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A Journal on Forensic Medicine
Minerva Medicolegale 2007 December;127(4):273-82
Lethal asphyxia: pathology and problems
Byard R. W., Cains G.
Discipline of Pathology University of Adelaide, Adelaide, Australia
Asphyxia results from tissues and organs receiving insufficient amounts of oxygen to maintain normal metabolic processes. The delivery of oxygen to the cellular level may be compromised at a variety of stages involving the intake, the transport and the uptake of oxygen. While deaths due to asphyxia may be classified according to the particular circumstances such as hanging, choking and drowning, each of these involves a number of different processes. Classifying asphyxia pathophysiologically gives a clearer indication of lethal mechanisms as oxygen deprivation at the subcellular level may be due to insufficient environmental oxygen, reduced transfer from the air to the blood, reduced transport from the lungs to the tissues and reduced transfer across cell membranes. While “classic signs of asphyxia” have been described for many years, petechial hemorrhages, congestion, edema, fluidity of the blood, cyanosis and engorgement of the right heart are in no way sensitive or specific for asphyxia. The diagnosis of an asphyxial death, therefore, often relies heavily on an accurate evaluation of the death scene, and careful exclusion of injuries or underlying organic diseases that may have caused or contributed to death.