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Asphyxia
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Asphyxia is defined as the interference with the uptake or utilization of oxygen with a subsequent reduction in the oxygen level within the blood, cells, tissues, and organs.1 Loss of consciousness occurs within seconds and may take as long as 13–18 seconds to occur, according to one report of four filmed hangings (two suicides and two autoerotic accidents).2 Respiratory arrest followed by cardiac arrest ensues after several minutes. In fact, the heart will continue to beat, and there will be a pulse for as long as ten minutes after respiratory arrest.1 Death due to asphyxia occurs in one of several ways: Obstruction of the external airway (nose and mouth)Obstruction of the internal airway (oral cavity, larynx, trachea, bronchi, lungs)Compression/occlusion of the blood vessels of the neck (carotid arteries, jugular veins)Severe flexion of the neck or compression of the chest or abdomenImpairment of O2 utilization by the body’s cellsDisplacement of O2 from the ambient environment
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Traumatic asphyxia almost exclusively affects children and occurs when there is sudden compression of the chest against a closed glottis. The resultant increase in intrathoracic pressure is transmitted to the venules and capillaries of the head, neck, and chest and results in their rupture. Traumatic asphyxia may present with conjunctival hemorrhage, facial swelling, and petechial hemorrhage of the face, neck, and chest (Perthe's syndrome) that usually resolve spontaneously. Severe cases of traumatic asphyxia may result in permanent neurological deficit, but the greatest morbidity and mortality from traumatic asphyxia is usually due to associated injuries.
History of Asphyxia-related Deaths
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
According to Püschel et al. (2004), there are almost as many different ways to classify asphyxial death as there are authors, and there are numerous definitions of the term ‘asphyxia’ itself, too. Asphyxia is a failure of body cells to either receive or utilize oxygen. This is accompanied by an increase in the blood carbon dioxide level. This has led to the differentiation between ‘external’ and ‘internal’ asphyxia. In the medicolegal context, asphyxia refers mainly to forms of external hypoxia and it can be further divided into mechanical and environmental asphyxia. Of greatest importance are fatalities due to mechanical asphyxia. Environmental asphyxia covers special sets of circumstances, such as entrapment in an airtight enclosure.
Predicting asphyxia in term fetus
Published in Journal of Obstetrics and Gynaecology, 2023
There were two groups as group 1 (asphyxia group) and group 2 as control group. Group 2, as the control group, were selected retrospectively with simple random sampling from the babies who were followed up with their mothers after birth as term, healthy babies without any anomaly, and the demographic characteristics of the mothers, baby’s gender, birth weight, type of birth and presence of risk factors before birth were similar to group 1 and the maternal hematological parameters before the birth were recorded. Our study was a retrospective study consisting of asphyxia and control groups. Group 1 consisted of asphyxia fetuses selected according to the study criteria from the neonatal intensive care unit as stage 3 HIE according to (Mrelashvili et al.2020) Sarnat and Sarnat classification, while group 2, the control group, term babies selected according to the study criteria from the mother side, healthy babies without a fetal anomaly.
Clinical utility of chromosomal microarray analysis and whole exome sequencing in foetuses with oligohydramnios
Published in Annals of Medicine, 2023
Xiaomei Shi, Hongke Ding, Chen Li, Ling Liu, LiHua Yu, Juan Zhu, Jing Wu
In addition, we found a homozygous point variation c.199-10T > G in the SLC25A20 gene in a fetus with severe oligohydramnios. Mutations in this gene cause CACTD. CACTD is a rare autosomal recessive metabolic disorder of long-chain fatty acid oxidation. The clinical manifestations are mainly neuropsychiatric abnormalities, cardiomyopathy, arrhythmias, skeletal muscle damage and liver dysfunction, renal tubular fatty changes, etc. Some patients have symptoms such as asphyxia, dyspnoea and oliguria [25]. Our study is the first study to evaluate the prenatal phenotype of foetus diagnosed with CACTD. The results identify a further expansion of the prenatal presentation of CACTD and contribute to the genetic diagnosis and counselling of this disorder.
Fatal self-poisoning with amitriptyline: a case report and brief review of literature
Published in Journal of Substance Use, 2023
Qing Gao, Bin Lv, Weisheng Huang, Tianying Sun, Hongmei Dong
A 27-year-old woman was found dead in an undisturbed bed in a dormitory by her roommate. A total of 3 empty amitriptyline bottles were found in the trash can. No evidence of struggle was reported at the death scene. According to the description from her family, the decedent had no history of illness or medication except depression with long-term amitriptyline use. The blood was collected by cardiac puncture through the chest wall the day the body was found. The body was frozen (−20°C) until the systematic autopsy was carried out five days after death. No signs of apparent injury and mechanical asphyxia were noted. On internal examination, no lethal anatomic changes such as structural heart disease were existed. A total of 10 ml of thick liquid with white granular substance was found in her stomach, and spotty hemorrhages on the gastric mucosa were observed. The following microscopic examination revealed brain swelling, focal pulmonary hemorrhages and edema. The widespread congestion was observed in multiple organs especially brain and lungs. The cardiac blood was analyzed by a gas chromatography-mass spectrometry method, which revealed a blood amitriptyline level of 8.8 μg/ml. The analysis demonstrated the absence of other toxicants and/or drugs in blood. The possibility of death from injury, mechanical asphyxia and/or lethal anatomical changes could be ruled out. In addition, the blood amitriptyline level could not support an overdose accident since the concentration was much higher than that used for therapeutic applications (0.12–0.25 μg/ml; Linder & Keck, 1998). Thus, amitriptyline intoxication should be attributed to intentional suicide in this case.