Hanging Flashcards
What might be checked in an autopsy for strangulation?
Lower back or neck - pressure
What signs under the skin?
Blood or skin: skirmish
Part of ligature: not instantaneous
What if bruising follows a similar pattern to the ridges?
Usually suicide
Define an expert witness
A person whose opinion by virtue of education, training, certification, skills or opinion is accepted by the judge as an expert.
What is perjury?
The offence of wilfully telling an untruth or making a misrepresentation under oath.
More common signs of hanging?
Pale face
Salivia
Elongated neck
Ligature mark obliquely places, high on neck, going upward
No abrasion/contusion around ligature
Fracture dislocation of cervical vertebrae is only seen in judicial hanging
Emphysematous bullae on lung surface
More common signs of strangulation?
Congested face, petechial haemorrhages
No dribbling or neck elongation
Subcutaneous tissue under ligature suffused with blood.
Common to bleed from nose, ears, mouth. Common to rupture carotid arteries
Common to fracture larynx/trachea/hyoid bone
RARE to fracture-dislocate cervical vertebrae
Other: other assault signs inc sexual assault
Clinical course of hanging?
PEA will occur in 3-11 minutes (based on animal studies)
Asystole occurs several minutes later
Brady-asystolic arrest can also occur
VERY RARE to see VF after asphyxial cardiac arrest
What is the proposed pathophysiology of most hangings?
Venous obstruction (superficial jugular)-> LOC Resulting decreased muscle tone in neck increases pressure --> arterial obstruction (direct or spasm).
Other theories: vagal direct stimulation (bradycardia/hypotension) or carotid sinus stimulation (carotid bodies also stimulate vagal collapse) -> CA
Compression or rupture of verternral and carotid arteries
Upper airway occlusion thought to be rare.
Complications post hanging?
Local injuries
Pulmonary complications (aspiration pneumonia, development of ARDS, pulmonary oedema)
Secondary cerebral injury
Laryngeal oedema and delayed airway obstruction
Better intact survival
LOC not CA
Witnessed arrest/bystander CPR/shockable rhythms
Types of judicial hanging?
Short Drop – dropped a few inches so suspended body weight and physical struggle causes noose tightening
Suspension hanging – executee lifted into the air using a crane of other mechanism
Standard drop hanging – dropped 4-6ft which may or may not break their neck
Measured/long drop hanging – drop distance calculated using the weight and height of the executee
What has been the change in knot position?
Nape of neck -> sub-mental/sub-aural
Other injuries/proposed pathophysiology in hanging not already mentioned?
Diffuse axonal injury
Hypoxic serizure
Aspiration
Medullary Explosion
Most common to least common?
Venous occlusion
Arterial occlusion
Carotid sinus stretching
Airway occlusion
