Hanging, strangulation, Asphyxial death

1. Hanging
ATULABHISHEK
(Galgotias university, Greater Noida)

2. Asphyxial deathAsphyxial deathAsphyxial deathAsphyxial death
Asphyxia is a condition of the body in which the supply of 02 to the blood and tissues
has been reduced appreciably below minimum critical level for maintenance of vital
functions of the body by any mechanical interference with respiration, causing first
unconsciousness or then death. If a person died due to asphyxia, such death is known
as asphyxia death.
The normal levels of oxygen in the arterial blood (pO2) with a 95% saturation of
hemoglobin ranges from 90 to 100 mm Hg in a healthy young adult.The same is 65–
80mmHg in above 60 years of age.
Hypoxia occurs when PO2 is less than 60 mmHg even though the hemoglobin isHypoxia occurs when PO2 is less than 60 mmHg even though the hemoglobin is
90% saturated. Severe hypoxia occurs when PO2 is 40 mmHg.
Death occurs when PO2 is less than 20 mmHg.
Axphyxial phenomenon
Reduction in O2 tension Capillary dilatation Capillary stasis
Capillary engorgement Stasis of blood in organs Diminished venous
return to heart Reduced pulmonary flow Deficient
oxygenation in lungs Asphyxia

3. Types of Asphyxia
1. MECHANICAL------ Air passages blocked mechanically
Hanging
Strangulation
Suffocation
Entrapment
Smothering
GaggingGagging
Choking
Burking
Overlaying
Traumatic asphyxia
Environmental
Postural or positional
Drowning

4. 2. PATHOLOGICAL------ Entry of oxygen in lungs decreased
due to disease of upper respiratory tract or lung. E.g.
bronchitis, acute edema of glottis, laryngeal spasm.
3. TOXIC------ Poisonous substances preventing use of oxygen.
Carbon monoxide poisoning, paralysis of respiratory centre by
opium, barbiturates, strychnine etc.
4. ENVIRONMENTAL--------Insufficient oxygen in inspired
air. e.g. enclosed spaces, irrespirable gas in environment as in
sewer gas, high altitude etc.sewer gas, high altitude etc.
5. TRAUMATIC------- Bilateral Pneumothorax, pulmonary fat
embolism from fracture of long bones, pulmonary thrombo-
embolism due to injury of lower limb etc.
6. POSTURAL------- in unconscious or stuporous person, where
upper half of body lower than remainder.
7. IATROGENIC -------- anesthetic deaths.

5. Hanging
Hanging is a suspension of a person’s body by ligature around the neck.
cause of death-Asphyxia & venous congestion
Purpose of hanging can be suicidal, homicide, judicial &Accidental
The four types of hanging:-
1) Complete hanging –complete hanging in which no body part is1) Complete hanging –complete hanging in which no body part is
touching the ground.
Whole body weight suspended
Trachea is always compressed
“asphyxia” –person will die from it
Cyanosis, congestion & petechiae (ccp- +nt) are present in a
complete hanging.

6. 2) Partial hanging – partial hanging in which some part of the body is
touching the ground.
Only head weight suspended
Patient will die from “venous congestion”
In this condition cyanosis, congestion & petechiae are absent (ccp-
absent)
3) Typical hanging
Knot is at - occipital (most common)
4) Atypical hanging
Knot is at - any other side

7. Post-mortem changes in complete hanging
1. “V” shape ligature mark
2. Cyanosis , congestion & petechiae - present( asphyxial),
absent(venous congestion)
3. “Tardieu’s spot”- venous congestion
4. Hyoid bone fracture- 10% cases
5. Protrusion of tongue
6. Semen discharge
7. Eye open→ pupil dilated → same side of the knot → La facie
sympathetique knot
8. Dribbling of saliva → opposite side of the knot

9. Judicial hanging
Perfect method of death. Complete,Atypical, sudden drop
Knot at – angle of mandible
C2 –C3 or C3 –C4 cervical damage → respiratory arrest
Carotid artery damage (very common)
↓↓
known as a “Amussat’s sign”

10. Point of comparison COMPLETE HANGING INCOMPLETE HANGING
Other name High point hanging Low point hanging
Touching the ground Negative Positive
Circumstances Presence of a near-by table
or chair
Negative
Main cause of death Cerebral ischemia Asphyxia
Face Less congested, sometimes
pale
Markedly congested
Hypostasis Lower half of the body According to the partHypostasis Lower half of the body According to the part
touching the ground
Type of knot Fixed knot or running noose Always running noose
Rope marks -Incomplete with fixed knot
-Above thyroid cartilage
-Oblique
-Deep and fades gradually
towards suspension point
-Complete
-Below thyroid cartilage
-Transverse
-Deep all through
Dribbling of saliva Positive Negative
Tear in carotid intima Positive Negative
Hyoid bone If fractured: outwards If fractured: inwards

13. Human experiment
Acute obliteration of neck circulation with
600mmHg cuff
Blurring of vision
Constriction of visual fields
Loss of conscious (6-6.5 sec)
Hypoxic convulsionHypoxic convulsion
EKG minimal change
Prolonged occlusion of cerebral circulation up to
100 sec.
Convulsion, Cyanosis, Involuntary urination, Involuntary
defection,
Bradycardia and dilation of pupils occurred after loss of
consciousness

14. Postmortem appearancePostmortem appearancePostmortem appearancePostmortem appearance
1. External appearance.
2. Internal appearance.
External appearance
-Above the ligature.-Above the ligature.
-Beneath the ligature.
-Below the ligature.

15. Above the ligature mark
Tilt of the head.
Protrusion of tongue.
Dribbling of saliva.
Le Facia Sympathique.
Tardieu spots.
Congestion (excessive accumulation of blood/ body fluid) of the face.Congestion (excessive accumulation of blood/ body fluid) of the face.
Petecheal hemorrhages.
Middle ear hemorrhages.
( petechiae hemorrhages- petechiae are tiny purple, red, or brown spots on
the skin. Petechiae are formed when tiny blood vessels called capillaries
break open. when these blood vessels break ,blood leaks into the skin.)

16. Beneath the ligature
Fixed or running noose.
Position of the knot.
Course of the ligature.
Width and multiplicity.
Point of suspension.
Slipping of ligature.
Weight of the body.
Below the ligature
Postmortem lividity (Glove and Stocking)
Relaxation of sphincters.
Injury to legs.(partial hanging)

17. Internal appearance
Hemorrhages in the neck.
Dry, white and glistening.
Rupture of platysma and sternomastoid.
Transverse tear in the intima of carotid artery.
Fracture of hyoid,cricoid and thyroid cartilages.Fracture of hyoid,cricoid and thyroid cartilages.
Congestion of organs.
Petechial hemorrhages.

18. Differential characteristics between Homicide and
Suicide by Hanging
There are five important features to consider to differentiate a
murder of a suicide by hanging:
1. Furrow or groove with Ecchymosis, or so called ligature mark,
which is caused by the pressure of the constrictor agent (rope,
cable, etc.) in the skin. In the hanging will find it incomplete, andcable, etc.) in the skin. In the hanging will find it incomplete, and
in the murder by constriction will find it complete.
2. Commonly blood appears in the hanged with the asphyxia own
characteristics, which will look like this: blackish, fluid and little
clotted.

19. 3. In a suicide, can occasionally see the retro-propulsion of the
tongue, when this is out of the mouth, caused by pressure that
makes the hyoid bone in the neck, and instinctively by the body to
take air.Therefore, when hung a body previously murdered, the
tongue out of the mouth we will not see.
4. It is possible case of homicide when the body shows signs of
struggle or recent injuries in other body parts.struggle or recent injuries in other body parts.
5.When the person died on the floor, and then the body was hung by
another person pretending suicide, can be found mortem lividity
(when blood settles by gravity into the lower region of the body),
either in the back or in the abdomen, it will not match with the
gravity and location of hanged.

20. Medical effects
People who survive hanging report seeing flashing lights and hearing
ringing sounds.
The neck of people who are hanged are usually marked with furrows
where the ligature had constricted the neck.An invertedV mark is also
often seen.
Because of the pressure on the jaw, the tongue is sometimes protruding,
causing it to dry.causing it to dry.
Depending on the circumstances, petechiae may be present on the
eyes, face, legs, and feet.
Cervical spine fractures are rare unless the hanging is a drop
hanging, which usually causes an injury known as hangman's
fracture.
Suspension hanging usually results in cerebral hypoxia and
decreased muscle tone around the neck.According to Aufderheide et
al., the most common cause of death of hangings is cerebral hypoxia.

21. Treatment
Most people who are hanged die before they are found; the term "near
hanging" refers to those who survive (at least for a while—for
example, until they reach hospital).
Initial treatment of survivors follows the "usual priorities of airway,
breathing, and circulation (ABC)".Treatment should be "directed atbreathing, and circulation (ABC)".Treatment should be "directed at
airway control with endotracheal intubation, ventilation using positive
end expiratory pressure (PEEP), and hyperventilation with
supplemental oxygen to control intracranial pressure".
One study of people who experienced near-hanging who were treated
appropriately at hospital found that 77 percent of them survived.

22. Types of strangulation
STRANGULATION
Application of external pressure on the neck either by bare
hands, or by a ligature, or by any other material.
It is a form of asphyxia caused by constriction of the neck
WITHOUT suspending the body.
THROTTLING: when constriction is produced by the
pressure of the fingers and the palms
GARROTING: loop of thin string thrown from back and
tightened
BANSDOLA: neck compressed between two bamboo
sticks
MUGGING: pressure upon neck by arm around the
throat

23. Sr.
No.
Trait Hanging Strangulation
1 Ligature mark Oblique, incomplete,
high in the neck
Transverse,
complete, mid
level or below
thyroid cartilage
2 Base Pale, hard,
parchment like
Contused
parchment like
3 Abrasion,
contusion &
Echymosis
Less prominent More prominent
4 Hyoid fracture More common Less common
5 Thyroid cartilage Less common More common

24. Sr.
No.
Trait Hanging Strangulation
6 Carotid Intimal tear Not seen
7 Signs of asphyxia Less marked More marked
8 Dribbling of saliva Often Rare
9 Bleeding from nose, Rare Often9 Bleeding from nose,
mouth & ears
Rare Often
10 Involuntary
discharge
Occasional Frequent
11 Manner Suicidal Homicidal
12 Injuries on other
body parts
Rare Common