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involved in male cross dressing in the last part of the nineteenth century, if not before. Further confessions of males appeared in the English Mechanic and.
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There are no pathognomonic signs of death by asphyxia. However, there are findings that are characteristically associated with the various forms of asphyxia. The nature and extent of these findings depend on the mechanisms s of asphyxia in the particular case, including features of the victim and, in some cases, the assailant. Even the presence of a ligature mark on the neck in a murder is not necessarily indicative of death by ligature strangulation, only that a ligature compressed the neck to some degree.
Nevertheless, interpreting the constellation of anatomic findings in conjunction with other investigative information allows most asphyxial deaths to be assessed accurately and reliably. There are several common findings in asphyxial deaths, which may be present in multiplicity or not at all, such as the following:. Layer-by-layer dissection of the anterior neck tissues is typically performed after blood has been allowed to drain from the chest and head. This dissection technique allows demonstration of injuries to the neck soft tissues, hyoid bone, larynx, and blood vessels.
Radiographic findings in asphyxial deaths are typically limited to identifying fractures of the hyoid and larynx, cervical spine fractures in hangings occasionally seen in nonjudicial hanging scenarios involving victims who jump from high structures, especially if the victims are elderly or have preexisting cervical spine diseases [eg, osteoporosis, ankylosing spondylitis, osteoarthritis] , or identifying a foreign object in the airway.
Photography and Documentation. Photography at the scene and in the morgue suite plays an important role in helping to determine and document the findings upon which the cause and manner of death opinions are based. Documentation should address specific issues pertinent to the particular case details. Comprehensive death investigation should include a thorough history, death scene investigation, and appropriate postmortem examination that includes toxicologic, other pertinent laboratory studies such as carboxyhemoglobin saturation in suspected carbon monoxide poisoning , and appropriate radiologic studies.
Toxicologic findings are often key in helping to understand why someone died. Determining handedness of the assailant cannot be reliably established. Most adults can strangle with either the dominant or nondominant hand. Specifics of strangulation are also difficult to establish, as it can be accomplished using forehand or backhand, overhand or underhand, 1 or 2 hands. Fingernail marks on the neck indicate injury to the neck caused by someone with nails sufficiently long to cause marks. The marks may be made by the assailant during strangulation or while attempting to control the victim.
Some ligature marks may have a sufficient pattern to allow recognition of the features of the ligature eg, woven cord.
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Determining the nature of a ligature is difficult when a ligature mark is inconspicuous or, sometimes, even when it is prominent. The presence of petechiae are not specific for mechanical asphyxia, and other causes need to be excluded—for example, postmortem extravasation, effects of other problems such as a blood vessel disorder or blood clotting problem.
Some homicidal asphyxial deaths, including suffocation and strangulation, can occur in the absence of demonstrable injuries. The time it takes to reach unconsciousness and the time it takes to die of asphyxia are influenced by the nature of the asphyxiant, duration of its application, efficiency of its application, and victim susceptibility.
Experimental studies and witnessed sometimes videotaped events of neck compression hanging and strangulation indicate very rapid loss of consciousness after carotid artery compression.
Studies of videotaped nonjudicial hangings have elucidated stereotypical behavior exhibited by the victim following the loss of consciousness. The minimal duration of neck compression after loss of consciousness to cause death has not been clearly defined. All the subjects studied by Rossen and Kabat who were subjected to seconds of total carotid artery occlusion survived. DiMaio and DiMaio reported that the infant will not usually auto-resuscitate once there is apnea.
The death of a suspect temporally related to apprehension by law enforcement can be consequent to a variety of potential causes and mechanisms. Occasionally, there may be an issue as to whether or not action by law enforcement personnel caused or contributed to death. Some of these actions potentially involve asphyxia. In some cases, the intention is to produce nonlethal mechanical asphyxia eg, application of neck restraint hold , whereas in others mechanical asphyxia is inadvertent eg, thoracoabdominal compression during a "dog pile".
In other cases, issues as to whether or not a particular restraint technique caused or contributed to asphyxia may need to be addressed.
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Examples of these issues include the effects of the restraint position eg, restrained in the prone position with or without hogtieing and the effect of chemical control agents eg, tear gas, mace, pepper spray. Neck restraint holds. Neck restraint holds, most typically involving carotid compression, have been used fairly commonly and represent a form of controlled strangulation.
The hold is applied until unconsciousness ensues; the subject is then immediately cuffed, and the hold released before the onset of any irreversible cerebral ischemic damage. Rarely, the delayed onset of asphyxia, sometimes lethal, may result from unrecognized laryngeal damage sustained during an episode of neck compression. Prone restraint positions. For a period of time, restraint position was often implicated as being causal or contributory to death.
This most often involved persons who had been hogtied and left in the prone position. Implication of the prone hogtied position was primarily based on studies in which recovery of oxygen saturation as measured by a transcutaneous earlobe blood oxygen saturation probe following exercise took longer in hogtied volunteers than in those who were not hogtied. Thoracoabdominal compression. Inadvertent development of asphyxia consequent to thoracoabdominal compression sustained during apprehension may be an issue.
Pressure can be applied to the chest, most commonly to the back, to facilitate the application of manacles. In many cases, the pressure is applied to the shoulders and lower back, buttock, or upper thighs using less than the full body weight of the restraining personnel. In other cases, multiple persons attempting to gain control of an unruly suspect can apply less targeted and less controlled pressure.
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Enzymatic debridement is performed by the application of a prescribed topical agent that chemically liquefies necrotic tissues with enzymes. These enzymes dissolve and engulf devitalized tissue within the wound matrix. Antimicrobial agents used in conjunction with collagenase can decrease the effectiveness of enzymatic debridement. This method can be used in conjunction with surgical and sharp debridement.
This method can be expensive depending on the insurance payer source; however, discount programs are available. Enzymatic debridement is commonly used in the long-term care setting because there is less pain and nurses can apply it daily. Autolytic debridement is the slowest method, and it is most commonly used in the long-term care setting.
There is no pain with this method. This method uses the body's own enzymes and moisture beneath a dressing, and non-viable tissue becomes liquefied. Maintaining a balance in moisture is important.
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Dressing frequency and absorbency. Dressing types commonly used are hydrocolloids, hydrogels, and transparent films semi-occlusive and occlusive.
How much do you know about debridement and chronic wounds? Take our question quiz to find out! Click here. Mechanical debridement is by irrigation, hydrotherapy, wet-to-dry dressings, and an abraded technique. This technique is cost-effective, can damage healthy tissue, and is usually painful. Wet-to-dry dressings are frowned on in the long-term care setting by state surveyors because of the options available with advanced wound care dressings. This type of dressing is used to remove drainage and dead tissue from wounds. A wet-to-moist dressing is another option accepted in long-term care.
This type of dressing is used to promote moist wound healing and is used to remove drainage and dead tissue from wounds. Deep wounds with undermining and tunneling need to be packed loosely. Without packing, the space may close off to form a pocket and not heal leading to infection or abscess. This type of dressing is to be changed daily, compared with the wet-to-dry dressing, which is changed every 4 to 6 hours. Surgical sharp and conservative sharp debridement is performed by a skilled practitioner using surgical instruments such as scalpel, curette, scissors, rongeur, and forceps.
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