1/11. Asphyxial death during prone restraint revisited: a report of 21 cases.Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/11. Petechiae of the baby's skin as differentiation symptom of infanticide versus SIDS.The successive killing of three siblings by their biological mother at two-year intervals is described. The children were 367 days, 75 days and 3 years old. Although sudden infant death syndrome (SIDS) or interstitial pneumonia could not be ruled out as the cause of death in the two younger children, who were killed first, the third child exhibited discrete signs of violence in the mouth and throat area which were interpreted as proof of infanticide. All three children had petechiae of the skin of the face and throat, the upper thorax, the shoulders and the mucous membranes of the mouth. None of the children exhibited signs of a disease-related hemorrhagic tendency. After the mother was convicted of murdering the three-year-old boy by smothering in combination with compression of the thorax, she confessed to having killed the other two children in a similar manner. In the absence of hemostatic disease, the presence of petechiae of the skin extending over the entire drainage area of the Vena cava superior can be regarded as evidence of an increase in pressure in the thoracic cavity secondary to obstruction of the airways with simultaneous chest compression.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/11. Self-strangulation: an uncommon but not unprecedented suicide method.The authors report two cases of self-strangulation in which the investigators had initially suspected homicide but eventually deemed the cases to be suicide. Self-strangulation may be mistaken for homicide because it is widely believed to be impossible to carry out this act without assistance. An accurate medicolegal evaluation of the circumstances, a thorough postmortem examination, and methodical inspection of the site are extremely important in such cases. It is equally important to examine the knot or other means used to exert pressure on the neck and to document its position. Finally, to gain a full understanding of these unusual cases, close collaboration between the two different fields, investigative and medicolegal, is essential.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/11. Strangulation with intravenous tubing: a previously undescribed adverse advent in children.Nonintentional strangulation in children is a widely recognized risk as a result of the vulnerability of their airway to occlusion by relatively low pressures. We describe 2 cases of strangulation by intravenous (IV) tubing in infants, 1 of which was fatal. This is the first documentation in the health science literature of this as a potential adverse consequence of IV therapy in young children. It is important that hospitals that care for such children recognize this potential risk and implement the appropriate strategies to minimize or eliminate it. Preventive interventions may include ongoing assessment of the need for continuous rather than intermittent IV infusions (saline or heparin locked IV sites), individualized level of supervision according to the child's age and behavior, and engineering modifications to the IV equipment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/11. Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia.OBJECTIVE: To report a case of orbital compartment syndrome mimicking cerebral herniation in a boy with severe traumatic asphyxia. DESIGN: Case report. SETTING: A tertiary-care pediatric intensive care unit. SUBJECT: A 12-yr-old boy with traumatic asphyxia syndrome. INTERVENTION: Mechanical ventilation, chest tube drainage, nitric oxide, lateral canthotomies, intracranial pressure monitoring. MEASUREMENTS AND MAIN RESULTS: A patient is presented with severe traumatic asphyxia syndrome complicated by prolonged hypoxemia, massive capillary leak syndrome, and acute onset of pupillary dilation and loss of reactivity to light. Ophthalmologic examination confirmed bilateral orbital compartment syndrome, which was treated emergently with bilateral canthotomies at the bedside. The procedure was followed by prompt return of pupillary size and function and decrease in intraocular pressure. The patient experienced complete recovery of vision in the right eye, but vision in the left eye was severely impaired. CONCLUSIONS: Our case report emphasizes the importance of considering orbital compartment syndrome in patients with traumatic asphyxia syndrome. Recognition of orbital compartment syndrome is important in this setting because prompt operative intervention may reduce the likelihood of permanent vision loss.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/11. Dirty diving. Sudden death of a SCUBA diver in a water treatment facility.We report a case of a sudden death in a SCUBA diver working at a water treatment facility. The victim, an employee of the facility with a specialty in electronics, was a sport diver not qualified in commercial diving. While attempting to clean sludge from a blocked drain 25 ft under water, the diver was suddenly pinned against the drain valve when the sludge plug was broken up. We review the mechanics of the incident and the actual cause of death, asphyxia, as opposed to drowning. We believe this to be the first reported case of traumatic (pressure) asphyxia in a SCUBA diver.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/11. Resuscitation by extracorporeal lung assist of a patient suffocating after inhalation of sawdust particles.A 17-yr-old male accidentally inhaled a massive amount of sawdust particles. Severe respiratory distress developed, resulting in subcutaneous emphysema and left pneumothorax. Therefore, sufficient positive-pressure ventilation was inapplicable. Under veno-venous extracorporeal lung assist (ECLA) with an artificial lung, the sawdust particles were removed by broncho-fibroscopy and lung lavage. After 36 h, the patient was weaned from ECLA without further complications.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/11. Identification of mechanical asphyxiation in cases of attempted masking of the homicide.Five homicides are described that had remained unexplained as to the causes of death after gross pathology. Although general signs of asphyxiation were present, they were lacking injuries specific of strangulation or oro-nasal occlusion. The diagnoses of asphyxiation were established by microscopical investigation of the lung and confirmed by subsequent police inquiries. An oro-nasal occlusion was involved in three cases, a strangulation or an oro-nasal occlusion, in another case. The victims were young and healthy. Toxicological investigations remained negative in four cases; one victim was anaesthetized by bromazepam and ether and had a blood alcohol concentration of 80 mg/100 ml. Lung histology and electron microscopy revealed acute emphysema, the development of a haemorrhagic-dysoric syndrome and a microembolism syndrome. With regard to the haemorrhagic-dysoric syndrome, the development of alveolar-interstitial edema is particularly important. This finding may also be diagnosed by light microscopy in semi-thin sections. It is emphasized that the combined action of several pathomechanisms is responsible for the rapid manifestation of the pulmonary lesions. Especially, the haemorrhagic-dysoric syndrome is brought about by the combined action of inspiratory intrapulmonary vacuum and raised intracapillary pressure. The complex pattern allows to compile the diagnosis of mechanical asphyxia even if there is no corresponding injury.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/11. Near-hanging injury in childhood: a literature review and report of three cases.Near-hanging injury is not an uncommon occurrence in children. Surprisingly, little discussion of this topic occurs in the pediatric literature. Previous reports note that children who present with an initial pH less than 7.2, apnea or agonal respiration, or who subsequently require mechanical ventilation, either die or survive with severe neurologic residua. We report a series of three pediatric patients aged 12 years or younger who initially presented with a combination of the above morbid criteria, all of whom survived with good neurologic outcomes. Children who suffer significant near-hanging injury should be considered at high risk to develop cerebral edema and therefore should be managed aggressively. Early cardiopulmonary resuscitation in the field is essential to reestablish cerebral blood flow. A good response to initial resuscitation is an important prognostic factor for eventual recovery. After arrival to the emergency department, therapy should include controlled hyperventilation, fluid restriction, and other supportive measures to limit intracranial pressure in high-risk patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/11. adult respiratory distress syndrome after attempted strangulation.We describe a case of severe acute lung injury after attempted strangulation. The patient presented initially with cerebral irritability and florid, noncardiogenic pulmonary oedema which were followed by a prolonged period of the adult respiratory distress syndrome, severe sepsis and multiple system organ failure, although the patient eventually survived. The pulmonary injury following strangulation is proposed to be a result of the generation of marked subatmospheric pressures within the lungs during vigorous inspiration against an obstructed airway, although the processes involved in the so-called neurogenic pulmonary oedema are difficult to exclude.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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