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Traumatic asphyxia Traumatic asphyxia (syn. crush asphyxia) is a form of asphyxia where exclusion of air💨🫁 from lungs is effected by mechanical fixation of chest in such a way that normal respiratory movements are prevented⛔️. It is mostly accidental, but may be homicidal and suicidal as well. 1. Causes a. Accidental (1) Riot crush - When large crowds👯👯♀️👯♂️ gather at a small place, and due to some disturbance (eg fire, 🔥explosion, electricity failure etc), everyone starts running hither and thither in a completely disorganized way resulting in a stampede. Chest of each individual is pressed violently by the mass of the crowd. Some individuals may fall down, and others may trample on their chests (human pile deaths). 👥🫂On December 4, 1981 (Friday), there were 300-400 people inside New Delhi's Qutub Minar, 🇮🇳including several school groups that were taking advantage of the free admission on Fridays. Suddenly the electricity failed and there was complete pandemonium inside. Everybody started running helter-skelter. In the ensuing mêlée 45 persons died of traumatic asphyxia. It is one of the most important historical instances of deaths by Traumatic Asphyxia.🫁 This day is now referred to as Black Friday. (2) Restraint asphyxia When a policeman forcibly restrains a criminal, especially by pinning him on the ground in a prone position, with his hands pinned backwards. The death may also be due to excited delirium syndrome . (3) Falling of earth or stone - usually in a coal mine or during tunneling or🪨🏢n a building collapse (4) During car repair - Mechanic repairing car positioned underneath a car-Jack slips→ Vehicle falls on top of his chest (5) Industrial accident - Machinery falling on victim's chest (6) During natural disasters 🌋- earthquakes and landslides (7) During railway shunting of carriages - victim may be pressed between two railway carriages (8) Heavy tree or branch of tree falling on a person sleeping underneath (9) Some snakes [Boas and pythons] kill by winding around chest, constricting it b. Homicidal (1) Assailant jumps on or steps upon the chest of victim (2) Jack-knifing - Victim's thighs and knees are forcibly hyperflexed against his own chest and abdomen, so he can't breathe [indirect compression of chest] (3) Traumatic asphyxia by bansdola - Chest is squeezed forcibly between two sticks placed across front and back of upper part of chest c. Suicidal (1) Victim allows a heavy weight to fall upon himself. Seen mostly in mentally ill. PM Appearances a. External (1) Face, lips🫦, scalp - Swollen, congested. (2) Head, neck, upper chest above the level of compression: (i) Intense congestion, petechial and confluent 🩸hemorrhages and deep purple or purple red 🔵cyanosis. This is due to retrograde displacement of blood from the SVC into the subclavian veins and head and neck veins, due to sudden compression of chest. The level of compression is often very clearly marked, below which the skin is pale or sometimes mildly cyanosed. (ii) The spread of blood 🔵to the veins of upper limbs is prevented by valves, but it can easily go in the valveless veins of head and neck, where it can rupture distal venules and capillaries 💢→ petechial hemorrhages of skin,Intense congestion of chest in a case of traumatic asphyxia. This man got crushed in a house colapse. Note the sharp line of demarcation between congested and pale skin on the chest. eyelids, conjunctivae, mucus membranes of mouth. Also bleeding from nose, mouth and ears. May cause "🩸blood blisters" underneath the sclera [due to hentorrhages] which bulge through the 👁️👀eye. (iii) The purple red color is both due to dilated bv as well as hemorrhages in the tissues around them. (iv) If patient recovers, the purple color gradually disappears in 10-14 days without the color changes seen in bruises. (3) Pallor - At the level of shirt collar or folds or creases in the garments, braces, buttons etc. b. Internal (1) Fractures#️⃣ - of ribs, sternum, vertebrae, and other bones depending on how the body was crushed. Brain - Congested. 🧠💦Shows petechial hemorrhages 3) CVS - Right side of heart markedly💗 distended. Subendocardial petechial hemorrhages. All veins above aorta are markedly distended. (♋️4) Lungs - Dark, heavy.🫁 Show subpleural petechial hemorrhages. (5) Internal organs - Congested.💦💧