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Lombardi Law Firm

Dusting off your coffin?

Steve Lombardi
Iowa personal injury, workers' compensation, motorcycle, quadriplegic, paraplegic, brain injury, death

Blog Category:
3/3/2014
Steve Lombardi
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What did this person die of? The scope of the diagnosis or pronouncement as to the cause of a person's death differs. It can be compression to the chest, heart or throat with such force as to stop the person from breathing; leading to death. Often quoted by the public as strangulation, that is one way of describing compression asphyxia. Asphyxia may be from natural, accidental or from intentional causes. The acts leading up to compression asphyxia is present in both civil personal injury cases and criminal cases involving some form of homicide or accidental death by willful means.
 
I read about this young lady and found it interesting. This younger generation in an effort to get high while leaving no trail have come up with something called "dusting". Listen to this report from Suzanne Phan of KCRA-3.

Inhalants are everyday products such as glue, gasoline, and hairspray, which some teens try to get high from by sniffing or "huffing" them. Though it may not seem dangerous, huffing is one way many teens hurt themselves -- or die -- each year. Get the facts about inhalants: what they are, how they work, and why they're dangerous to use, even just once.

What Are Inhalants?

Inhalants, as you may have guessed, are substances such as paint, gasoline and glue that can be sniffed or inhaled to get high. Some people use inhalants to kick-start their sex drive. People call inhalants by a lot of different names, including "snappers," "poppers," "whippets" and "amies." Some people refer to inhaling as "huffing" or "dusting." Whatever you call it, it's not safe!

Teens sometimes inhale fumes from household products from plastic bags or balloons, or by sniffing a vapor-soaked rag. Inhalants can also be sniffed, snorted or sprayed into the mouth or nose. Some people inhale over and over again in a short time period to make the high last longer, putting them at great risk of harming themselves.

Now let us get back to compression asphyxia. In researching this medical condition I stumbled upon a tribute to Michaela McAreavey nee Hart with several video clips on YouTube. While I can't be sure of the facts generated by the investigation the caption reads: "Michaela McAreavey nee Harte murdered during her honeymoon in Mauritius. " Negligent Homicide by Traumatic Asphyxia, Yoshitome, Yamamoto, Naka, Ishizu, International Journal of Legal Medicine, Department of Legal Medicine, Okayama University Graduate School of Medicine and Dentistry, January 14, 2004

Fetal Asphyxia defined.     See also Dr. Ferris' discussion below.

ASPHYXIA,     Dr. J.A.J. Ferris 

DEFINITION The physiological definition of "asphyxia" is complex and often means more than hypoxia.  In the field of forensic pathology, asphyxia is considered to be a consequence of a struggle to breathe against some mechanical interference with respiration. General Autopsy Findings in Asphyxial Deaths The following are general findings in death by asphyxia.  Their prominence will vary with individual cases and petechial hemorrhages, in particular, may be completely absent, or extremely rare.  It is also important to note that all of the findings in asphyxial deaths may be found, on occasion, in other circumstances.
1.             Pulmonary edema, with froth in trachea and bronchi. 
2.             Bulky, crepitant and over‑distended lungs. 
3.             Right ventricular dilatation. 
4.             Petechial hemorrhages on the conjunctival and facial tissue, usually above the level of the airway obstruction in strangulation cases. 
 
Suffocation Suffocation results from the mechanical obstruction to the entry of air into the lungs by obstruction of the external respiratory orifices.  Common agents used are plastic bags, soft pillows, or soft materials used to occlude the mouth and nostrils. Smothering can be homicidal, suicidal, or accidental.  In homicidal suffocation, there is usually considerable physical disparity between the assailant and victim, or the victim is debilitated by drugs or injury. Scene investigation may not be helpful.  Some cases of Sudden Infant Death Syndrome have been erroneously attributed to overlying by the mother. The autopsy findings are subtle and injuries may be completely absent.  Examination of a suicidal death by suffocation with a plastic bag usually reveals moisture on the face and on the inner surface of the bag. In homicidal suffocations, there may be fingernail scratches, or bruises to the face, or tears to the buccal mucosa.  There may be marks associated with use of a tape or a gag.  If neck compression does not occur, petechial hemorrhages may not be found.  The diagnosis of suffocation may be impossible to establish with certainty on the basis of the postmortem examination alone. 
 
Upper Airway Obstruction (Choking) The usual mechanisms of asphyxia in choking are mechanical obstruction of the airway, usually involving the pharynx, larynx and trachea. The most common situation is the so‑called "cafe coronary".  Victims are usually intoxicated, or have pre‑existing neurological debilitation.  Choking occurs suddenly while eating.  The obstructing foreign body may be removed prior to autopsy.  Children may choke on small toy objects, nuts or grapes. The vast majority of choking deaths are accidental.  Suicides and homicides occur very rarely. Inhalation, or aspiration, or gastric contents as a primary event is extremely unusual.  When aspiration occurs, drugs, such as alcohol, a head injury, or serious neurological disease process should be sought.  Significant aspiration of gastric contents during an epileptic seizure is relatively unusual. The autopsy findings in choking, again, may be subtle, particularly if the occluding object has been removed.  Petechiae may be present if significant retching has occurred.  There may be injuries to the buccal mucosa, related to resuscitation.  The right ventricle of the heart is dilated and the lungs hyperinflated and possibly edematous.  Inhalation of blood may play a significant accelerating role in trauma cases, such as those associated with facial fractures.  Aspiration is usually the mechanism of death and not the cause of death and a complete autopsy and toxicological examination are necessary to identify these modifying factors. 
 
Hanging As in most asphyxial deaths, hanging can be suicidal, accidental, or homicidal, but suicidal hangings are by far the most common. Hanging deaths result from compression of the airway and neck vessels as a result of suspension in such a manner that the force acting on the ligature is that of all or part of the weight of the body. Examination of the scene is important.  The posture, position and method of hanging and ligature used must all be examined and injuries, other than those attributable to hanging, require careful assessment and interpretation.  It is important to remember that complete suspension is not necessary.  In most hanging deaths, the ligature and ligature mark lie above the thyroid prominence, with a point of suspension usually behind one ear.  Frontal knots are unusual.  The appearance of the ligature mark varies with the type of ligature used and with the physical characteristics of the individual neck.  Soft broad ligatures may not leave any recognizable marks.  In most cases, the ligature does not completely encircle the neck. Successful hanging can be accomplished in a variety of positions, including a semi‑reclining sitting or lying position.  The only requirement is for sufficient sustained pressure to be applied to the neck. 
 
 The findings at autopsy and hanging include the ligature mark, which is usually abraded and parchmented and may, depending on the ligature used, show specific patterning.  The deepest furrow is opposite the point of suspension and fades as it approaches the knot.  Scratches, in relation to the ligature mark, with the appearance of fingernail scratches, should be documented and investigated. Petechial hemorrhages are usually completely absent, when the full weight of the body acts on the ligature, but are present in varying degrees of prominence, when the victim is only partly suspended.  Layered neck dissection usually shows completely absent, or only minimal, bruising into the soft tissue.  Dissection of the carotid arteries may show occasional linear traction type tears.  Fractures of the vertebrae do not occur unless there is a significant drop, such as a judicial hanging. Accidental hangings are far more common in children, than in adults.  They are frequently the result of articles of clothing caught up in machinery. Auto‑erotic asphyxial deaths usually involve males and occur in isolated or secluded sites.  There may be evidence of transvestitism, bondage, mirrors, cameras, etc. 
 
 
Ligature and Manual Strangulation Strangulation results when the application of a constricting force to the neck is such that the force exerted is other than that of the weight of the body.  The two types of strangulation include manual strangulation and strangulation by ligature.  The victims are usually women, children, or the elderly.  Ligature suicides can occur, but the ligatures must be fashioned in such a manner that the pressure on the neck is maintained after loss of consciousness. At autopsy, in cases of ligature strangulation, the ligature mark is usually horizontal and crosses the neck in the region of the lower end of the thyroid cartilage.  Particularly with ridges on thin ligatures, a furrowed mark will be evident.  Large bulky ligatures may not leave any surface evidence of injury to the neck.  Petechial hemorrhages to the face and conjunctiva are usually prominent, as are the usual signs of asphyxia in the lungs and heart.  A layer by layer dissection of the neck should be performed, with the neck incision extending up to the level of the mastoid processes.  Serial photographs should document the distribution and pattern of bruising to the soft tissue and muscle. Pure ligature strangulation is relatively uncommon and there is usually an associated manual component.  Consequently, fractures of the hyoid and thyroid are seen, due to compression of these structures against the cervical vertebrae.  Other associated injuries should be carefully sought for and documented, such as scratches to the face, or neck, or bruising to the extremities.  Evidence of an associated sexual assault should also be sought.  Decomposition may render marks difficult, or impossible, to recognize. 
 
 
Mechanism of Death in Neck Compression In hanging, unconsciousness is rapid, due to obstruction of circulation to the brain.  Significant obstruction of the carotid arteries can occur with a tension of approximately ten pounds.  Vascular obstruction is the main mechanism, leading to death with neck compression. In ligature and manual strangulation, incomplete carotid occlusion is expected to occur and the struggle may continue for a period of time.  This accounts for the injuries and petechial hemorrhages evident at autopsy in strangulation cases.  As in all cases of neck compression, the rapidity of death can be effected by susceptibility of the victim to carotid sinus stimulation.  Neck holds used by the police may be extremely dangerous and there is some evidence that cocaine intoxication increases susceptibility to sudden cardiac arrest from vagal inhibition.
 
 
Crush or Traumatic Asphyxia These situations occur when external compression of the chest prevents effective respiratory moments.  These deaths are almost always accidental and occur in situations, such as pinning of the victim beneath an overturned car, or in crowds or mob panics.  In this category also falls the procedure, "burking". At autopsy, there is evidence of severe congestion and cyanosis above the level of compression frequently with a sharp line of demarcation.  Petechial hemorrhages are prominent and may be confluent above the point of compression.  There may be associated sternal, or spinal, fractures and interstitial emphysema. 
 
 
Positional Asphyxia Position alone can cause death.  Victims suspended upside down in industrial accidents may die as a result of the effects of the abdominal organs compressing the diaphragmatic movement necessary for respiration.  Acute positional flexion of the neck in a deeply intoxicated individual may result in hypoxia and subsequent death. 
 



Category: Pedestrian Accidents & Injuries


1 Comments to "Dusting off your coffin?"

Thanks for sharing an info about asphyxia. This makes more people aware on one of the common cause of suspicious death. It is good that people should be aware on the causes of death so that they cannot wrongly formulate wrong perceptions right away.
Posted by Forensic Toxicology on March 25, 2012 at 12:06 AM

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