic or chemical
4- environmental
5- Miscellaneous
• Traumatic
• Positional/postural
• Iatrogenic
4. Mechanical Asphyxia
Suffocation is Lack of oxygen in the inspired air
Smothering
Hanging
Strangulation خنق (Ligature or Manual )
Throttling / Mugging see picture next slide (خنق)
Gagging : Level of obstruction is Nasopharynx
Choking : Level of obstruction is Larynx
Drowning غرق
Traumatic asphyxia
6. Mechanical Asphyxia
Failure of oxygen transportation (For example carbon monoxide poisoning)
Failure of oxygen utilization (For example cyanide poisoning)
7.
8. Pathological Asphyxia
Entry of oxygen to the lungs is prevented by disease of
the upper respiratory tract or lungs, e.g. laryngeal
edema, spasm, tumors or abscess.
9. Toxic or chemical Asphyxia
Cessation of the respiratory movements due to paralysis
of the respiratory center in poisoning with morphine,
barbiturates or strychnine.
Inhibition of oxidative processes in the tissue preventing
the use of oxygen in the blood, e.g. cyanide poisoning
10. Environmental Asphyxia
Breathing in vitiated atmosphere (منهك جو) , as
in high altitude, climbing or fling, or inhalation of
carbon monoxide (CO), sewer gas (الصحي الصرف غاز)
or pure helium
11. Traumatic Asphyxia
Blunt trauma to the thorax may result in pneumothorax,
hemothorax or pulmonary embolism that will interfere
with oxygenation and ventilation by compressing
otherwise healthy parenchyma
12. Positional/postural Asphyxia
Positional asphyxia is due to abnormal body position that
prevents adequate gas exchange.
- In alcoholics or addicts, where the person is unconscious and the upper portion
of the body is lower than rest, or neck is forcibly flexed on the chest which prevents
normal respiratory movements. Deaths in such cases are diagnosed based on
circumstantial evidence in combination with excluding other significant underlying
causes of death.
- Positional/restraint asphyxia may occur in hogtying (individual is placed in a
prone position, their hands are cuffed together behind their back, and their ankles
are bound and tied to their wrists).
14. Tardieu’s or Bayard’s ecchymosis/spots
Tardieu’s spots ( petechial hemorrhage ):
They are usually round, dark-red, well-defied, pin-head sized spots, found
in those parts where capillaries are least supported, e.g. conjunctiva, face,
epiglottis, subpleural surface of lungs, heart, meninges and thymus.
They are not pathognomic of asphyxia, and their absence does not exclude
asphyxia (rarely seen in drowning).
It can be seen in other forms of death—electrocution, poisoning, coronary
thrombosis, in persons on anticoagulants, with bleeding disorders such as
scurvy, leukemia and thrombocytopenia, but distribution is more
generalized
15.
16. Hanging
Hanging is a form of asphyxia caused by suspension of
the body by a ligature which encircles the neck, the
constricting force being at least part of the weight of the
body.
17. Classification of Hanging
*** On the basis of position of the knot :
Typical hanging: When the point of suspension is
placed centrally over the occiput, i.e. the knot is at
the nape of neck on the back.
Atypical hanging: Knot of ligature is anywhere other
than on the occiput.
18.
19. Classification of Hanging
*** On the basis of degree of suspension:
Complete hanging: Body is fully suspended and no part of
body touches the ground. Constricting force is weight of the
body.
Incomplete or partial hanging: Lower part of the body is
touching the ground (toes or feet touching the ground) or in
sitting, kneeling, lying down or prone position. Weight of the
head acts as the constricting force.
20.
21. Classification of Hanging
*** On the basis of intent (النية) :
Suicidal
Homicidal
Accidental
Autoerotic
Judicial ممكنالشنق حكم يكونقضائيبعض فيالدول
22. Cause of Death in Hanging
Asphyxia: Constricting force of ligature causes compressive narrowing of
laryngeal and tracheal lumina, leading to asphyxia.
Venous congestion: Jugular veins are blocked by the ligature which
results in stoppage of cerebral circulation; occurs if ligature is made up of
broad and soft material.
Combined asphyxia and venous congestion: Commonest cause.
Cerebral anemia: It occurs when ligature is made of thin cord.
Reflex vagal inhibition leading to sudden cardiac arrest.
Fracture/dislocation of cervical vertebrae: It is seen in judicial
hanging. ( C2,3,4)
23. Pathophysiology ( Not too important )
Venous obstruction leading to cerebral congestion,
hypoxia and unconsciousness, which in turn, produces
loss of muscle tone leading to airway obstruction, occurs if
ligature is made up of broad and soft material.
Arterial blockage due to pressure on carotid artery, leading
to cerebral anemia and collapse due to low cerebral blood
flow occurs when ligature is made of thin cord.
Reflex vagal inhibition caused by pressure to the carotid
sinuses and increased parasympathetic tone leading to
sudden cardiac arrest (less common)
25. Fatal period in Hanging
Usual period is 3–5 min which may extend to 5–8 min of
suspension leading to death
Death is immediate, if cervical vertebrae are fractured or if
the heart is inhibited.
Death is rapid, if cause is asphyxia.
Death is least rapid, if coma is responsible.
26. Occlusion of jugular veins – 4.5 lbs of pressure ( 2kg )
Occlusion of carotid arteries – 11 lbs of pressure ( 5 kg )
Occlusion of trachea – 33 lbs of pressure ( 15 kg )
Occlusion of vertebral arteries – 66 lbs of pressure ( 30 kg )
The weight of the head (10 to 12 pounds) ( 4.5- 5.5 kg ) is in
fact sufficient to occlude the carotid arteries.
27. Hyoid bone may be fractured in persons, more
commonly above the age of 40 years ( calcified ) . The
fracture is usually due to ligature forcing the hyoid bone
backwards, which results in increased divergence of greater
horns .
Transverse carotid intimal tears may be seen in
obese victims, long drops and posteriorly placed
knots (Amussat’s sign).
28. There may be hemorrhages on ventral surface of the
intervertebral disks beneath the anterior longitudinal ligament
in the lumbar spine (Simon’s sign–a vital sign of hanging). It
may also be seen in other traumatic elongation or
overextension of spinal column (e.g. traffic accidents),
drowning and putrefaction تحلل (‘false positive’).
Ligature furrow angles upward behind ears – usually
above thyroid cartilage.
May have no furrow with soft ligature.
May see Tardieu spots in gravity-dependent areas.
29. Factors which influence the appearance of ligature
mark ??
Ligature material: If it is tough and narrow, then the mark is deep and prominent.
If it is soft and broad, then mark is less prominent or deep.
Period of suspension: Longer the suspension, deeper is the groove, and it is more
prominent and parchmentized (مشدود)؟؟
Degree of suspension: Mark becomes more prominent and deep in case of total
suspension.
Weight of the body: Heavier the body, more marked is the ligature impression.
Position of knot: Main force applied to the neck by ligature is opposite to the point
of suspension.
Slipping of ligature during suspension: Produces double impression of ligature.
30. Judicial Hanging
In case of judicial hanging, the ligature is looped around the
neck with the knot under the chin (submental), but subaural
(below auricle) knot is also used.7 The drop is at least the
height of the person (5–7 feet, depending on the weight) and
the hanging is complete.
The ligature around the neck causes a forceful jerky impact
on the neck at the end of the fall, so as to cause fracture of
cervical column (fracture dislocation of C2 from C3, rarely
C3 and C4 vertebrae—hangman fracture) with stretching or
tearing of cervical spinal cord, but not decapitation الرأس قطع
In judicial hangings, odontoid process of 2nd cervical
vertebra ( Axis ) is usually not fractured.
31. Hangman’s fracture
Hangman’s fracture: It was found that when the
hangman’s knot was placed beneath the chin, death
occurred rapidly because of fracture of the pedicles/lamina
of C2 vertebra and a traumatic spondylolisthesis of the C2
over C3 (anterior subluxation/ dislocation).
This knot placement became standard, and most efficient
method of execution .اعدام The mechanism of the injury is
forcible hyperextension of the head. This injury may also
be seen in sports, fall or road traffic accidents
32.
33. Strangulation
It is a form of violent asphyxial death caused by
constriction of air passage at the neck by means of a
ligature or by any means other than suspension of the
body.
34. ligature strangulation
The Ligature mark ( furrow ) is usually horizontally placed across
the middle or lower part of neck, at or below the level of thyroid
cartilage. The mark is transverse, circular and continuous.
Occludes jugular veins and carotids
death is due to occlusion of the carotid arteries with cerebral
hypoxia.
Loss of consciousness in 10-15 seconds
Marked congestion above ligature – confluent scleral petechiae,
conjunctival petechiae, facial petechiae
Fractures of the hyoid bone and thyroid cartilages in 12.5% of cases
35. Cause of death
Asphyxia due to elevation of the larynx and tongue
closing the airway at pharyngeal level.
Cerebral anoxia due to venous congestion.
Vagal inhibition.
Rarely, fracture dislocation of cervical vertebrae
36. Throttling or Manual Strangulation
Asphyxia produced by compression of the neck by human hands.
Cause of death
Asphyxia from obstruction of respiration.
Cerebral anoxia from interference with cerebral circulation.
Vagal inhibition from pressure on carotid nerve plexus consisting of fibers
of vagus, sympathetic and glossopharyngeal nerves.
About half of the deaths are due to vagal inhibition.
Pressure must be applied for 2 minutes (min) or more to cause death.
37. Suicide is not possible as loss of consciousness would
result in release of the pressure on the neck.
Virtually all cases are homicides. A higher percentage of
victims are women.
Death is alleged to be due to stimulation of the carotid
sinuses with resultant bradycardia, vasodilatation,
hypotension and cardiac arrest.
38. Congestion above level of compression – petechiae of
sclera, conjunctiva, face
Hemorrhages in strap muscles of neck
Fractures of hyoid bone and thyroid cartilages
Abrasions and fingernail marks on skin
Inward compression fracture of hyoid bone is the most
diagnostic finding of throttling
39. The amount of force required to compress neck structures is
estimated as—
jugular vein: 2 kg,
carotid artery: 5 kg,
trachea: 9 – 15 kg and
vertebral artery: 30 kg.
This implies that venous flow is decreased before arterial and
airway obstruction occurs.
For fractures of thyroid cartilage lamina: 14.3 kg
and cricoid cartilage: 18.8 kg force is required.
40. Hyoid Bone Fractures
Fracture of the hyoid bone occurs in 50–70% of cases
in subjects above 40 years of age.
41. AUTOEROTIC
Autoerotic hangings are accidental in manner.
The victim is usually a male, rarely a female.
In these cases, the individual induces transient cerebral hypoxia, by
“hanging” himself or herself for a short period of time, in order to
increase the pleasure associated with masturbation.
Almost always male – found nude or wearing female clothing
Often have an escape mechanism in place – either escape
mechanism fails, or timing is miscalculated
Usually pornography at scene
42. CHEMICAL Asphyxia
Carbon monoxide
o Colorless, odorless, tasteless
o Produced with incomplete combustion of burning products, fires,
automobile exhaust, defective heating equipment
o Competes with oxygen for binding sites on hemoglobin
o 250-300 times greater affinity for hemoglobin than oxygen
o Smokers have levels of 3-10%
o Death in levels >50% (may be fatal at 20-30% in elderly, cardiac
disease, respiratory disease)
o Autopsy
• Pinkish livor mortis
• Bilateral necrosis of the globus pallidus (with survival)
•
Other gases causing asphyxia – Helium, carbon dioxide, methane,
hydrogen, cyanide, hydrogen sulfide
43. CHOKING
Aspiration of a foreign body – balloon, button, penny, et
Aspiration of a food bolus
Café coronary – individual eating in restaurant suddenly collapses, witnesses start
CPR, thinking the cause is cardiac “Heimlich maneuver”
Alcohol or drug intoxication and neurological or mental impairment are
precipitating condition
Must be large bolus lodged in airway (small amounts of food in airway are often
seen as part of end of life aspiration in many types of death)
Bolus may have been removed by first responders
Homicidal – gag in oral airway
44. SMOTHERING Asphyxia
Mechanical airway obstruction or occlusion
Homicide
Suicide – usually plastic bag over head
Accident – e.g.., child in enclosed space; environment with
increased oxygen consumption, such as underground well
with high CO2 content
Autopsy findings – nonspecific or none.
45. POSITIONAL Asphyxia
Infant trapped between mattress and railing
Infant trapped in soft bedding
Intoxicated person passes out in position incompatible
with chest Expansion
Death due to mechanical inability to expand chest
cavity
46. Drowning
Drowning is the process of experiencing respiratory impairment
from submersion/immersion in liquid.
Outcome may include delayed morbidity, delayed
or rapid death, or life without morbidity.
Drowning was previously defined as immediate death secondary
to asphyxia while immersed in a liquid, usually water, or within
24 h of submersion. The definition excluded aspiration of vomit,
blood, saliva, bile or meconium.
48. Typical or wet drowning
Water is inhaled into the lungs and the victim has
severe chest pain (seen in 80–90% of cases). It is also
known as primary drowning.
Fresh water and brackish (الملوحة قليل) water drowning
Sea (salt) water drowning
„
49. In fresh water and brackish water drowning (0.5–0.6% NaCl),
the aspirated water is rapidly absorbed from the alveoli into
the circulation leading to hemodilution and hemolysis.
Circulatory overload, hyponatremia, hyperkalemia, together
with myocardial hypoxia result in fall of systolic blood
pressure followed by ventricular fibrillation.
52. In sea (salt) water drowning (3–4% salinity), the aspiration of
water results in withdrawal of water from the pulmonary
circulation into the alveolar spaces as a result of the osmotic
differential, while at the same time electrolytes (sodium,
chloride, magnesium from sea water) pass into the blood.
There is hemoconcentration with crenation of RBCs, but not
hemolysis and little change in the sodium/ potassium balance.
The pulse pressure decreases slowly and is followed by AV
dissociation, but not ventricular fibrillation.
In both fresh water and salt water drowning, there is
terminal pulmonary edema.
55. Atypical drowning
Dry drowning.
Immersion syndrome (Hydrocution, submersion
inhibition or cold water drowning).
Near drowning (post-immersion syndrome or secondary
drowning).
Shallow water drowning (submersion of the
unconscious).
56. Dry drowning
In dry drowning, water does not enter the lungs due to laryngeal spasm
induced by small amounts of water entering the larynx.
Seen in 1–2% of cases.
Death may be extremely rapid and time elapsed is insufficient for typical
drowning to occur.
Two mechanisms have been postulated:
1- Reflex cardiac arrest due to vasovagal stimulation.
2- Laryngeal spasm and airway closure causing lethal hypoxemia.
In these cases, autopsy findings and tests for drowning are negative, and
the lung fields are dry.
57. Immersion syndrome
(Hydrocution, submersion inhibition or cold water drowning): It refers
to syncope resulting from cardiac dysrhythmias on sudden contact with
water that is at least 5°C lower than body temperature.
The syndrome occurs as a result of:
Cold water stimulating the nerve endings of the surface of the body.
Water striking the epigastrium.
Cold water entering eardrums, nasal passages, pharynx and larynx.
Falling or diving into water with feet fist or duck diving by the
inexperienced.
58. Mechanism: Vagal stimulation leading to asystolic cardiac arrest
(‘diving reflex’), or ventricular fibrillation secondary to QT
prolongation after a massive release of catecholamine on contact
with cold water.
The resultant loss of consciousness leads to secondary drowning.
The findings of typical drowning are absent, and diagnosis of
hydrocution is difficult because aspiration of water into the lungs
does not occur.
The syndrome particularly affects the middle-aged or elderly men
who have ingested some amounts of ethanol. Underlying cardiac
disease could increase the risk of sudden collapse.
59. Near drowning
(post-immersion syndrome or secondary drowning)
Near drowning refers to survival beyond 24 h after a submersion
episode.
Death is caused by complications or sequelae (e.g. ARDS,
pneumonia, sepsis, hypoxic ischemic encephalopathy, cerebral
edema and DIC).
Secondary drowning sometimes refers to a victim who initially
responds well to resuscitation but then suffers respiratory
decompensation.
60. Shallow water drowning
(submersion of the unconscious):
Alcoholics, drugged, epileptics, infants, children and
unconscious persons may die due to drowning in
shallow water in a pit or drain.
61. Epidemiology of drowning
„Drowning victims are predominantly male (> 65%).
It occurs in the summer months, more frequently
seen in rivers, lakes, ponds برك and creeks جداول .
„The age groups affected are the children (< 4 years)
and young adults (15–24 years).
Drugs and alcohol abuse among the teenagers are other
associated factors
62. Cause of Death
Asphyxia: Most common cause of death.
In fresh water drowning, death results from ventricular fibrillation. While
in salt water, it is due to cardiac arrest from fulminant pulmonary
edema and associated changes.
Vagal inhibition due to impact with water.
Laryngeal spasm.
Concussion/head injury.
Apoplexy: Subarachnoid hemorrhage from rupture of berry aneurysm or
cerebral hemorrhage by rupture of cerebral vessels from sudden on-rush
of blood to the brain due to excitement or sudden fall from height into cold
water.
Secondary causes
Septic aspiration pneumonia
Sudden bursting of aneurysm.
63. Symptoms: apart from recalling of memory of past events, there may be
mental confusion along with auditory and visual hallucinations, tinnitus
and vertigo.
In wet drowning, there is chest pain.
Treatment: First and immediate step consists of application of artificial
respiration with closed chest cardiac massage, even in absence of pulse and
respiration and irrespective of injuries sustained during drowning.
Defibrillator should be used when there is ventricular fibrillation.
Fatal period
„Fresh water drowning: 4–5 min.36
„ Sea water drowning: 8–12 min.
64. Postmortem Examination
The diagnosis of drowning is one of exclusion.
Most of the signs are not specific of death due to
drowning and are rather signs of submersion of body
under water for some period. Any dead body, whatever
the cause of death, will develop signs of immersion if
left for a sufficient time in water.
Moreover, some of the signs are not appreciable in
case of putrefaction.
65. Postmortem staining: Light pink in color, present
over face, neck, front of upper part of chest, upper
and lower limbs as the body usually flats with face
down, buttocks up, legs and arms hanging down in
front of the body
66. Froth
Froth: Presence of fine, copious white ‘shaving-lather’ like
froth at the mouth and nostrils is the
most characteristic antemortem external finding.
Production of this tenacious, fie, lathery foam is a vital
phenomenon.
The mass of foam, consisting of fine bubbles, does not
collapse when touched with the point of a knife.
It may be absent when wiped off, but reappears again by
itself or by applying simple pressure on chest.
67. Mechanism of production of froth:
The inhalation of water irritates the mucous membrane of air passages
due to which the tracheal and bronchial glands secrete large quantities
of tenacious mucus, and the alveolar lining cell irritation produces
edema fluid. Vigorous agitation of the seromucoid secretion,
surfactant, aspirated water and retained air converts the mixture of
endogenous and drowning medium into froth.
Other conditions in which froth can be seen:
- Strangulation - Electric shock
- Putrefaction - Acute pulmonary edema
- Epileptic fit - Opium/OPC poisoning
In all these cases, froth is not fine, not of such large quantity or
tenacious in nature as in drowning