A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
1. A POWER POINT PRESENTATION
BY
DR.SANGEETA CHOWDHRY &
DR.SUNIL SHARMA
DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY
GOVT. MEDICAL COLLEGE, JAMMU
ASPHYXIAL
CONDITIONS
3. ASPHYXIAL CONDITIONS-
DEFINITIONS
Suicide (Latin
suicidium, ‘to kill
oneself’) is the act of
intentionally causing
one's own death.
4. ASPHYXIAL CONDITIONS-
DEFINITIONS
Failed suicide attempt
(Latin: tentamen
suicidii) refers to a
suicide that did not
result in death. Some
are regarded as not
true attempts at all, but
rather parasuicide.
5. ASPHYXIAL CONDITIONS-
DEFINITIONS
Hanging or 'self-
suspension' is a form of
asphyxia caused by
suspension of the body
by a ligature which
encircles the neck, the
constricting force being
at least part of the
weight of the body. It
may be either complete
(feet are not touching the
ground) or partial (feet
are touching the
ground).
6. ASPHYXIAL CONDITIONS-
DEFINITIONS
Strangulation is a form of
asphyxia caused by
mechanical disruption of
blood flow through the
vessels of the neck
and/or blockage of air
passage through the
trachea by means of a
ligature or by any means
other than suspension of
the body.
7. CLASSIFICATION OF STRANGULATION
Ligature strangulation:
When ligature material
is used to compress
the neck. It includes
the use of any type of
cord-like object, such
as an electrical cord or
purse strap.
9. CLASSIFICATION OF STRANGULATION
Mugging: Strangulation
caused by holding the
neck of the victim in
the bend of elbow (i.e.
the ‘sleeper hold’) or
knee of the assailant.
10. CLASSIFICATION OF STRANGULATION
Garroting: Strangulation
is caused by
compression of the neck
by a ligature which is
quickly tightened by
twisting it with a lever
(rod, stick or ruler)
known as Spanish
windlass which results in
sudden loss of
consciousness and
collapse.
11. ASPHYXIAL CONDITIONS-
DEFINITIONS
Drowning is the process
of experiencing
respiratory impairment
from
submersion/immersion
in liquid.
12. ASPHYXIAL CONDITIONS-
DEFINITIONS
Suffocation is a form of
asphyxia caused by
mechanical obstruction
to the passage of air
into the respiratory
tract by means other
than constriction of
neck or drowning.
13. CLASSIFICATION OF SUFFOCATION
Smothering is caused
by mechanical
occlusion of external
air passages from
outside, i.e. the nose
and mouth by
hand, cloth, pillow, pla
stic bag or other
material
14. CLASSIFICATION OF SUFFOCATION
Choking is caused by
an obstruction within
the trachea, either
partially or completely,
from inside by a
foreign body, like coin,
fruit seed, toffees,
candies, fish or any
other material.
15. CLASSIFICATION OF SUFFOCATION
Gagging results from
pushing a gag (rolled
up cloth or paper balls)
into the mouth,
sufficiently deep to
block the pharynx. It
combines the features
of smothering and
choking.
17. CLASSIFICATION OF SUFFOCATION
Traumatic asphyxia
results from respiratory
arrest due to
mechanical fixation of
chest, so that the
normal movements of
chest wall are
prevented.
18. CLASSIFICATION OF SUFFOCATION
Confined space
entrapment occurs
when there is
inadequate oxygen in
the enclosed space
due to consumption or
displacement by other
gases.
20. EPIDEMIOLOGY
The rate of suicide is far
higher in men than in women
(3-4: 1) with suicidal
hangings more common.
However, recent trends
suggest that women are
gradually using hanging than
other methods of suicide.
Women are more likely than
men to be victims of
strangulation (domestic
violence or sexual assault).
Nearly all reported
autoerotic strangulation
incidents involve men.
Accidental strangulation may
occur in both men and
women.
21. CAUSES
Several populations
are at risk of hanging
or strangulation.
Toddlers: The neck
may get caught and
strangled in ill-
constructed cribs as
they put their heads
out. Window cords
have also been
implicated in such
deaths.
22. CAUSES
Adolescents: Incidence
of accidental hanging,
throttling or
strangulation due to
‘choking game’
(voluntary asphyxia in
order to enjoy the altered
sensations due to
cerebral hypoxia).
Playground slide tie rope
has been implicated in
accidental strangulation.
Emulating TV shows and
depression can also lead
to hanging.
23. CAUSES
Adults: Autoerotic
accidents, assaults, and
suicidal depression are
common causes (e.g.
prisons, where hanging
is easier and available
method). Accidental
strangulation from scarfs
and ‘chunni’ (in females)
and by cotton cloth
entangled in the rotor of
a machine (in males)
have been reported.
Elderly: Depression can
lead to hanging.
24. CAUSES
Isadora Duncan
syndrome: The world
famous dancer Isadora
Duncan died on 14
September 1929 as a
result of her long scarf
which she was wearing
got caught in the wire
wheels of her Buggati
car. She died at the
scene and was later
found to have sustained
a fractured larynx and
carotid artery injury.
25. PATHOPHYSIOLOGY
The proposed
mechanisms of the
observed features
seen in most of the
asphyxial conditions
(whether by hanging,
manual strangulation,
application of ligature,
or postural
asphyxiation (in
children whose necks
are caught in an object
such as a crib)
includes the following:
26. PATHOPHYSIOLOGY
Venous obstruction
leading to cerebral
congestion, hypoxia and
unconsciousness, which
in turn, produces loss of
muscle tone leading to
airway
obstruction, occurs if
ligature is made up of
broad and soft material.
For manual strangulation
and suicidal near-
hanging victims, it is a
significant factor that
produces loss of
consciousness.
27. PATHOPHYSIOLOGY
Arterial blockage
due to pressure on
carotid artery, leading
to cerebral anemia and
collapse due to low
cerebral blood flow
occurs when ligature is
made of thin cord.
28. PATHOPHYSIOLOGY
Reflex vagal
inhibition caused
by pressure to the
carotid sinuses and
increased
parasympathetic
tone leading to
sudden cardiac
arrest (less
common)
29. PATHOPHYSIOLOGY
Most experts agree that
regardless of the events
occurring in any given
hanging or
strangulation, death
ultimately occurs from
cerebral hypoxia and
ischemic neuronal death.
Notably, none of the
proposed mechanisms
advocates airway
compromise as the
immediate cause of signs
and symptoms observed in
such cases. In fact, although
mechanical airway
compromise occurs and
ultimately complicates
patient management, it
appears to play a minimal
role in the immediate death
of victims.
30. CLINICAL EFFECTS OF ASPHYXIA
Sphincter Voiding of
Asphyxia relaxation urine, stools,
semen
Capillary
Decreased endothelium
oxygen tension damage
and reduced Hb
Increased
Cyanosis capillary Tardieu’s
permeability spots
Unconscious
ness Pulmonary
edema Capillary
rupture
Loss of Capillary Increased
muscle stasis and intracapillary
power engorgement pressure
31. Triad of asphyxial stigmata may be seen
Cyanosis: Bluish
discoloration of skin,
face (particularly in
the lips, tip of nose,
ears lobules),
nailbeds and mucous
membranes
32. Triad of asphyxial stigmata may be seen
Petechial
hemorrhages
(Tardieu’s spots) are
found in those parts
where capillaries are
least supported, e.g.
conjunctiva, face,
epiglottis, on the
face. They tend to be
better made out in
fair skinned persons.
33. Triad of asphyxial stigmata may be seen
Congestion and
edema of the face
due to raised venous
pressure.
34. EVALUATION AND DOCUMENTATION
HISTORY
In practice, it has been observed
that manually strangled or
garroted or suicidal hanging
victims are brought to the hospital
in unconscious state for the
purposes of treatment. Such cases
are brought to the emergency
department after being found by
strangers, friends, family members
or sometimes police. On many
occasions the exact history may
not be disclosed by the relatives.
The history in such cases is
lacking, vague or cooked up. In
such cases, the doctor must try to
extract the history from different
sources available.
35. EVALUATION AND DOCUMENTATION
Even if the victim is conscious,
she may not always report the
attempted strangulation
episode. As is common with
cases of domestic violence,
the victim may be hesitant to
fully describe what happened
or will minimize the severity of
the attack. Moreover, visual
evidence of force applied to
the neck during such incident
is often absent or minimal on
initial medical evaluation. The
lack of physical findings may
lead authorities to discount the
patient’s report. Hence,
specific questions often are
required to elucidate the
history.
36. EVALUATION AND DOCUMENTATION
The victim should be asked about the
method or manner of
strangulation, whether hands,
elbow and forearm, knee, ligature
or any other method was used.
Whether the victim attempted
hanging? The number of such
episodes, whether single, multiple
or repeated with different
methods. Other circumstances
should also be enquired like
whether the victim also
smothered, shaken, knocked or
pounded into a wall or the
ground? Was the victim also hit or
physically sexually or assaulted?
Whether the victim has consumed
any alcohol, drug or any other
poison (any smell from breath)?
37. EVALUATION AND DOCUMENTATION
The practitioner has to
enquire about specific
symptoms like
whether the victim lost
consciousness, if there
is any neck pain, any
difficulty in breathing
or swallowing, any
change of
voice, headache, and if
there was any urinary
and/or fecal
incontinence.
38. EVALUATION AND DOCUMENTATION
Hanging victims are more
likely to arrive in the
emergency department
with a depressed level of
consciousness than are
victims of manual
strangulation. This is
presumably due to the
more intensive and
prolonged compressive
force applied to the neck
due to hanging than is
typically seen with
manual pressure.
39. CLINICAL PRESENTATION
The victim may present with deceptively
harmless signs and symptoms with no
or minimal external signs of soft tissue
injury because of the slowly
compressive nature of forces involved
in non-lethal strangulation. The upper
airway may also appear normal beneath
intact mucosa, despite hyoid bone or
laryngeal fractures. It takes time for
hemorrhage and edema to develop after
compressive injuries (may take 36
hours after the episode), and the patient
can develop edema of the supraglottic
and oropharyngeal soft tissue, leading
to airway obstruction.
40. SIGNS AND SYMPTOMS
The clinical
presentations can
vary according to the
method, force and
duration of
asphyxiation. The
following specific
clinical
manifestations are
possible in
asphyxiation victims:
41. SIGNS AND SYMPTOMS
Dysphonia or
hoarseness of voice
is commonly seen.
Patient may
sometimes present
with aphonia.
42. SIGNS AND SYMPTOMS
Dysphagia or
swallowing difficulty
may occur due to
injury to larynx or
hyoid bone which is
not common symptom
on initial assessment,
but may be reported
subsequently in 2
weeks. Sometimes it
may be painful
(odynophagia).
43. SIGNS AND SYMPTOMS
Dyspnea is very
common, but often a late
development.
Respiratory distress is
seen in 2 weeks which
may be due
hyperventilation or
psychogenic (anxiety,
fear, depression).
Difficulty breathing can
also be due to laryngeal
edema or hemorrhage,
although those injuries
are less common in
surviving victims.
44. SIGNS AND SYMPTOMS
Pain and swelling in
the throat or neck is
common after attempted
strangulation. The patient may
be able to localize it to a
specific area of injury, or it
may be diffuse and poorly
localized. Edema may be
caused by internal
hemorrhage, injury to
underlying neck structures or
fracture of the. Laryngeal
fracture can manifest as
severe pain on gentle
palpation of the larynx or
subcutaneous emphysema
over or around the laryngeal
cartilage.
45. SIGNS AND SYMPTOMS
Altered mental
status:
Restlessness,
confusion, loss of
orientation or
combativeness due
to cerebral hypoxia
or from concomitant
intracranial injury or
ingestion of drugs or
ethanol.
46. SIGNS AND SYMPTOMS
Neurologic
symptoms include
changes in vision, tinnitus,
ptosis, facial droop, or
unilateral weakness, paralysis
or loss of sensation. In many
patients, the findings are
transient and believed to be
caused by focal cerebral
ischemia produced by the
strangulation process that
resolves with time. In rare
cases, damage to the internal
carotid artery may induce
thrombosis with a delayed
neurologic presentation.
47. SIGNS AND SYMPTOMS
Petechiae can occur at or
above the area of compression
and are most frequently seen
on the face, periorbital region,
eyelids, scalp and conjunctiva.
Facial and conjunctival
petechiae are evidence of
prolonged elevated venous
pressure. It has been found
that the jugular vein needs to
be occluded for at least 15-30
seconds for the development
of facial petechiae.
Subconjunctival hemorrhage
is usually seen after a
vigorous struggle between the
victim and assailant.
48. SIGNS AND SYMPTOMS
Neck: Injury to the soft
tissues in the neck may
manifest with abrasions
(scratches), hyperemia, e
cchymoses and edema.
The hyperemia may be
transient and not visible
by the time of
assessment.
Ecchymoses and
swelling may take time to
develop and may not be
visible on initial
assessment.
49. SIGNS AND SYMPTOMS
Attempted
throttling: Fingertips may
produce faint oval or round
bruises 1.5-2 cm in size (may be
more in case of continued
bleeding). A grip from right hand
produces a bruising due to bulb of
pressing thumb over the cornue of
hyoid/thyroid on anterolateral
surface of right side of victim's
neck and several fingertip bruising
marks and overlying nail scratch
abrasions over left side. A single
bruise on the victim’s neck is most
frequently caused by the
assailant’s thumb as bruises made
by tips of thumbs are more
prominent than with other fingers.
50. SIGNS AND SYMPTOMS
Multiple abrasions
on the neck may
be defensive in nature
from use of victim's
own fingernails in an
effort to dislodge the
assailant's grip but
commonly are a
combination of lesions
caused by both the
victim and the
assailant’s fingernails.
51. SIGNS AND SYMPTOMS
Chin abrasions
may also occur from
the defensive actions
as the victim tries to
protect their necks
from the manual
strangulation of the
assailant.
52. LIGATURE MARK (‘FURROW’) IN ATTEMPTED
HANGING AND STRANGULATION
S. No. Features Hanging Strangulation
1. Direction Oblique Transverse
2. Continuity Non-continuous Continuous
3. Level in the neck Above thyroid At or below thyroid
4. Base Pale, hard, Soft and reddish
parchment-like
53. SIGNS AND SYMPTOMS
Attempted
throttling: Fingertips may
produce faint oval or round
bruises 1.5-2 cm in size (may be
more in case of continued
bleeding). A grip from right hand
produces a bruising due to bulb of
pressing thumb over the cornue of
hyoid/thyroid on anterolateral
surface of right side of victim's
neck and several fingertip bruising
marks and overlying nail scratch
abrasions over left side. A single
bruise on the victim’s neck is most
frequently caused by the
assailant’s thumb as bruises made
by tips of thumbs are more
prominent than with other fingers.
54. SIGNS AND SYMPTOMS
Lungs: Aspiration
pneumonitis may occur due to
inhalation of vomitus during
the episode. Pulmonary
edema is a seen generally in
comatose hanging victims.
The cause of the pulmonary
edema can either be due to
anoxic injury to the central
nervous system (neurogenic
pulmonary edema) or from the
large negative intrathoracic
pressures seen when the
victim struggles to breathe in
against an occluded airway
(obstructive pulmonary
edema).
56. SIGNS AND SYMPTOMS
Fractures of the
thyroid cartilage or
hyoid bone in
victims of accidental
strangulation and
direct injury to the
trachea is rare with
strangulation. Carotid
artery injury is also
uncommon after
attempted hanging and
strangulation.
57. SIGNS AND SYMPTOMS
Injury to other organ systems
from strangulation is
uncommon. Case reports of
diaphragmatic
injury, multiple organ
failure, and thyroid storm
after attempted
strangulation; cricotracheal
separation and common
carotid artery dissection, and
laryngotracheal separation
after attempted hanging; and
laryngeal rupture and carotid
artery stenosis after
accidental strangulation have
appeared in the medical
literature.
58. SIGNS AND SYMPTOMS
Examination for other
associated injuries in
cases female
patients regarding
injuries on
lips, face, cheeks, abdom
en, back, genital
organs and breast (if
there is any history
suggesting sexual
abuse). In such cases
complete examination of
genital organs is of vital
importance.
59. Diagnosis
The majority of the victims present with
some common features, a combination of
these findings should be taken into
consideration for diagnosis:
Hyperemia and/or ecchymosis
Facial or conjunctival petechiae
Change of voice or difficulty in breathing
Marks on the neck
Loss of consciousness or altered mental
status
60. DIAGRAMS AND PHOTOGRAPHS
It is important to document the injuries through
diagrams and photograph that may be seen at the time
of examination for evidence purpose. The injuries should
be mentioned in the pictograph given along with the
medico-legal report. The following photographs may
also be taken:
Distance photo: Full body photograph to identify the
victim and location of injury.
Close-up photo: Photographs of injuries along with a
ruler from different angles to maximize visibility and to
document the size.
Follow-up photo: As the injuries may take time to
develop, taking follow-up photographs at different time
intervals will document injuries as they evolve.
61. LABORATORY AND IMAGING
Arterial blood
gases (ABGs)
analysis should be
done in all patients
who require
intubation, for
subsequent
ventilator
management.
62. LABORATORY AND IMAGING
Pulse oximetery
is indicated in
patients with altered
mental status and
respiratory distress.
It also makes ABGs
unnecessary in
patients who do not
require endotracheal
intubation.
63. LABORATORY AND IMAGING
Neck X-ray should be done
in nearly all strangulation victims
and patients with a mechanism
consistent with hanging. It is
useful to detect fractured hyoid
bone and for evaluation of
subcutaneous emphysema due to
fractured larynx. Fractures of the
cervical vertebrae are extremely
rare in strangulation injuries
unless there has been a hanging
with a free-fall drop of the body.
Generally, a fractured hyoid bone
indicates a severe, occult soft-
tissue injury, even in a patient
whose medical condition is
otherwise stable.
64. LABORATORY AND IMAGING
Chest X-ray is
indicated after
endotracheal
intubation for
placement
confirmation, diagnosi
s of pulmonary
edema, aspiration
pneumonitis and acute
respiratory distress
syndrome (ARDS).
65. LABORATORY AND IMAGING
CT scan is indicated to
detect hyoid bone and
laryngeal fractures, injury
to carotid arteries and other
soft-tissue abnormalities
that may not be apparent
on plain radiographs. CT
head is done to evaluate
neurological status. CT is
more sensitive for bony
injuries, subcutaneous
emphysema, soft-tissue
edema, and internal
hemorrhage.
66. LABORATORY AND IMAGING
Doppler vascular
imaging, CT
angiography or
arteriography is useful
to detect injury to the
carotid arteries (in
patients with unilateral
neurological findings).
The current ‘gold
standard’ for blunt
carotid artery injury is
four-vessel selective
angiography.
67. LABORATORY AND IMAGING
MRI is the most
useful imaging
modality for the
majority of such
victims because of
its highest sensitivity
for deep soft-tissue
injury including the
larynx and vessels.
69. MANAGEMENT
Like any other traumatic
injuries, the management
of a strangulation victim
starts with the ABCs
Airway
Breathing
Circulation Fluid
resuscitation must be
done judiciously as there
is risk of subsequent
ARDS and cerebral
edema.
70. MANAGEMENT
The choice and
sequence of imaging is
dependent on patient’s
clinical condition,
suspected injuries and
availability of the
specific modalities in
that set-up. An ENT
consultation can
establish both the
need for, and the
timing of, these
studies.
71. MANAGEMENT
Like any other
traumatic injuries, the
management of a
strangulation victim
starts with the ABCs—
airway, breathing, circu
lation. Fluid
resuscitation must
be done judiciously as
there is risk of
subsequent ARDS and
cerebral edema.
72. MANAGEMENT
Orotracheal
intubation should be
done preferably by an
anesthetist. It can be difficult if
laryngeal edema is present or
if direct traumatic disruption of
the larynx has occurred.
Cricothyroidotomy is indicated
for any patient with severe
respiratory distress and
completely obstructed airway.
If associated neck injuries
render cricothyroidotomy
difficult, percutaneous
translaryngeal ventilation may
be used to temporarily
oxygenate a patient.
75. COMPLICATIONS
Neurologic sequelae
including muscle
spasms, transient
hemiplegia, central
cord syndrome and
seizures. Long-
term paraplegia
or quadriplegia
and short-term
autonomic dysfunction
may be seen in spinal
cord injury.
77. PROGNOSIS
The prognosis for survivors of
hanging and strangulations
arriving to the emergency
department is widely variable. The
outcome is determined by the
presence of cardiopulmonary
arrest (as indicated by a
requirement for cardiopulmonary
resuscitation and/or invasive
airway management) and degree
of anoxic brain injury (as
correlated with a low
Glasgow Coma
Score and cerebral edema on
initial CT scan). In general, the
emergency room disposition of
such victims is primarily
determined by their clinical
condition and evidence of injury to
their deep neck structures.
78. MEDICO-LEGAL FORMALITIES WHILE DEALING WITH
ATTEMPTED STRANGULATION OR HANGING
Medical
practitioners who
examine such cases in the
emergency have to follow a
protocol regarding the
documentation of medico-legal
formalities; besides imparting
treatment in order to save the life
of patient. Injuries due to assault
are required to be informed to the
police (if police is not
accompanying) to ensure safe
disposition of the patient. In case
of suspected child abuse, child
protective agency should be
notified. The preparation of
medico-legal report is guided as
per the protocol .
79. LEGAL PROVISIONS
In India, attempt to commit
suicide is an offence
punishable under
Sec. 309 IPC. It
states that whoever
attempts to commit suicide
and does any act towards
the commission of such
offence, shall be punished
with simple imprisonment
for a term which may
extend to 1 year or with
fine, or with both. Attempt to commit suicide is
an offence punishable under
Sec. 309 IPC
80. LEGAL PROVISIONS
Abetment of
suicide: As per
Sec. 306 IPC, any
person who abets the
commission of suicide
shall be punished for a
term which may extent
to 10 years
imprisonment and
shall also be liable to
fine. GOPAL KANDA, THE SIRSA MLA
IS THE MAIN ACCUSED OF A CASE
UNDER SECTION 306 IPC
81. The Protection of Women from Domestic
Violence Act, 2005
Salient features of the
Act:
The term 'domestic
violence' covers all
forms of
physical, sexual, verba
l, emotional and
economic abuse that
can harm, cause injury
to, endanger the
health, safety, life, limb
or well-being, either
mental or physical of
the aggrieved person.
82. The Protection of Women from Domestic
Violence Act, 2005
Salient features of the Act:
‘Aggrieved' person' is not
just the wife but a
woman who is the sexual
partner of the male
irrespective of whether
she is his legal wife or
not. It includes daughter,
mother, sister, child
(male or female),
widowed relative, or any
woman residing in the
household who is related
in some way to the
respondent.
83. The Protection of Women from Domestic
Violence Act, 2005
Salient features of the
Act:
‘Respondent’ is any
male, adult person who
is, or has been, in a
domestic relationship
with the aggrieved
person that includes
his mother, sister and
other relatives; the
case can also be filed
against relatives of the
husband or male
partner.
84. THE PROTECTION OF WOMEN FROM
DOMESTIC VIOLENCE ACT, 2005
Information to Protection
Officer: The information
regarding any acts of domestic
violence does not necessarily
have to be lodged by the
aggrieved party but by any
person who has reason to
believe that such an act has
been or is being committed.
Any medical
officer, neighbors, social
workers or relatives can all
take initiative on behalf of the
victim.
85. THE PROTECTION OF WOMEN FROM
DOMESTIC VIOLENCE ACT, 2005
Duties of medical facilities:
If an aggrieved person or a
Protection Officer or a
service provider requests
the medical practitioner to
provide any medical aid to
the victim, the doctor
should provide medical aid
to the aggrieved person in
the medical facility.
86. THE PROTECTION OF WOMEN FROM
DOMESTIC VIOLENCE ACT, 2005
Penalties: The magistrate can
impose a penalty up to 1 year
of imprisonment and/or a fine
up to Rs. 20,000/- for an
offence under this Act. The
offence is also considered
cognizable and non-bailable.
The decision can be taken
under the sole testimony of the
aggrieved person; the court
may conclude that an offence
has been committed by the
accused.
87. THE PROTECTION OF WOMEN FROM
DOMESTIC VIOLENCE ACT, 2005
The magistrate can impose
monetary relief and monthly
payments of maintenance. The
respondent can also be made to
meet the expenses incurred and
losses suffered by the aggrieved
person as a result of domestic
violence and can also cover loss
of earnings, medical
expenses, loss or damage to
property and can also cover the
maintenance of the victim. The Act
also allows the magistrate to make
the respondent pay compensation
and damages for injuries including
mental torture and emotional
distress caused by acts of
domestic violence.
88. KEY ELEMENTS OF STRANGULATION AND
SUFFOCATION STATUTE
The Strangulation and Suffocation Law in the Unites
States defines and provides penalties for a person
who engages in intentional strangulation and
suffocation. The states of Iowa, South Dakota,
California, Wisconsin, Tennessee, Virginia and New
York have passed laws making it a felony (a crime
punishable by death or imprisonment in excess of 1
year) under certain conditions to knowingly impede
someone’s breathing.
89. ‘Dangerous weapon’ means any firearm, whether loaded or
unloaded; any device designed as a weapon and capable of
producing death or great bodily harm; any ligature or other
instrumentality used on the throat, neck, nose, or mouth of
another person to impede, partially or completely, breathing or
circulation or blood; any electric weapon, or any other device or
instrumentality which, in the manner it is used or intended to be
used, is calculated or likely to produce death or great bodily
harm.
‘Substantial bodily harm’ means bodily injury that causes a
laceration that requires stitches, staples, or a tissue adhesive;
and fracture of a bone; a broken nose; a burn; a petechia; a
temporary loose of consciousness, sight or hearing; a
concussion; or a loss or fracture of a tooth.
90. SAMPLE CASE REPORT
Domestic violence: A lady 29 years was admitted in Medicine
unit in emergency as a suspected case of poisoning with history of
found unconscious at her residence; alleged by her husband to
have taken some drugs at her home. On examination, the lady
was cyanosed. She was managed and treated as a case of
suspected poisoning. Next day, the department of Forensic
Medicine was approached for review of the case and on thorough
examination, a ligature mark was found all around the neck which
was circular, and horizontally placed below the level of thyroid
cartilage (Fig. 1). The patient was immediately shifted to ICU
where it was confirmed that the patient had developed pulmonary
edema. On detailed investigation by the investigating officer, it
was confirmed that the husband had tried to strangulate her over
some dispute but could not succeed.
91. SAMPLE CASE REPORT
Sexual assault with manual strangulation: A young girl aged
13 years was found from an abandoned street in semi-
unconscious condition. She was shifted to Govt. Medical
College Jammu for treatment. During examination, cresentric
abrasions along with multiple oval shaped bruises were
found over the neck and nasal region. Two days after, when
she regained her consciousness fully; her statement was
recorded by the police. It was revealed in the statement that
she was kidnapped by her close relative and then taken to
abandoned street and was sexually assaulted there and when
she tried to cry, she was throttled and smothered by the
accused, thereafter she fell unconscious.
92. SAMPLE CASE REPORT
Traumatic asphyxia: A truck conductor was brought to the
emergency in Govt. Medical College Jammu in semi-
conscious condition with labored breathing, intense
cyanosis, and tachycardia. The history revealed by the police
that he was helping the driver by standing at the back side of
truck for the purpose of parking. However, the driver could
not control the truck while reversing the same that lead to
fixation of the conductor in between the backside of truck
and the wall resulting in traumatic asphyxia. On examination,
multiple bruises and contusions over the chest with fracture
of ribs were found. Patient was immediately shifted to ICU but
could not survive and died after two days.
93. THANKX FOR Y0UR PATIENCE...
IT IS A SUZY
WORK...................