Asphyxial deaths - Revision history

Michael at 04:02, 6 January 2017

2017-01-06T04:02:10Z

← Older revision		Revision as of 04:02, 6 January 2017
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	Features:<ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref><ref>URL: [http://netk.net.au/Forensic/Drowning.pdf http://netk.net.au/Forensic/Drowning.pdf]. Accessed on: 20 September 2010.</ref>		Features:<ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref><ref>URL: [http://netk.net.au/Forensic/Drowning.pdf http://netk.net.au/Forensic/Drowning.pdf]. Accessed on: 20 September 2010.</ref>
	*Lung emphysema; "kissing lungs" = lungs touch one another -- on opening the chest.		*Lung emphysema; "kissing lungs" = lungs touch one another -- on opening the chest.
	*Froth in the trachea.		*Froth in the [[trachea]].
	*Paltauf spots -- light-red washed-out appearing fingertip-sized spots.<ref>URL: [http://www.mijnwoordenboek.nl/EN/theme/ME/EN/DE/P/3 http://www.mijnwoordenboek.nl/EN/theme/ME/EN/DE/P/3]. Accessed on: 20 September 2010.</ref>		*Paltauf spots -- light-red washed-out appearing fingertip-sized spots.<ref>URL: [http://www.mijnwoordenboek.nl/EN/theme/ME/EN/DE/P/3 http://www.mijnwoordenboek.nl/EN/theme/ME/EN/DE/P/3]. Accessed on: 20 September 2010.</ref>
	**Thought to arise from hemolysis + fluid decedent drown in.		**Thought to arise from hemolysis + fluid decedent drown in.

Michael: /* Toxicology */

2016-01-04T03:51:15Z

Toxicology

← Older revision		Revision as of 03:51, 4 January 2016
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	===Toxicology===		===Toxicology===
	*Classically has the smell of "rotten eggs".<ref name=pmid20920221>{{cite journal \|author=Morii D, Miyagatani Y, Nakamae N, Murao M, Taniyama K \|title=Japanese experience of hydrogen sulfide: the suicide craze in 2008 \|journal=J Occup Med Toxicol \|volume=5 \|issue= \|pages=28 \|year=2010 \|pmid=20920221 \|pmc=2954931 \|doi=10.1186/1745-6673-5-28 \|url=}}</ref>		*Classically has the smell of "rotten eggs".<ref name=pmid20920221>{{cite journal \|author=Morii D, Miyagatani Y, Nakamae N, Murao M, Taniyama K \|title=Japanese experience of hydrogen sulfide: the suicide craze in 2008 \|journal=J Occup Med Toxicol \|volume=5 \|issue= \|pages=28 \|year=2010 \|pmid=20920221 \|pmc=2954931 \|doi=10.1186/1745-6673-5-28 \|url=}}</ref>
	*Lab: ''thiosulfate'' ~~- not available in Canada as of 2010~~.		*Lab: ''thiosulfate''.

	===Gross===		===Gross===

Michael: /* Gross */

2015-06-05T03:08:08Z

Gross

← Older revision		Revision as of 03:08, 5 June 2015
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	*Patterned ovoid contusions (from the fingers).		*Patterned ovoid contusions (from the fingers).
	*+/-Defensive-type injuries.		*+/-Defensive-type injuries.

			====Image====
			<gallery>
			Image:Hofmann_Lehrbuch_suidide_hanging.jpg \| Drawing of suicide by hanging. (WC/National Library of Medicine)
			</gallery>

	===Microscopic===		===Microscopic===

Michael: /* Choking */ w

2013-04-17T04:15:36Z

Choking: w

← Older revision		Revision as of 04:15, 17 April 2013
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	Associations:		Associations:
	*Ethanol intoxication.<ref name=pmid20666919>{{Cite journal \| last1 = Nikolić \| first1 = S. \| last2 = Zivković \| first2 = V. \| last3 = Dragan \| first3 = B. \| last4 = Juković \| first4 = F. \| title = Laryngeal choking on food and acute ethanol intoxication in adults--An autopsy study. \| journal = J Forensic Sci \| volume = 56 \| issue = 1 \| pages = 128-31 \| month = Jan \| year = 2011 \| doi = 10.1111/j.1556-4029.2010.01510.x \| PMID = 20666919 }}</ref>		*[[Ethanol]] intoxication.<ref name=pmid20666919>{{Cite journal \| last1 = Nikolić \| first1 = S. \| last2 = Zivković \| first2 = V. \| last3 = Dragan \| first3 = B. \| last4 = Juković \| first4 = F. \| title = Laryngeal choking on food and acute ethanol intoxication in adults--An autopsy study. \| journal = J Forensic Sci \| volume = 56 \| issue = 1 \| pages = 128-31 \| month = Jan \| year = 2011 \| doi = 10.1111/j.1556-4029.2010.01510.x \| PMID = 20666919 }}</ref>
	*Neurologic disease.<ref name=pmid17209932>{{Cite journal \| last1 = Dolkas \| first1 = L. \| last2 = Stanley \| first2 = C. \| last3 = Smith \| first3 = AM. \| last4 = Vilke \| first4 = GM. \| title = Deaths associated with choking in San Diego county. \| journal = J Forensic Sci \| volume = 52 \| issue = 1 \| pages = 176-9 \| month = Jan \| year = 2007 \| doi = 10.1111/j.1556-4029.2006.00297.x \| PMID = 17209932 }}</ref>		*Neurologic disease.<ref name=pmid17209932>{{Cite journal \| last1 = Dolkas \| first1 = L. \| last2 = Stanley \| first2 = C. \| last3 = Smith \| first3 = AM. \| last4 = Vilke \| first4 = GM. \| title = Deaths associated with choking in San Diego county. \| journal = J Forensic Sci \| volume = 52 \| issue = 1 \| pages = 176-9 \| month = Jan \| year = 2007 \| doi = 10.1111/j.1556-4029.2006.00297.x \| PMID = 17209932 }}</ref>

Michael: /* General */ w

2013-04-17T03:15:46Z

General: w

← Older revision		Revision as of 03:15, 17 April 2013
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	Epidemiology:		Epidemiology:
	*Extremes of age.<ref name=pmid17209932/>		*Extremes of age.<ref name=pmid17209932/>
	**Old - often ~~assoc.~~ with neurologic disease or alcohol.		**Old - often associated with neurologic disease or [[alcohol]].
	**Young - may be foreign body ingestion.		**Young - may be foreign body ingestion.

Michael: /* Drowning */

2012-12-23T13:34:04Z

Drowning

← Older revision		Revision as of 13:34, 23 December 2012
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	==Drowning==		==Drowning==
	===General===		===General===
	~~Classic~~:		*Drowning is difficult to prove on autopsy.<ref name=pmid16378701>{{cite journal \|author=Piette MH, De Letter EA \|title=Drowning: still a difficult autopsy diagnosis \|journal=Forensic Sci. Int. \|volume=163 \|issue=1-2 \|pages=1–9 \|year=2006 \|month=November \|pmid=16378701 \|doi=10.1016/j.forsciint.2004.10.027 \|url=}}</ref> The diagnosis is often based on circumstance, i.e. the scene.
	*~~Autopsy~~ is often negative, i.e. there is no anatomical cause of death.		**The [[autopsy]] is often negative, i.e. there is [[negative autopsy\|no anatomical cause of death]].

	~~Drowning is difficult to prove on autopsy.<ref name~~=~~pmid16378701>{{cite journal \|author~~=~~Piette MH, De Letter EA \|title~~=~~Drowning: still a difficult autopsy diagnosis \|journal~~=~~Forensic Sci. Int. \|volume~~=~~163 \|issue~~=~~1-2 \|pages~~=~~1–9 \|year~~=~~2006 \|month~~=~~November \|pmid=16378701 \|doi=10.1016~~/j.~~forsciint~~.~~2004~~.~~10.027 \|url=}}</ref> The diagnosis is often based on circumstance~~, ~~i.e~~. ~~the scene~~.		====Laboratory====
			There are a few tests of debated value:<ref name=pmid16378701/>
			*Diffusion of particulates into the blood (left ventricle) from the water.
			**Diatom test.
			*Haemodilution.
			**Mostly useless - CPR interferes with it, not reliable if there putrefaction or autolysis.
			*Transport of aveolar element into blood circulation.

	===~~Macroscopic~~===		===Gross===
	External:		====External findings====
	*''[[Plume of froth]]'' ([[AKA]] ''cone of foam'') at the mouth/nostrils (fresh drowning only).<ref name=pmid16378701/><ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref>		*''[[Plume of froth]]'' ([[AKA]] ''cone of foam'') at the mouth/nostrils (fresh drowning only).<ref name=pmid16378701/><ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref>
	**Classic DDx for this finding is: narcotics, [[congestive heart failure]].		**Classic DDx for this finding is: narcotics, [[congestive heart failure]].
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	*Wrinkled skin ([[AKA]] ''washerwoman skin'' and ''hydration changes'') - changes due to water immersion; changes may be present in the context of immersion post-mortem.<ref name=pmid6741294>{{cite journal \|author=Reh H \|title=[Early postmortem course of washerwoman's skin of the fingers] \|language=German \|journal=Z. Rechtsmed. \|volume=92 \|issue=3 \|pages=183–8 \|year=1984 \|pmid=6741294 \|doi= \|url=}}</ref>		*Wrinkled skin ([[AKA]] ''washerwoman skin'' and ''hydration changes'') - changes due to water immersion; changes may be present in the context of immersion post-mortem.<ref name=pmid6741294>{{cite journal \|author=Reh H \|title=[Early postmortem course of washerwoman's skin of the fingers] \|language=German \|journal=Z. Rechtsmed. \|volume=92 \|issue=3 \|pages=183–8 \|year=1984 \|pmid=6741294 \|doi= \|url=}}</ref>

	Internal:<ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref><ref>URL: [http://netk.net.au/Forensic/Drowning.pdf http://netk.net.au/Forensic/Drowning.pdf]. Accessed on: 20 September 2010.</ref>		====Internal findings====
			Features:<ref name=pmid12134758>{{cite journal \|author=Bohnert M, Ropohl D, Pollak S \|title=[Forensic medicine significance of the fluid content of the sphenoid sinuses] \|language=German \|journal=Arch Kriminol \|volume=209 \|issue=5-6 \|pages=158–64 \|year=2002 \|pmid=12134758 \|doi= \|url=}}</ref><ref>URL: [http://netk.net.au/Forensic/Drowning.pdf http://netk.net.au/Forensic/Drowning.pdf]. Accessed on: 20 September 2010.</ref>
	*Lung emphysema; "kissing lungs" = lungs touch one another -- on opening the chest.		*Lung emphysema; "kissing lungs" = lungs touch one another -- on opening the chest.
	*Froth in the trachea.		*Froth in the trachea.
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	*Fluid in the paranasal sinuses.<ref name=pmid8643988>{{cite journal \|author=Hottmar P \|title=[The presence of fluid in the paranasal sinuses in comparison with other diagnostic signs of drowning] \|language=Czech \|journal=Soud Lek \|volume=40 \|issue=4 \|pages=34–6 \|year=1995 \|month=December \|pmid=8643988 \|doi= \|url=}}</ref>		*Fluid in the paranasal sinuses.<ref name=pmid8643988>{{cite journal \|author=Hottmar P \|title=[The presence of fluid in the paranasal sinuses in comparison with other diagnostic signs of drowning] \|language=Czech \|journal=Soud Lek \|volume=40 \|issue=4 \|pages=34–6 \|year=1995 \|month=December \|pmid=8643988 \|doi= \|url=}}</ref>

	===Microscopic~~/Laboratory~~===		===Microscopic===
	~~There~~ are ~~a few tests of debated value:<ref name=pmid16378701/>~~		*None that are specific.
	*Diffusion of particulates into the blood (left ventricle) from the water.
	**Diatom test.
	*Haemodilution.
	**Mostly useless - CPR interferes with it, not reliable if there putrefaction or autolysis.
	*Transport of aveolar element into blood circulation.

	==Carbon monoxide toxicity==		==Carbon monoxide toxicity==

Michael: /* Gross findings */ tweak

2012-12-23T13:31:02Z

Gross findings: tweak

← Older revision		Revision as of 13:31, 23 December 2012
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	*CO binds to myoglobin.		*CO binds to myoglobin.

	===Gross ~~findings~~===		===Gross===
	External:		====External findings====
	*Salmon pink skin.		*Salmon pink skin.

	Internal:
			DDx of pink skin includes:
			*[[Hypothermia]].
			*Cyanide poisoning.
			*Fluoroacetate poisoning.

			====Internal findings====
	*General: organs pink hue.		*General: organs pink hue.
	*Brain: globus pallidus [[necrosis]] - bilateral.<ref name=pmid21150349>{{Cite journal \| last1 = Fielding \| first1 = J. \| last2 = Lang \| first2 = W. \| last3 = White \| first3 = OB. \| title = Carbon monoxide poisoning: impact on ocular motility. \| journal = Cogn Behav Neurol \| volume = 23 \| issue = 4 \| pages = 256-61 \| month = Dec \| year = 2010 \| doi = 10.1097/WNN.0b013e3181c5e2c1 \| PMID = 21150349 }}</ref>		*Brain: globus pallidus [[necrosis]] - bilateral.<ref name=pmid21150349>{{Cite journal \| last1 = Fielding \| first1 = J. \| last2 = Lang \| first2 = W. \| last3 = White \| first3 = OB. \| title = Carbon monoxide poisoning: impact on ocular motility. \| journal = Cogn Behav Neurol \| volume = 23 \| issue = 4 \| pages = 256-61 \| month = Dec \| year = 2010 \| doi = 10.1097/WNN.0b013e3181c5e2c1 \| PMID = 21150349 }}</ref>

	Notes:		Notes:
	*The DDx of pink skin includes:
	**[[Hypothermia]].
	**Cyanide poisoning.
	**Fluoroacetate poisoning
	*Bilateral necrosis of the putamen is seen in [[methanol toxicity]].		*Bilateral necrosis of the putamen is seen in [[methanol toxicity]].

Michael: /* Mechanism of death */ tweak

2012-05-01T17:22:01Z

Mechanism of death: tweak

← Older revision		Revision as of 17:22, 1 May 2012
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	The mechanism of death in [[asphyxial death]]s seems to be an exam favourite.		The mechanism of death in [[asphyxial death]]s seems to be an exam favourite.

	~~The short~~ answer ~~it is:~~		===Short answer===
	*Brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref><ref name=pmid20456578/>		*Brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref><ref name=pmid20456578/>

	~~The long~~ answer ~~is:~~		===Long answer===
	*It depends on who one asks. Other explanations include ~~"cardiac inhibition secondary to nerve stimulation" and "respiratory asphyxia".~~<ref name=pmid20456578>{{Cite journal \| last1 = Clément \| first1 = R. \| last2 = Redpath \| first2 = M. \| last3 = Sauvageau \| first3 = A. \| title = Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. \| journal = J Forensic Sci \| volume = 55 \| issue = 5 \| pages = 1268-71 \| month = Sep \| year = 2010 \| doi = 10.1111/j.1556-4029.2010.01435.x \| PMID = 20456578 }}</ref>		*It depends on who one asks.
			*Other explanations include:<ref name=pmid20456578>{{Cite journal \| last1 = Clément \| first1 = R. \| last2 = Redpath \| first2 = M. \| last3 = Sauvageau \| first3 = A. \| title = Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. \| journal = J Forensic Sci \| volume = 55 \| issue = 5 \| pages = 1268-71 \| month = Sep \| year = 2010 \| doi = 10.1111/j.1556-4029.2010.01435.x \| PMID = 20456578 }}</ref>
			**"Cardiac inhibition secondary to nerve stimulation".
			**"Respiratory asphyxia".

	==The obsolete asphyxia quintet==		==The obsolete asphyxia quintet==

Michael: /* Mechanism of death */ +ref

2012-05-01T17:20:58Z

Mechanism of death: +ref

← Older revision		Revision as of 17:20, 1 May 2012
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	The short answer it is:		The short answer it is:
	*Brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref>		*Brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref><ref name=pmid20456578/>

	The long answer is:		The long answer is:

Michael: re-format

2012-05-01T17:19:43Z

re-format

← Older revision		Revision as of 17:19, 1 May 2012
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	An introduction to forensic pathology is in the ''[[forensic pathology]]'' article.		An introduction to forensic pathology is in the ''[[forensic pathology]]'' article.

	==~~Overview~~==		=Overview=
			==Classification==
	===DiMaio classification<ref>{{Ref HoFP\|155-64}}</ref>===		===DiMaio classification<ref>{{Ref HoFP\|155-64}}</ref>===
	{{familytree/start}}		{{familytree/start}}
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	{{familytree \| C01 \| \| C02 \| \| C03 \| \| \| \| C05 \| \| C07 \| \| \| \| \| \|C01=Hanging\|C02=Ligature\|C03=Manual\|C05=Abnormal<br>skin colour\|C07=No abnormality\|}}		{{familytree \| C01 \| \| C02 \| \| C03 \| \| \| \| C05 \| \| C07 \| \| \| \| \| \|C01=Hanging\|C02=Ligature\|C03=Manual\|C05=Abnormal<br>skin colour\|C07=No abnormality\|}}
	{{familytree/end}}		{{familytree/end}}

			==Mechanism of death==
			The mechanism of death in [[asphyxial death]]s seems to be an exam favourite.

			The short answer it is:
			*Brain stem hypoxia due to ischemia caused by venous obstruction in the neck.<ref>URL: [http://www.forensicmed.co.uk/pathology/mechanisms-of-death/ http://www.forensicmed.co.uk/pathology/mechanisms-of-death/]. Accessed on: 1 May 2012.</ref><ref>URL: [http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/ http://www.forensicmed.co.uk/pathology/pressure-to-the-neck/]. Accessed on: 1 May 2012.</ref>

			The long answer is:
			*It depends on who one asks. Other explanations include "cardiac inhibition secondary to nerve stimulation" and "respiratory asphyxia".<ref name=pmid20456578>{{Cite journal \| last1 = Clément \| first1 = R. \| last2 = Redpath \| first2 = M. \| last3 = Sauvageau \| first3 = A. \| title = Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. \| journal = J Forensic Sci \| volume = 55 \| issue = 5 \| pages = 1268-71 \| month = Sep \| year = 2010 \| doi = 10.1111/j.1556-4029.2010.01435.x \| PMID = 20456578 }}</ref>

	==The obsolete asphyxia quintet==		==The obsolete asphyxia quintet==
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	*''Fluid blood'' is considered totally useless as a sign of anything.		*''Fluid blood'' is considered totally useless as a sign of anything.

			=Specific types of asphyxial deaths=
	==Hanging==		==Hanging==
	===General===		===General===
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	*[[Hanging]] - furrow/depression typically rises to a point of suspension.		*[[Hanging]] - furrow/depression typically rises to a point of suspension.

	==See also==		=See also=
	*[[Forensic pathology]].		*[[Forensic pathology]].

	==References==		=References=
	{{reflist\|2}}		{{reflist\|2}}

	==External links==		=External links=
	*[http://failuremag.com/index.php/feature/article/the_game_that_makes_parents_gasp/ The choking game (failuremag.com)].		*[http://failuremag.com/index.php/feature/article/the_game_that_makes_parents_gasp/ The choking game (failuremag.com)].

	[[Category:Forensic pathology]]		[[Category:Forensic pathology]]