No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults—A 25-year study
Abstract
A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19-86 years (mean=41.8 years) and of the females was 19-75 years (mean=38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes (N=37), industrial accidents (N=9), farm accidents (N=6) and entrapment beneath vehicles (N=5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.
... There are several types of asphyxial events which may compromise tissue oxygenation that include thoracic compression [40], neck compression or an abnormal body position [41][42][43]. Crush asphyxia refers to mechanical compression of the thorax, common in roll-over crashes with complete or partial occupant ejection resulting in a vehicle landing on top of the occupant compressing the thorax [40]. ...
... There are several types of asphyxial events which may compromise tissue oxygenation that include thoracic compression [40], neck compression or an abnormal body position [41][42][43]. Crush asphyxia refers to mechanical compression of the thorax, common in roll-over crashes with complete or partial occupant ejection resulting in a vehicle landing on top of the occupant compressing the thorax [40]. Thoracic compression may result in fractures to the ribs or sternum, lung and vascular injuries and other injuries associated with blunt force trauma [40]. ...
... Crush asphyxia refers to mechanical compression of the thorax, common in roll-over crashes with complete or partial occupant ejection resulting in a vehicle landing on top of the occupant compressing the thorax [40]. Thoracic compression may result in fractures to the ribs or sternum, lung and vascular injuries and other injuries associated with blunt force trauma [40]. Accidental asphyxia due to hanging is almost exclusively the result of a seat belt slipping over the thorax onto the neck and may have concomitant neck injuries such as ligature markings or fracture of the hyoid bone or thyroid cartilage [43]. ...
Injuries from motor vehicle collisions are frequently encountered in routine forensic practice. While the most common lethal events involve blunt force trauma with injuries to the head and neck, chest, abdomen, pelvis and limbs, review of the literature and case files shows that a wide variety of other fatal situations can occur that may involve sharp force and penetrating trauma, incineration, drowning, asphyxia, organic diseases and combinations of these. The following overview details potential factors that may contribute to death following vehicle crashes.
... As reported by Byard 28 and Byard et al 41 and confirmed by other published data, there is a tendency to ignore the fact that much agricultural work involves a high degree of risk. Accidents in agricultural contexts often result in serious injury, disability, or death, and this is especially true in cases involving farm workers who get trapped in the rotating augers of feed mixer wagons. ...
... Coroners and forensic pathologists may be required to answer questions involving the whole dynamic profile of the accident to identify the circumstances surrounding the death, the traumatic injuries sustained and the ultimate cause of death. 20,28,41 Therefore, medicolegal investigations have to determine whether the action of augers was in fact responsible for the fatality and to confirm a cause-effect relationship between the dynamics of the accident and the fatal injuries inflicted by the dangerous moving parts of the mixer wagon upon the victim's body. 20,28,41 Those conducting the autopsy must describe, evaluate, and attempt to correlate the wounds and dismemberments observed with the specific mechanical parts of the machinery to demonstrate that death was caused by reckless behavior (eg, getting too close to the machinery) and/or by the incorrect handling or use of the machinery despite other versions or explanations. ...
... 20,28,41 Therefore, medicolegal investigations have to determine whether the action of augers was in fact responsible for the fatality and to confirm a cause-effect relationship between the dynamics of the accident and the fatal injuries inflicted by the dangerous moving parts of the mixer wagon upon the victim's body. 20,28,41 Those conducting the autopsy must describe, evaluate, and attempt to correlate the wounds and dismemberments observed with the specific mechanical parts of the machinery to demonstrate that death was caused by reckless behavior (eg, getting too close to the machinery) and/or by the incorrect handling or use of the machinery despite other versions or explanations. 20,28,41 A medicolegal inspection should involve not only the death scene but also the mechanical functions and features of each structural component of the machinery, especially of the augers, and verify whether the morphological features of different lesions observed on the corpse match the specific parts of the augers, that is, the continuous spiral of the upper augers or the bottom auger with a cutaway section and/or flighting with attached knives, and the counter-knives fixed to the side walls of the wagon. ...
Feed mixer or total mixed ration mixer wagons are powerful agricultural machines used to shred and mix silage with other ingredients and deliver it direct to the feeding troughs on livestock farms. Fatalities involving these feed mixers may occur when operators become trapped in the augers or, less frequently, are crushed by moving wagons. Death can occur very rapidly because of dismemberment, multiple lesions, or crushing. The aim of this review is to focus on the diagnostic evaluations that need to be performed to confirm that the death was accidental and to exclude a hypothesis of murder or suicide. Forensic investigations in such cases must involve the detailed analysis of the death scene and the mechanical characteristics of the machinery with an accurate postmortem and toxicological examination.
... It is characterized by petechial hemorrhage on the face, neck, and palpebral conjunctiva due to obstruction of venous return, and the absence of organic findings such as multiple rib fractures and thoracoabdominal organ injury 5)11)15)12) . 10 Eleven people were killed (9 children under 10 years old and 2 women in their 70s) and 247 people were injured (severe: 7; moderate: 19) in a human stampede at a fireworks display in Japan in 2001. It is estimated that all the casualties had fallen underfoot of people in the crowd, resulting in pressure on the chest and causing death due to traumatic asphyxia 14,15 . ...
... These previous studies in dogs and mice considered only the magnitude of loads applied to the chests, loading time, and survival status. We hypothesized that in humans, we may be able to simulate the state of dyspnea preceding the occurrence of respiratory failure and death, but under conditions with much smaller load magnitudes than those 10 applied in the animal studies. If maintenance of such dyspnea over a long period could be shown as a potential cause or respiratory failure or death, the load conditions could serve as a predictor of traumatic asphyxia. ...
... Irotec, Osaka, Japan) applied to the chest and abdomen (Fig. 1). Using 2 nylon belts 10 (170 × 240 mm) placed over the front of the chest and abdomen of each subject, the weighted load (by gravity) was applied via the chains connected to both ends of the belts. ...
Background: Traumatic asphyxia is a major cause of death in fatal crowd disasters, but the relationship between compression site, load magnitude, load time, and the medical event remains unclear. This study sought to estimate thoracoabdominal compression conditions (load magnitude, load time) resulting in respiratory failure in adults.
Methods: A total of 8 load patterns—A (chest load: 0 kg, abdomen load: 10 kg), B (0, 20), C (10, 0), D (10, 10), E (10, 20), F (20, 0), G (20, 10), H (20, 20) —were applied in 14 healthy adult female subjects. Blood pressure, heart rate, respiratory rate, SpO2, tidal volume, vital capacity, respiratory phase, and modified Borg dyspnea score were measured over time. The Breathing Intolerance Index (BITI) was also calculated.
Results: Vital capacity decreased in patterns C, D, E, F, G, and H. BITI reached the critical range of ≥ 0.15, where respiratory failure occurs about 45 min later, after 14 min in pattern G and 2 min in pattern H. Vital capacity ≤ 1.85 L and modified Borg scale score 8.3 corresponded to BITI 0.15 and were regarded as equivalent to reaching the critical range. Furthermore, the change in chest load was positively correlated with BITI when abdominal load was kept constant.
Conclusions: In human women, respiratory failure could occur within 1 h due to respiratory muscle fatigue even when the total thoracoabdominal load is only about 60% of the body weight. Vital capacity ≤1.85 L and modified Borg scale score ≥8.3 can be considered as indices for predicting respiratory failure.
... In general, a person who dies from traumatic asphyxiation often appears strangled with features extending down to the neck, with no signs of local damage. [2,20,21] However, physical features such as these are not always visible. Studies have shown that, in up to 10% of cases, no petechial hemorrhages are seen on the face or conjunctiva. ...
... The reason for this is unclear, but may be related to rapidness of death, lack of obvious chest compression or vagus nerve stimulation, lack of occlusion of the epiglottis, or concurrence of both left heart and right heart impairment at the time of chest compression. [1,18,20,21] On gross examination, lungs may have a purplish red color, congestion, or subserous bleeding with or without obvious expansion of the right heart or superior vena cava; sometimes, there is no evidence of trauma despite severe direct external compression on the chest and abdomen. [1][2][3]9] Traumatic asphyxia is a diagnosis of exclusion. ...
... In addition to supporting evidence from a scene investigation, suffocation death should only be considered after excluding fatal injuries and poisoning. [1,9,21] Overlaying asphyxia is a special form of traumatic asphyxia, often secondary to nasal compression. Physical examination findings are usually absent, so overlaying can be difficult to determine unless the same-bed sleeper admits to crushing the infant or child. ...
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.
... Traumatic asphyxia was first described as 'masque ecchymotique' by Charles-Prosper Ollivier d'Angers in 1837 when he conducted an autopsy on a woman crushed by a crowd in a Paris riot. [1][2][3] This syndrome, variously known today as masque ecchymotique, 1 traumatic cervico-facial cyanosis, 4 acute thoracic compression syndrome, 5 and Perthes syndrome, 6 is caused by sudden compression trauma to the chest with a degree of limited inspiration. Clinical and autopsy findings, with or without external traumatic findings, include facial congestion and swelling, edema and cyanosis, petechial and purpuric haemorrhages on the upper chest, and petechial haemorrhages on the conjunctivae and face. ...
... Clinical and autopsy findings, with or without external traumatic findings, include facial congestion and swelling, edema and cyanosis, petechial and purpuric haemorrhages on the upper chest, and petechial haemorrhages on the conjunctivae and face. 1,3,7 In the literature, additional clinical findings have been reported, including hemotympanium, 8 opthalmologic findings (e.g., retinal haemorrhages and exudates, 9 proptozis, exopthalmos, orbital edema, diplopia, temporary blindness, visual loss), 3,10,11 and neurological findings due to hypoxia. 3,6 Although this syndrome has been reported in many clinical case reports since its initial description, there is a lack of autopsy studies describing its external and internal autopsy findings. ...
... Scores were determined according to the injury pattern recorded in the autopsy report and calculated according to the Abbreviated Injury Scale (2005, Update 2008). 13 All cases were then classified into groups, as recommended by Byard et al. 1 and compared with ISS and NISS scores. Group A (n = 6) included cases with petechiae on the conjunctivae and face or head congestion with only minor external examination findings; cause of death was determined by autopsy and circumstances. ...
Results:
The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture.
... Physicians who are clinically aware of TA should face no difficulty in making the correct diagnosis. However, in the absence of the typical clinical features in subjects who die at the site of the accident, the diagnosis of TA can sometimes be one of exclusion (Byard et al. 2006). The treatment is generally supportive although certain associated injuries may require surgery (Eken and Yıgıt 2009;Lateef 2015). ...
... Despite the alarming appearance of patients with TA, the majority have a favorable prognosis (Shiber et al. 2013;Lateef 2015). In this rare syndrome, death may result from asphyxia secondary to thoracic compression or from the associated injuries (Byard et al. 2006). ...
Background
Traumatic 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.
Results
During 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.
Conclusions
Due 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.
... Regarding the evaluation of casualties and injuries, evaluations were associated with different subjective perceptions and clinical symptoms. The typical clinical symptoms of compression asphyxia include conjunctival/facial petechiae and head and neck congestion/ swelling; however, such features do not denote a fatal result and may regress after some time (Byard et al. 2006). For example, survivors may manifest some neurological impairment but no specific damage to their brains after an accident (Lee et al. 1991). ...
... Intolerable and may lead to specific non-fatal trauma or internal injury X $ N(4,1) Many subjects complained that they had difficulty breathing and asked for the tests to be stopped. In real incidents, petechiae of the conjunctivae and face occurred and other significant (but nonlethal) injuries were observed, including rib and sternal fractures or extensive bruising of the chest (Byard et al. 2006). 5 ...
Frequent and intense interactions between individuals inevitably occur in crowd disasters. Previous studies indicate that the primary risk evaluation parameters for individuals in crowds during these interactions are exerted force and its duration. In this study, a series of controlled laboratory experiments simulating static and fluctuant loads were conducted to obtain real-time exerted force data and the associated individual subjective feelings. An individual risk evaluation method is then established to assign a specific individual risk value to each data set of exerted force and its duration according to the individuals’ feelings. This method divides the range of risk value into three zones: comfortable zone, uncomfortable zone and crisis zone. The transition from uncomfortable zone to crisis zone is not a single numerical value but a range that considers individual differences. The method presented in this paper can assist in developing pedestrian simulation models as well as managing crowd events.
Practitioner Summary: Accident surveys indicate that casualties and injuries usually occur under a long-term static load or heavy dynamic load. We tested human body extrusion experiments in four conditions, measured the real-time load intensity and duration of the individual's action on the thoracic cavity during the mutual extrusion process, and an individual risk evaluation method had be established based on the force exerted on the body and its duration to prevent crowd disasters.
... Obviously, this compression of the chest does not only produce haemodynamic effects (increase in the peripheral venous pressure in the upper body, associated with the continued arterial blood flow towards the periphery) but also respiratory consequences, with hypoxaemia caused by the arresting of breathing movements and alveolar ventilation [18,21,31,[33][34][35][36][37]. ...
... If the chest is immobilized but not crushed, the discoloration of the skin associated with crush asphyxia will be absent since there will be no increase in venous capillary pressure; but because the breathing movements and alveolar ventilation will be obstructed, arterial hypoxaemia will occur and lead rapidly to death by cardiac arrest [18,[29][30][31]33,34]. ...
The evaluation of the dynamics of accidents involving the overturning of farm tractors is difficult for both engineers and coroners. A clear reconstruction of the causes, vectorial forces, speed, acceleration, timing and direction of rear, front and side rollovers may be complicated by the complexity of the lesions, the absence of witnesses and the death of the operator, and sometimes also by multiple overturns. Careful analysis of the death scene, vehicle, traumatic lesions and their comparison with the mechanical structures of the vehicle and the morphology of the terrain, should help experts to reconstruct the dynamics of accidents and may help in the design of new preventive equipment and procedures.
... In a study involving 513 non-lethal tractor injuries, rollover (25%) was the most common mechanism, and falling was the second most common mechanism of injury (20%) (17 hemorrhages on all face, and conjunctivas may be observed (24). In addition, these characteristic pathological findings may not be seen in approximately 5% of mechanical asphyxia due to vehicles (25). In this study, no internal organ injury was detected in 42.85% ...
Objective: Tractor-related accidents are more common than other agricultural vehicles. Tractor overturning is one of the major risk factors for farmers. In this study, it was aimed to discuss the sociodemographic characteristics, autopsy findings, the cause of death and measures to be taken of the tractor-related deaths with literatüre.
Material and Methods: In this study, reports of tractor-related deaths were investigated retrospectively in cases where an autopsy was performed in the Morgue Department of Istanbul Council of Forensic Medicine between 2008 and 2012.
Results: It was determined that 42 (0.2%) of 20,559 cases who were autopsied in Istanbul between 2008-2012 were tractor-related deaths. Thirty-eight (90.5%) of the cases were male and four cases (9.5%) were female. The average age was 44.54±20.66 (min: 2, max: 80) with the most common death occurring at 60 years and above. Twenty-six (61.9%) of the cases were drivers. The most common death occurred in July and November (n: 7, 16.6%). The death occurred due to tractor overturns in 50% of the cases (n: 21), whereas the reason for death was falling from the tractor in 31% (n=13), traffic accident in 7.1% (n=3), run-over in 7.1% (n=3) and lightning strikes in 4.8% (n=2).
Conclusion: In the prevention of tractor-related deaths, is necessary to prohibit the use of tractors as a means of transport and increase the use of seat belts and roll-over protective structures (ROPS) in all tractors.
... presented with subconjunctival hemorrhage. It is consistent with previous literature except that subconjunctival hemorrhage was of less percentage [8]. Compared to other existing literature were subconjunctival hemorrhage was seldomly absent [9], we got a much lower occurrence as 56.86%. ...
Background
Traumatic 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.
Methods
Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.
Results
The 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.
Conclusion
TA 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.
... It differs from crush/traumatic asphyxia in that there is no pressure applied to the chest to prevent expansion. A classic example of the latter is an individual who becomes trapped while working under a car when it slips off supports [2]. Homicidal crush asphyxia with suffocation has been termed 'burking' after the famous nineteenth century body snatchers Burke and Hare [3]. ...
Positional asphyxia occurs when the mechanics of normal respiratory processes are impaired by the position of the body, not by external crushing forces. It is a well-known complication of drug and alcohol intoxication. However, less well appreciated is the potential role of neck hyperflexion as a specific cause of death in individuals with acute alcohol intoxication. Two cases are reported to demonstrate the usefulness of meticulous scene descriptions and documentation in cases of alcohol toxicity. Case 1: An intoxicated 51-year-old woman was found deceased with neck hyperflexion due to pressure on her head from a vehicle bumper bar (blood alcohol 0.24%). Case 2: An intoxicated 46-year-old man was found lying on his back with his neck acutely flexed and his chin pressed firmly into his shoulder (blood alcohol 0.4%). In both cases the deaths were attributed to positional asphyxia due to hyperflexion of the neck associated with alcohol intoxication, with potential exacerbation from concussion and alcohol/drug effects. Careful review of the scene findings and statements from those who are first to find a body in cases of acute alcohol intoxication may be necessary to determine the incidence of marked neck hyperflexion and its possible role in these deaths.
... In rollover crashes, occupants may be pinned underneath vehicles and die of crush asphyxia. 13 This sometimes may involve occlusion of the airways if the face is pushed or held into soft soil or sand. 14 Compression asphyxia may also occur within the cabin of a vehicle if unconscious, intoxicated or injured occupants are lying on top of each other. ...
A retrospective review of autopsy files at Forensic Science South Australia in Adelaide, Australia, was undertaken over a five-year period from January 2014 to December 2018 for all motor vehicle crashes with rollovers ending with the vehicle inverted and the occupants suspended by the lap component of their seat belts. There were five cases, all male drivers (aged 18–67 years; M age = 32 years). Acute neck flexion or head wedging was noted in four cases, with facial petechiae in four and facial congestion in one. Deaths were due to positional asphyxia in four cases, with the combined effects of positional asphyxia and head trauma accounting for the remaining case. Although all drivers had evidence of head impact which may have caused incapacitation, in only one case was this considered severe enough to have contributed to death. A blood alcohol level above the legal limit for driving was detected in two cases, but no other drugs were detected. This series demonstrates another subset of cases of seat belt–associated deaths where suspension upside down by the lap component of a seat belt had occurred after vehicle rollovers. Predisposing factors include incapacitation of the victim and delay in rescue. The postulated lethal mechanism involved respiratory compromise from the weight of abdominal viscera on the diaphragm, as well as upper airway compromise due to kinking of the neck and wedging of the head.
... Compression (also known as mechanical, crush, traumatic) asphyxia refers to a form of suffocation where pulmonary respiration and/or vascular flow is impeded by external pressure(s) on the body. This may take the form of a heavy weight compressing the neck, chest, abdomen, or wedging of the body within a narrow space (1). This phenomenon as a cause of death has been observed due to compression against inanimate objects, for example, within a crushed motor vehicle (2), car doors (3), revolving doors (4), bar bells (5), or from sustained external chest compression by another individual (6). ...
Introduction:
Community donation bins have become more common in the urban setting over the past several years. Many nonprofit organizations use these sturdy metal enclosures for unobserved collection of various donated items such as clothing, books, and household items. Although the donated items are often of low individual value, donation bins may become a target of individuals in low socioeconomic situations seeking desired items for personal use or resale, or for personal shelter within the bin.
Methods:
To identify donation bin-associated deaths, we reviewed cases taken under the jurisdiction of the coroner for investigation in the provinces of British Columbia and Ontario, Canada, over the years 2009 to 2019.
Results:
We present the circumstances and postmortem findings of five deaths that occurred in British Columbia and Ontario (Canada) between 2009 and 2019, wherein the decedents were each believed to have been reaching into donation bins and became caught within the door mechanism and died as a consequence of compression asphyxia involving the chest and/or neck.
Discussion:
Donation bins have the potential for harm when individuals attempt to access the bin contents through the entry portal. We advocate for greater attention and changes in the placement location and/or design of these potentially dangerous devices.
... Compression or crush asphyxia has caused death from soft-drink (soda) vending machine tipping, building collapse, vehicle accidents, crowd collapse, and trench caveins. 17,18 A fully-loaded soda vending machine weighs up to 500 kg (1100 lbs.), with most of the mass in the top, and such a load can kill an adult human. Most of the published fatal chest compression cases involve the mass of a car or tractor typically over a ton (> 1000 kg) compressing the torso. ...
Kroll, M.W., Brave, M.A. Defending Non-Firearm Arrest-Related Death Incidents. International Municipal Lawyers Association (IMLA). Conference Paper. IMLA 2020 Mid-Year Seminar, April 24-27, 2020, Washington, D.C.
... Positional asphyxia can be defined as a form of asphyxia which occurs in individuals who are found in an abnormal body position which prevents adequate gas exchange such as from upper airway obstruction or a limitation in chest wall expansion. [14][15] The term "positional asphyxia" was transferred to "restraint asphyxia," "compressional and/or traumatic asphyxia" and was applied to law enforcement arrest and restraint situations attempting to support the argument that short-term pressure on the back of the arrestee caused on contributed to the person's sudden death. The prone restraint process generally involves one or two officers placing one or both knees on the person's back to assist in the control and restraint of person in handcuffs and/or leg restraints. ...
... Traumatic asphyxia usually occurs as a result of a very heavy object compressing the chest as in a person crushed under a heavy vehicle such as a car or tractor, a factory worker pinned or crushed by heavy machinery [16][17][18], and in some cases of infant death from overlay [19]. ...
Background
Suffocation is a major class of asphyxial deaths encountered in forensic post-mortem examinations. Several studies have described the patterns of different types of suffocation deaths but there is a paucity of studies and autopsy findings of suffocation in the Nigerian environment. This study is aimed at determining the prevalence and pathological features of suffocation-related deaths at autopsy as seen in the Chief Medical Examiner’s Office in Lagos State, Nigeria.
Methodology
This is a 7-year autopsy-based study of suffocation deaths between 1 st January 2008 and 31st December 2014. Demographic data and morphologic features of asphyxia were retrieved from autopsy reports, case notes, and extracts from Coroners’ request forms submitted by the Police. The results were analysed using SPSS Version 20.
Results
Suffocation deaths accounted for 57(24.8%) of all asphyxial deaths and 0.77% of all autopsies done over the study period. The peak age group of suffocation death was 31–40 years with a male to female ratio of 2:1. Most (89.47%) of suffocation cases were due to aspiration of stomach contents. Hyperaemia of the airways, petechial haemorrhages and pulmonary oedema were the most common morphologic features seen.
Conclusion
This study showed that almost all suffocation deaths were due to gastric aspiration mostly secondary to delayed medical intervention. Most of the decedents were in the 4th decade of life with a male preponderance. One case of homicidal suffocation due to combined smothering and choking was observed.
... However, these deaths have occurred from auto accidents, building collapse, cave-ins, crowd crush, and occupational accidents. 42,43 To date, none of the published human clinical studies, or epidemiological studies, support the hypothesis that the pronerestraint position causes or contributes to ventilatory compromise. When gas exchange is severely impaired in critically ill lungdisease patients, they are commonly repositioned to receive ventilation in the prone position rather than in the supine position as the prone position improves gas exchange. ...
INTRODUCTION: It has been suggested that law enforcement officer (LEO) weight on the backs of prone subjects may cause asphyxia. METHODS: Law enforcement officers used their agency-trained "local" single- and double-knee techniques, the "Wisconsin" 3-Point Ground Stabilization, and the Human Factor Research Group Inc single-knee tactical handcuffing techniques, and the weight force was measured. RESULTS: Forty-one LEOs (36 men, 5 women) participated, aged 38.4 ± 8.3 years, and weighing 96.2 ± 19.4 kg. The double-knee technique transmitted more weight than single knee (P < 0.0001). Wisconsin technique force was lower than other single-knee techniques (P < 0.0001). Double-knee weight was 23.3 kg plus 24% of LEO's body weight. Mean values for local and Human Factor Research Group Inc single-knee were 30.9 and 32.9 kg, respectively. The Wisconsin single knee weight force was given by 15.4 kg plus 9.5 kg for a male. CONCLUSIONS: A double-knee technique applies more weight force than single-knee techniques. The Wisconsin single-knee technique provides the least weight force of single-knee techniques. Law enforcement officer body weight is irrelevant to prone-force weight with single-knee techniques. With double-knee restraint, it has a modest influence. Our data do not support the hypothesis of restraint asphyxia.
... In the last quarter, 76 to 100 percent of the snake, it was found the junction between the small and large intestine, the caecum, the kidneys (right in front of the left) and the cloaca. Traumatic asphyxia is a form of mechanical asphyxia where respiration is prevented by external pressure on the body: a heavy weight compressing the lungs or abdomen, wedging of the body within a narrow space death in large crowds have been reported [14][15][16] . The brain appeared normal on gross and in histopathological examination. ...
A carcass of a male Indian rock python measuring about 4.25 meters in length and 25 kg in weight was
presented to the Department of Veterinary Pathology, College of Veterinary and Animal Sciences,
GBPUA&T, Pantnagar on 24.08.2011 for conducting necropsy examination. The history revealed motor
vehicle crushing trauma (road accident) on the previous day at 4 P.M. Gross pathological findings
revealed crushed wound behind the head and neck with exposed bone. Necropsy findings revealed
lesions of lung areas that had ruptured and lead to massive external and internal hemorrhage. Liver and
spleen was also crushed in. The air sacs were full of clotted blood and intestine had infestation of few
round worms (Ophidascaris sp.) measuring about 4-5 inches in lengths and 2 plastic wires of
approximately one and a half feet long. There was an enormous amount of clotted blood in the
respiratory tract. Kidney and reproductive organs revealed no gross lesions. Histopathological
examination of lungs, air sacs and liver revealed massive hemorrhagic lesions. On the basis of gross and
histopathological findings it was diagnosed that death occurred due to cardio-pulmonary arrest (traumatic
shock) as a result of massive blood loss due to rupture of venacava, major aorta, lungs and liver.
... In carcharinids (including the bull shark C. leucas), heterodonty is characterized by triangular and serrated teeth on the upper jaw aiming at cutting, while teeth from the lower jaw are slender and smoother (see Section 3.4), acting as puncturing/holding devices before the shark starts moving the head laterally for cutting the tissues. Whatever their sharpness and shape, these jaws and teeth constitute a potential threat to humans, also considering that certain species, such as the tiger shark, may produce biting forces of up to 3300 kg/cm 2 [14][15][16]. ...
... The classic triad of traumatic asphyxia consists of head and neck cyanosis, subconjunctival haemorrhage and petechiae. Cases of crush asphyxia are mainly a consequence of motor vehicle crashes, crushing among other bodies in a panicked crowd (human pile deaths/riot crush), entrapment beneath vehicles or falling down in a narrow space [6]. Homicides resulting from traumatic asphyxia are commonly found in association with other asphyxial methods such as smothering (Burking) or strangulation [7]. ...
Traumatic or crush asphyxia is a rare condition characterized by the mechanical fixation of the chest causing compromise of the respiratory movements and blockage of venous return from the
head. The classical triad consists of head and neck cyanosis, subconjunctival haemorrhage and petechiae. The condition depicts the most extreme side of ‘classic signs’ of asphyxia. The present
case relates to a laborer whose dead body was found pinned under an overturned tractor on an irregular bumpy road. Autopsy revealed hallmark findings of crush asphyxia in the form of dark
purplish red discoloration of head, neck, shoulders and upper trunk along with petechiae and ecchymoses, with sparing of abdomen and rest of the lower portion of body. The same is described along with underlying pathophysiological mechanism and the possible variations in the pathological findings at autopsy.
... Our patient presented traumatic asphyxia due to a compression between the ground and a heavy object, this mechanism is common in reported cases. Other etiologies of Perthes syndrome are: motor vehicle crashes, crushing in a panicked crowd, entrapment beneath vehicles or falling down in a narrow space [5]. ...
... A variety of asphyxial issues may arise during forcible restraint that range from direct crush asphyxia due to chest and abdominal compression caused by officers/individuals lying on top of a struggling individual, to direct neck compression from bar arm or carotid sleeper holds across the neck. Careful documentation of the presence or absence of facial and/or conjunctival petechiae, with layer dissection of the neck to check for, or to exclude, bruising, are all important components of the autopsy examination in such cases [12,13]. Abnormal positions of the body, particularly if hogtied face down with wrists and ankles bound together behind the back (the so-called prone maximal restraint position PMRP), may result in lethal positional asphyxia, although it has been questioned whether this position per se is sufficient to cause lethal asphyxia without other additive factors [11,14]. ...
... Yet, the history of traumatic injury should rule out SVC obstruction, while skull fractures are rare in traumatic asphyxia, unless the force of compression is applied to the head. [8] In our patient, there was no significant evidence of basilar skull fracture both clinically and radiologically, and the history of trauma and crush injury mechanism excludes SVC obstruction to be the cause of the situation. The exact pathophysiology of traumatic asphyxia is still not clear. ...
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
... This case was previously listed in an audit of 79 cases of crush asphyxia between 1980 and 2004 in South Australia. 8 ...
Search of files at Forensic Science SA, Australia, over the past 20 years (1997-2016) revealed three cases of death due to crush asphyxia associated with the use of ride-on lawn mowers. (1) A 61-year-old man was trapped under a ride-on mower that had rolled over. Autopsy examination revealed congestion and petechial haemorrhages of the face and chest, and markings on the chest associated with underlying rib fractures. (2) A 78-year-old man was trapped under a ride-on mower that had also rolled over. Autopsy examination revealed petechial haemorrhages of the face and chest and markings on the chest. (3) A 72-year-old man was found wedged between a ride-on mower and a tree, with petechial haemorrhages of the face and chest, and markings on the front and back of the chest. These cases demonstrate a rare cause of crush asphyxia, often in older males in the domestic environment, which may arise from more than one mechanism.
... Most of the published fatal chest compression cases involve the mass of a car or tractor (typically > 1000 kg) compressing the torso, and hence they set a high upper bound on the mass required for ribcage failure. 22,23 Historical quantitative records exist of judicial ''pressing'' or the application of chest mass for interrogation or execution that is useful for model validation. 24 Cadaver car-safety tests of steering-wheel impacts also provide some useful chest compression data. ...
Background
Fatalities from acute compression have been reported with soft-drink vending machine tipping, motor vehicle accidents, and trench cave-ins. A major mechanism of such deaths is flail chest but the amount of force required is unclear. Between the range of a safe static chest compression force of 1000 N (102 kg with earth gravity) and a lethal dynamic force of 10–20 kN (falling 450 kg vending machines), there are limited quantitative human data on the force required to cause flail chest, which is a major correlate of acute fatal compression asphyxia.
Methods
We modeled flail chest as bilateral fractures of six adjacent ribs. The static and dynamic forces required to cause such a ribcage failure were estimated using a biomechanical model of the thorax. The results were then compared with published historical records of judicial “pressing,” vending machine fatalities, and automobile safety cadaver testing.
Results and conclusion
The modeling results suggest that an adult male requires 2550 ± 250 N of chest-applied distributed static force (260 ± 26 kg with earth gravity) or 4050 ± 320 N of dynamic force to cause flail chest from short-term chest compression.
... It is also called crush asphyxia [1]. Historically Ollivier, Tardieu and Perthes were the first ones in describing this phenomenon [2][3][4]. ...
Traumatic asphyxia is a clinical condition that is caused by the sharp increase in venous pressure in the territory of the superior vena cava due to a violent compression of the thorax. It is also called traumatic apnea, bruise mask, Perthes´ syndrome and Morestin´s syndrome. Case Report: This case report describes a male patient with a history of chest trauma secondary to a crushing impact from a bus for a period of approximately 10 minutes. He came to the emergency room with periorbital ecchymosis and bilateral conjunctival hemorrhage. Imaging studies showed left clavicular fracture, rib fractures and pulmonary contusion without other associated pathologies. The patient was handled with supplemental oxygen and analgesia, showing a favorable clinical evolution. Conclusion: The diagnosis is clinical, requires holistic management to rule out life-threatening injuries.
Keywords :Asphyxia, Oxygen, Pain Management, Rib Fractures, Thoracic Injuries
... Unfortunately, the findings at autopsy are often nonspecific and unhelpful in determining a likely cause and mechanism of death. In cases of chest compression during restraint, there may be facial and conjunctival petechiae supportive of venous engorgement from external pressure to the torso (10). In other instances, the findings may be entirely nonspecific, even when there has been significant hyperthermia. ...
The body of a 19-year-old male was found apparently concealed underneath bushes with recent head and facial trauma, and multiple superficial abrasions. Subsequently, it was discovered that the decedent had been running into objects and buildings following the ingestion the evening before of what was thought to be lysergic acid diethylamide (LSD). Blood staining of a nearby wall close to where the body was lying was in keeping with the described behavior. Toxicology revealed 3,4-methylenedioxymethamphetamine (Ecstasy), in addition to two only recently available drugs 2-(4-bromo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine, (25B-NBOMe), and 1-(3,4-methylenedioxyphenyl)-2-(1-pyrrolidinyl)-1-butanone, (MDPBP). At autopsy, the skull was fractured with cerebral swelling, contusions, and subarachnoid hemorrhage. Death was due to blunt cranial trauma against a background of mixed drug toxicity. The case demonstrates a rare cause of death in a drug-induced acute delirium, as well as highlighting two new designer street drugs that may result in significant aberrant behavior.
In majority of deaths from asphyxiation that affect the cerebral blood flow, compression occurs at the neck. Compressive asphyxia caused by a heavy weight is usually the result of an accident. The authors used the Korean national police agency's scientific crime analysis system to identify two cases of suicide by strangulation which were not otherwise specified, wherein asphyxiation occurred from an object pressing on the neck. In the first case, a man in his 50s died after the compression of his neck with a barbell shaft using a bench
press. In the second case, a man in his 80s died due to compression from the side bar of a single bed that pressed on his neck. As far as the authors know, there have been no reported cases of suicide in forensic literature that occurred due to compression from an object such as a barbell shaft of a bench press or a side bar of a bed. Upon classifying the types of asphyxiation, accurate statistics should be prepared and researched, with accurate understanding and classification of the terms therein. Each case in the present report is discussed along with a brief literature review.
Aim
To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies.
Methods
Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases).
Results
All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients’ injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered.
Conclusion
In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.
Traumatıc Asphyxıa is commonly known as condition encountered in injuries caused by motor vehicles. It is thought that the closure of the glottis is secondary response to fear and that the intracavitary pressure increases and causes harmful situations, in this case where the physiopathology due to sudden thorax compression and closure of the glottis is important.
Our case, 18 year old man, no known diseases, suddenly work machine overturns and thorax was under pressure during 30 minutes. The glasgow coma scale (GKS) was observed as 7 in the emergency department and he was intubated. After that he was taken to intensive care and the diagnosis was made here. Treatment was started and the patient was discharged without any sequelae.
Traumatic asphyxia is rarely seen and can be mortal, can be easily treated with supportive treatment if there is no pathology except for isolated tirade.
Review of the files of the Pathology section of Forensic Science SA over 17 yrs (January 2003-December 2019) revealed 32 adult cases of positional asphyxia (age range 18-87 years; average 49 years - m:f ratio 3:1). Predisposing/causative conditions were accidents, N = 8, alcohol intoxication N = 7, neurological disease N = 7, drug intoxication N = 5, morbid obesity N = 2, combinations of factors N = 2, and a single homicide N = 1. There was one case with below normal weight (BMI 17.9), with 6 cases having normal weights (BMI range 18.9-24.6, average 22.3), 9 being overweight (BMI range 25.3-29.5, average 27.9), and 16 being obese (BMI range 30-66.2, average 40.9). Only 7 cases (22%) had either under/normal weight compared to 25 (78%) who were overweight/obese (p < 0.05). Increasing body mass appears to be a risk factor to be considered in all forms of positional asphyxia; BMI should, therefore, be routinely taken into account in the forensic evaluation of such cases.
Introduction: Head injury is a leading public health problem causing loss of life and limb particularly among
young population throughout the world and our country is not an exception to this. Now-a-days, the term “head
injury” has been replaced by the new term “traumatic brain injury (TBI).” The incidence of head injury is rising
day by day worldwide because of inadequate traffic education, increased mechanization, and less implementation
of road safety rules. Materials and Methods: The present study was undertaken on fatal head injury cases of road
traffic accidents autopsied at Al-Ameen Medical College and District Hospital, Bijapur. The aim of this study was to
describe in detail all the autopsy findings in head injury due to RTA. Results: Two-wheelers was the most commonly
involved vehicle 114 (63.4%) cases. Next in the order was Pedestrians 47 (26.2%). In 54.9% victims facial injury was
seen. Abrasion was seen in 61 (33.9%) victims (Isolated or in combination with other injures). In majority of the
victims, contusion of the scalp was seen -137 (76.1%) (Isolated or in combination with other injures). Laceration was
seen in 24 (13.3%) victims. In this study 166 (92.2%) had skull fracture. Fracture of vault and base together was seen
in 121 (67.2%) Fracture of base alone was seen in 31 (17.2%) and in combination with vault constitute 152 (84.4%).
In majority of victim comminuted fracture was seen 112 (70.0%). Conclusion: From this study it is definite that head
is one of the most accessible, vital and vulnerable part of the body in road traffic accidents and so good things to
avoid accident or to protect from accident, wear helmet and avoid alcohol during driving. Following road safety
rules is atmost important to avoid accidents and head injury related to accident.
This represents one of several sections of "A Bibliography Related to Crime Scene Interpretation with Emphases in Geotaphonomic and Forensic Archaeological Field Techniques, Nineteenth Edition" (The complete bibliography is also included at ResearchGate.net.). This is the most recent edition of a bibliography containing resources for multiple areas of crime scene, and particularly outdoor crime scene, investigations. It replaces the prior edition and contains approximately 10,000 additional citations. As an ongoing project, additional references, as encountered, will be added to future editions.
The following citations consist of those which did not seem to fit any of the other taphonomy categories, are combinations of categories, or discuss taphonomy generally. Some address forensic anthropological techniques while others describe traumas or conditions which do not comfortably fit into the other categories under the heading Taphonomy. Many of these citations may cross-reference to other categories given their diversity. For example, someone interested in commingled human remains should check this bibliography’s section on Mass Fatality and Human Rights Investigations. As with each of the categories in this Taphonomy section, Criminal and Cultural Behavior helps explain the context of the original traumas. (1052 citations)
Two cases of accidental deaths caused by the sharp ends of fence or gate posts are reported. Case 1: A 47-year-old man was found hanging by his ankle in an inverted position on fencing. He had attempted a shortcut to a railway platform by climbing over a metal rail fence. He had slipped and been impaled through his ankle by the sharp end of the fence post, resulting in death from positional asphyxia. Case 2: An 18-year-old male slipped while climbing over a gate and died after being impaled on a spear tip finial, which had lacerated his external iliac vein. Death was due to exsanguination. These cases demonstrate two rare examples of accidental deaths from impalement by the ends of sharp fence posts. Mechanisms of death in such circumstances involve suspension with positional asphyxia and vascular injury with exsanguination.
Aims:
To investigate the neuropathology and brain weight in traumatic asphyxia caused by different accidents such as industrial accidents and road traffic collision.
Material and methods:
Post mortem records of 20 cases of traumatic asphyxia (TA) resulting from different causes of which four brains are available for comprehensive neuropathological examination. The expected brain weights for given body height and associated 95% confidence range were calculated according to the following formula: baseline brain weight (BBW) + body height x rate (g/cm). The 95% confidence range was calculated by adding and subtracting the standard error (SE) x 1.96 (7-8).
Results:
There was a trend for higher brain weight in the TA cohort but it was not significant (1494 g vs 1404 g, p = 0.1). The upper limits of the brain weight of 95% confidence was 1680 g vs 1660 g, p = 0.9. The neuropathological examination of four available brains from the TA cohort showed severe congestion of blood vessels, perivascular haemorrhages and occasional βAPP deposits consistent with early axonal disruption.
Conclusion:
Brain examination is informative as part of investigation of TA. Developing ischaemic changes and an increase in brain weight are the most likely indicators of a prolonged period of patient's survival.
The investigation of a death that occurs in custody requires a careful and methodical approach since concerns of police or institutional misconduct may be raised. The medicolegal official charged with the investigation and ultimate certification of death bears heavy responsibility to the decedent's family, the public, law enforcement and other institutions. A wide variety of causes of death and manners of death are seen in these deaths. This paper reviews causes, mechanisms, manners, findings, and evaluation of persons who have died in temporal relation to legal apprehension.
Rates of death because of asphyxia in motor vehicle crashes have been previously estimated using county and statewide data sets, but national estimates have not been reported. The literature regarding asphyxia in motor vehicle crashes primarily involves discussions about clinical findings, and crash-related variables have been sparsely reported. The current study calculated a nationwide fatality rate for asphyxia in motor vehicle crashes of 1.4%. Seventeen case studies of asphyxia were also reported providing crash-, vehicle-, and occupant-related variables. These included type of accident, crash severity, seat belt use, containment status, extent of occupant compartment intrusion, height, weight, and injury pattern. The data presented can be used to better understand the injury mechanism, identify risk factors, develop possible protective countermeasures, and create situational awareness for emergency responders and investigators.
There is probably not a year that goes by when injuries or deaths do not occur at incidents involving crowds. The internet resource of Still provides an insight into over 160 such incidents that have occurred between 1902 and December 2014 [1]. Examples of incidents covered at this site as well as within the published literature or accessible on Internet based resources include those involving football stadia, underground stations, gymnasia, nightclubs, access tunnels, religious and music festivals, as well as riverfronts, bridges and railway stations [2–22]. Although the cause of the incident may be suggested to be the action of the crowd, the crowd is often not the underlying cause. Rather it is the inappropriate utilisation of space and the failure of the organisers of the event or location to provide a safe environment for the crowd.
Deaths due to buffalo attack have not been well described. A 72-year-old man was trampled by a water buffalo (Bubalus bubalis) while attempting to move the animal within an enclosed area at an abattoir. At autopsy, there were numerous injuries involving the chest, head, neck, and left upper arm. Blunt force injury had resulted in multiple rib fractures with a flail chest and fracture/dislocation of the mid-cervical vertebrae caused either by physical crushing by the animal against the walls of the enclosure or by stomping. There was also evidence of crush asphyxia with bilateral conjunctival hemorrhages and petechial hemorrhages. In addition, there was a deep degloving injury of the upper left arm compatible with goring by one of the buffalo horns. While large animal attacks may result in death from multiple injuries, careful dissection and examination of specific injuries at autopsy may clarify the complex interaction of lethal mechanisms.
Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.
Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51-year-old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77-year-old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2-year-old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.
Asphyxia occurs when inadequate amounts of oxygen are supplied to the tissues and organs to maintain normal metabolic processes. Oxygen delivery to the cells may be blocked at a variety of stages involving its intake, transport, and uptake. Oxygen deprivation may be caused by low environmental oxygen levels, decreased transfer from the air, reduced transport from the lungs, and inadequate transfer across cell membranes. Determining whether lethal asphyxia has occurred relies on an accurate evaluation of the death scene, and the careful exclusion of underlying injuries or organic diseases that may have caused or contributed to death.
Vulnerability to accidents characterizes the extremes of life for reasons that may be similar in each age group. Two cases are reported to demonstrate increased risks of entrapment and crushing injury involving the use of electrically controlled beds/tables. Case 1: A frail 98-year-old woman with a history of dementia suffered a lethal crush injury to her head when she fell out of bed and accidentally activated its lowering mechanism. Case 2: An 18-month-old girl suffered a lethal crush injury to her head when she became trapped under a lowered electric massage table. Common devices may be dangerous if individuals do not have the mental or physical capabilities to deal with them. The forensic assessment of such deaths involves an evaluation of the neurocognitive level and physical strength of the decedent as documented in previous clinical assessments, in addition to a careful examination of the structure and function of the bed/table.
Scene investigation is an important part of the medicolegal autopsy. In many cases of death cannot be determined without knowledge of the circumstances. A case is presented in which the diagnosis of compression asphyxia and smothering was made only after analysis of the scene findings.
A literature review of traumatic asphyxia is given. The most important presuppositions for the development of traumatic asphyxia are: a) thoracic compression, b) warning of impending disaster just prior to trauma leading to inspiration and closing of the glottis.
These mechanisms result in an increase of the intrathoracic pressure with subsequent reflow of blood into the cranio-cervical veins which are not protected by valves. — Independently the prevention of thoracic breathing leads to severe asphyxia. Death occurs only in prolonged thoracic compression and is either due to pulmonary congestion or to asphyxia.
Morphological and biochemical examinations were performed systematically with four fatalities of asphyxia and three cases who had died of both, asphyxia and polytrauma.
The autopsy findings corresponded to the well-known picture of traumatic asphyxia: edema, cyanosis and hemorrhages in the region of the upper v. cava, excessive pulmonary congestion and signs of suffocation.
Histological changes were felt to be due to three major pathomechanisms: a) Changes of hypoxidosis due to asphyxia: vacuolisation and edema of hepatocytes, the renal tubular epithelium and the heart muscle cells, mobilization of alveolar cells with formation of multinucleated giant-cells. b) Intermediate or severe degrees of pulmonary microembolism mainly consisting of fat droplets and bone marrow and additionally of smaller quantities of free megacaryocytes. c) Interstitial and intraalveolar edema of the lungs and interstitial edema of the heart muscle mainly due to the haemodynamic disturbances.
Biochemically the serum catecholamine concentrations were moderately or strongly elevated pointing to asphyxial pathomechanisms. — Fatal termination is supposed to be due to a combined action of haemodynamic dysregulation, asphyxia and pulmonary microembolism.
Soda pop vending machine tipping continues to be a dangerous behavior that can result in lethal or crippling injuries. This study analyzes 64 cases of injuries secondary to crushing by a soda machine. All were male victims except one. The average age was 19.8 years with a range of 5-39 years. Thirteen victims sustained multiple trauma. Fifteen victims were killed. Increased public awareness coupled with support by the government and private industry has contributed to a sharp reduction in incidence of accidents and improved public safety.
Patients with traumatic asphyxia treated at a single institution during a 10-year period were studied to determine the incidence and sequelae of neurologic impairment associated with this entity. Traumatic asphyxia was identified in 14 patients from 4 to 73 years old. Each had sustained thoracic crush injuries from objects weighing more than 1,000 pounds. The mechanism of injury was crush by farm implement in six patients, entrapment beneath a vehicle in five, compression by a large hay bale in one, crush by a farm animal in one, and a ditch cave-in in one. Craniocervical cyanosis and subconjunctival hemorrhage were apparent in all patients. Associated chest wall and intrathoracic injuries were present in 11 (79%) patients. Neurologic abnormalities included loss of consciousness in eight patients, prolonged confusion in five, seizures in two, and pronounced visual disturbances in two. There were no deaths in this series and no long-term neurologic sequelae were evident. However, careful serial neurologic assessment should be performed in these patients and other causes of neurologic symptoms excluded.
During a 5-year period, we treated 14 cases of traumatic asphyxia. There were 12 male and 2 female patients ranging in age from 2 to 32 years. Most suffered crushing injuries at work or were run over by motor vehicles. Mild to severe cervicofacial cyanosis and petechiae developed in all patients. A fear response was reported by 12 of the patients. Subconjunctival hemorrhage was also found in 12 patients. Nine patients had tachypnea and 7 complained of dyspnea. Most of the patients suffered some associated injuries including 8 head injuries, 7 pulmonary contusions, and 6 cases of blunt abdominal trauma. Less-associated injuries were rib fractures, brachial and radial nerve injuries, hemothorax, and pneumothorax. The hospital stay ranged from 4 to 28 days (mean, 14 days) and follow-up from 10 to 60 months (mean, 32 months). Treatment for traumatic asphyxia included measurement of arterial blood gases, oxygen supplementation, and intubation with mechanical ventilation. The patients' recovery conditions were relative to the severity of injury and the associated injuries.
Traumatic asphyxia is a distinctive clinical syndrome characterized by cervicofacial cyanosis and edema, multiple petechiae, and subconjunctival hemorrhage after a severe crush injury of the thorax or of the upper part of the abdomen. A case of traumatic asphyxia is reported, and its clinical and pathophysiologic features are discussed.
Abuse and misuse of soda vending machines has resulted in a considerable number of injuries and deaths. The machines fall forward when rocked or tilted and crush those in front. These accidents are all preventable by a simple and cheap device. There should be a law compelling safety requirements for these machines. This is a report of a recent case in which a young man was crushed to death.
Traumatic asphyxia secondary to a crush injury of the chest is characterized by craniocervical cyanosis, subconjunctival hemorrhage, and severe vascular engorgement of the head and neck. These signs are believed to be due to high venous pressures causing stasis and capillary rupture. A "fear response" that produces a strong Valsalva maneuver is thought to be necessary for their development. The lower torso seems to be protected, and previously this was thought to be due to its superior system of valves. We present here ultrasonographic evidence that the inferior vena cava is compressed or obliterated during a Valsalva maneuver, and propose that this compression protects the lower torso during traumatic asphyxia.
Fifteen male patients, 15 to 24 years of age, sustained injuries after rocking soda machines. The machines fell onto the victims, resulting in a variety of injuries. Three were killed. The remaining 12 required hospitalization for their injuries. Unless changes are made to safeguard these machines, people will continue to suffer severe and possibly fatal injuries from what are largely preventable accidents.
(JAMA 1988;260:2697-2699)
Petechiae can be important corroborative evidence of asphyxia, but are also seen in persons who have died of other means. It is not uncommon to encounter them in cases in which cardiopulmonary resuscitation has reestablished blood flow and pressure in small vessels already damaged by hypoxia resulting in the formation of petechiae. This report documents some representative cases.
Conjunctival petechiae were mentioned in 227 (4.5%) of 5,000 consecutive autopsy reports of the Dade County Medical Examiner Department. They were most frequently observed in those who had died natural deaths (particularly due to cardiovascular disease), followed by those who had died from asphyxia, head injury, and central nervous system disorders. The incidence of conjunctival petechiae in victims of homicidal asphyxiation was 78%. These data suggest that conjunctival petechiae most often are the result of hypoxia coupled with an acute increase in cephalic vascular pressure. The latter factor may be the consequence of mechanical vascular obstruction or acute right heart failure.
Compression of the chest causing facial petechiae, violaceous facial hue, subconjunctival hemorrhages, and frequent mental status abnormalities has been termed traumatic asphyxia. We identified 35 such cases occurring in the State of New Mexico from 1980 to 1985 from records of the Office of the Medical Investigator (n = 30) and from cases presenting to the University of New Mexico Trauma Center (n = 5). Among those found at highest risk for traumatic asphyxia were people ejected from motor vehicles, men working under cars that were inadequately supported and fell onto the victims, children under the age of 5 years who were crushed under household furniture, and people involved in construction activities. Traumatic asphyxia following a moving motor vehicle accident was significantly associated with alcohol ingestion (p less than 0.001). Preventive and therapeutic strategies should focus on the groups and events identified.
Scene investigation is an important part of the medicolegal autopsy. In many cases the cause of death cannot be determined without knowledge of the circumstances. A case is presented in which the diagnosis of compression asphyxia and smothering was made only after analysis of the scene findings.
Stadium crowd surges frequently occur following major athletic events. A recent crowd surge injured more than 80 persons by trampling and/or crushing. This incident was reviewed to identify injury patterns consistent with crush-related injury. In addition, the incident was reviewed to determine which stadium policy and design factors may have potentiated this event.
A recent crowd surge occurred following a college football game. This resulted in 86 people being transported to the University of Wisconsin and other area hospitals. All charts were reviewed to evaluate patient outcomes. The stadium was examined as were security system video tapes to evaluate stadium factors that contributed to this event. Current policies were obtained through the university sports administration.
Of 86 patients transported for evaluation of stadium-related injuries, 10 were treated for traumatic asphyxia. Other injuries requiring hospital admission included musculo-skeletal trauma in two patients and one grade II liver injury. Six others were admitted overnight for observation. Several stadium factors were identified that contributed to the event, and appropriate changes in crowd control policies and stadium design were instated to prevent recurrence.
This report details the largest single report of traumatic asphyxia second to the England Hillsborough disaster. Several stadium factors were identified that resulted in crush-related injury. Cooperative review and modification of stadium policies and design may prevent such events in the future.
Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonasphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.
Three cases are described in which deaths after motor vehicle accidents occurred as a result of positional asphyxia associated with exposure to gasoline. The deceased individuals were aged 16, 34, and 35 years, respectively (M:F = 1:2) and had all been in the back seat of motor vehicles involved in rollover accidents that had resulted in spilling of gasoline with contamination of the cabins. Major components of gasoline were detected in blood and tissues by headspace gas chromatography. Postmortem toxicologic investigations of such cases, which include analyses for volatile hydrocarbons, may therefore produce additional significant information.
The present study was undertaken to examine specific features of unintentional traumatic asphyxial deaths in childhood.
Coronial files and records at the Forensic Science Centre in Adelaide, South Australia, were examined over a 35-year period from 1966 to 2000 for all cases of traumatic asphyxial death occurring in children under the age of 17 years.
Six cases of unintentional fatal traumatic asphyxia were identified. All of the victims were boys with an age range of 2-15 years (mean 6.8 years) and all were found dead at the scene. Fatal traumatic asphyxia resulted from entrapment beneath a chest of drawers, beneath a table tennis table, between a pile of wooden pallets and a metal fence, between a conveyor belt and its frame, and under a motor vehicle (in two cases).
Fatal traumatic asphyxia in childhood is a rare event, with younger children commonly being trapped by furniture or by industrial equipment while playing, and older children being trapped under motor vehicles in similar circumstances to adult traumatic asphyxial deaths. Unsupervised play of young children around heavy and potentially unstable pieces of furniture may be dangerous, particularly if more than one child is present. Unsupervised play of young children in industrial yards should be avoided.
Because death from suffocation in traffic fatalities has not been well described, we delineated the clinical, circumstantial, and autopsy findings associated with suffocation in a series of motor vehicle crashes. Medical examiner case files from a 5-year period were reviewed. Scene investigation, autopsy, toxicology, and first-responder reports were examined. Crash descriptions were reviewed, including vehicle type, mechanism of crash, response time, restraint use, occupant ejection, and victim position in cabins of vehicles. Mechanisms of suffocation, including torso compression, inversion, neck flexion, facial occlusion, and blood aspiration, were determined for each case. The files were searched for factors relevant to the diagnosis of suffocation, namely, cerebral concussion, alcohol intoxication, obesity, petechiae, lung weights as a proxy for livor, natural disease, and impact wounds. Twenty-nine traffic fatality cases were identified in which suffocation caused death. In 26, suffocation mechanisms were solely responsible for death. In 3, death was caused by suffocation in combination with other mechanisms. Twenty-five subjects were occupants of vehicles with cabins and 4 were motorcycle riders. The most common mechanism of suffocation was torso compression. Most subjects had either multiple mechanisms of suffocation or a single mechanism acting in concert with concussion or alcohol intoxication. Concussion and intoxication were common, with one or both present in 20 subjects, including all of those with blood aspiration. Petechiae were frequent but were found consistently only among those with inversion. Cutaneous chest petechiae were associated with inversion and torso compression. Lung weights were highest among those with blood aspiration and lowest among those with inversion. Body mass index was highest among those with inversion, suggesting that obesity could be a risk factor for this mechanism.
We presented an unusual case of negligent homicide by thorax compression, which is the expanded concept of traumatic asphyxia. A 58-year-old man was restrained in the prone position by six prison officers. They were ordered by their superiors to continue restraining him for about 15 min and the victim died. At the forensic autopsy, typical findings of thorax compression with intramuscular hemorrhages on the back and multiple fractures of the ribs were observed. No evidence of neck compression/smothering or other fatal issues likely to occur by chest compression was found. The reconstruction of the scene corresponded exactly with the localization of the injuries found in the victim. This is the first case of death by pure thorax compression without other fatal factors during intentional restraint, in which the force causing the chest compression was distinctly determined by the autopsy and reconstruction.
Nine people died of traumatic asphyxia due to an uncontrolled crowd at a community basketball game in New York City in 1991. We reviewed the circumstances, postmortem findings, and the causes of death. The majority of people had petechiae of the conjunctivae and face consistent with chest compression. There were minimal superficial blunt injuries and no fractures or acute intoxications. These deaths are often incorrectly attributed to blunt force injuries, while the cause typically is asphyxia due to chest compression.
Petechial hemorrhages or ecchymoses in the skin of the face and/or in eyelids and/or conjunctivae are one important feature in postmortem diagnosis of lethal strangulation. On the other hand, petechial bleedings can occur in various causes of death, especially in cases of neck or thoracic compression, they can occur in acute cardiac failure, as a result of blood or skin diseases or as a postmortem phenomenon. The focus of this investigation (retrospective study of 279 corpses, found initially in a prone position or some other face down position) was to analyse the frequency of postmortem (hypostatic) hemorrhages and factors which may influence their development. Petechial hemorrhages in livor mortis in the skin of the trunk and extremities were found in 110 cases (39%). The frequency ranged from 41% in the side position and 44% in the kneeling position to 50% in the prone position. Increasing intensity of livor mortis resulted in an increasing frequency of hemorrhages, up to 59%. In cases with a body-mass-index (BMI) of more than 26 the frequency of hemorrhages increased up to 64%. In cases without livor mortis when the corpses were found as well as in cases with complete movement of livor mortis after turning the corpses, no hemorrhages were found. If hypostasis was partly or completely fixed, the rate of hemorrhages increased up to 50%, without additional increase in longer postmortem intervals. Obviously postmortem petechiae develop neither very soon nor days after death, but within a period of several hours after death.
The diagnosis of crush asphyxia typically relies on a history of chest or abdominal compression with the finding of skin petechiae and congestion. The following three cases of crush asphyxia demonstrate a distinctive pattern of petechiae and congestion associated with close-fitting clothing: Case 1, a 49-year-old woman who was crushed under a large hay bale; Case 2, a 35-year-old woman who was crushed between a wall and a car; Case 3, a 49-year-old woman who was crushed between a crane and the side of a truck. At autopsy in all three cases there were facial, conjunctival, neck and upper anterior chest petechiae. However, few or no petechiae, and reduced congestion, were observed in areas beneath the victims' brassieres. Deaths in these cases were all due to crush asphyxia, with the pattern of petechiae on the chests of the victims influenced by close-fitting clothing that had compressed cutaneous vasculature. This brassiere 'sign' provided a readily observable and easily recordable sign of crush asphyxia due to chest compression, and illustrated that vascular engorgement is necessary for the development of petechiae in these circumstances.
Zum Tod durch Perthes'sche Druckstauung
- W Grellner
- B Madea
W. Grellner, B. Madea, Zum Tod durch Perthes'sche Druckstauung, Arch. Kriminol. 198 (1996) 167-175.
Asphyxia, in: Forensic Pathol-ogy
- D J Di
- V J M Maio
- Di
D.J. Di Maio, V.J.M. Di Maio, Asphyxia, in: Forensic Pathol-ogy, Elsevier, New York, 1989, pp. 207–252 (Chapter 8).
Suffocatio in and 'asphyxia', in: Knight's Forensic Pathology
- P Saukko
- B Knight
P. Saukko, B. Knight, Suffocatio in and 'asphyxia', in:
Knight's Forensic Pathology, 3rd ed., Arnold, London, 2004,
pp. 352-367 (Chapter 14).
Ueber ''Druckstauung'', Dtsch
- G Perthes
G. Perthes, Ueber ''Druckstauung'', Dtsch. Z. Chir. 55 (1900)
384-392.
Suffocatio in and ‘asphyxia’
- Saukko