Gantung diri

Organ dan Jaringan Kemungkinan TemuanPemeriksaan luar dan kulit Menyesuaikan pola dan alur pengikat; ada atau tidaknya

sianosis dan petechiae; penjuluran lidahTardieau spotsUkuran dan pola pengikat harus sesuai dengan ukuran dan pola alur

Leher Lingkar pengikat lebih kecil dibandingkan lingkar leherFraktur cornu laryngeal superior atau hyoid pada lansia

Asfiksia

Organ dan Jaringan Kemungkinan TemuanPemeriksaan Luar Sianosis; benda asing dalam mulut atau faring; tanda jerat;

perdarahan scleraPleura dan pericardium Petechiae, Tardieus spotsJantung Hipertrofi Ventrikel kananParu Edema pulmonal akut pada hipoksia kronikOtak Edema serebral pada acute mountain sicknessTelinga tengah Perdarahan mukosa

(1) Handbook of autopsy practice third edition. Jurgen Ludwig, MD. Humana press. Totowa, New Jersey. 2002

Bruises may be seen on the neck in cases of manual strangulation and are thenusually associated with other signs of asphyxia. (2)

Retinal hemorrhages are strongly suggestive of abuse when accompaniedby intracranial injuries and in the absence of a confirmed history of severeaccidental injury. Unilateral or bilateral retinal hemorrhages are present in 75–90% of cases of shaken baby syndrome (36). Retinal hemorrhages can also befound after severe closed chest injury, asphyxia, coagulation disorders, carbonmonoxide poisoning, acute hypertension, sepsis, meningitis, and normal birth(usually disappearing by 2 weeks, rarely persisting to 6 weeks). (2)

The anesthetic effects of alcohol may also result in deaths from asphyxiation.These deaths are the result of the intoxicated individual moving into orbeing placed or left in a position that impedes respiration either by occlusionof the external respiratory orifices or the internal airways (particularly thelarynx) or restricts the free movement of the chest wall. These positions mayresult from lying face down on a bed, marked extension or flexion of the neck,or lying across an edge with the head down. Deaths resulting from impairmentof respiration in this manner classically result in profound asphyxial changesinvolving the upper body, and these deaths are ascribed to postural asphyxia. (2)

Pressure on the neck is not, of course, the only mechanism whereby anindividual may suffer anoxia or asphyxiation. Any action that partially orcompletely occludes the mouth and/or the nose will result in difficulty inbreathing and may result in asphyxiation. (2)

Ligature StrangulationBecause the possibility of suspension is reduced by the changes in thedesign of the cells, the possibility of other forms of self-asphyxiation are likelyto increase. Self-strangulation by ligature is considered to be possible but difficult(14); because the pressure has to be applied to the neck in these cases bythe conscious muscular effort of the hands and arms, it follows that whenconsciousness is lost and the muscular tone lessens, the pressure on the ligaturewill decrease, the airway obstruction and/or the vascular occlusion willcease, and death will generally be averted. However, if the ligature is knottedor if the material is “non-slip” and looped around itself, then it is possible forthe individual to apply the pressure to the neck and for that pressure to bemaintained even after consciousness is lost and, as a result, death may follow.As with hanging, the key to preventing these deaths lies in careful evaluationand, if necessary, the removal of clothing and observation. (2)

The major features of asphyxiation are cyanosis, congestion, and petechialhemorrhages (14). These features are seen to a greater or lesser extent inmany, but not all, cases of asphyxiation. They often are completely absent inmany plastic bag asphyxiations and in hanging, they have variable presencein manual strangulation, and they are most commonly seen in ligature strangulation. (2)

Asfiksia merupakan istilah yang sering digunakan untuk menyatakan berhentinya respirasi yang efektif atau ketiadaan kembang kempis.

Berikut ini terdapat beberapa cara seseorang mengalami asfiksia:

1. Kompresi pada leher (gantung dan jerat)2. blokade pada jalur napas (sufokasi, penyumpalan)3. kompresi pada dada, leher atau wajah (asfiksia postural atau asfiksia posisional)4. bahan kimia dan kurangnya oksigen yang tersedia

1. kompresi pada leherPada kasus gantung (biasanya gantung diri), leher dikompresi oleh tali atau kawat. Penekanan pada leher biasanya akan menutup peredarahan darah, dan juga jalan napas (laring atau trakea). Rupturnya pembuluh darah pada jaringan tubuh setelah gantung dalam waktu yang lama, terutama pada ekstremitas bawah disebut Tardieu spots.Tanda trauma pada leher adalah bukti gantung diri dan jerat. Biasanya terdapat kontusio atau lecet. Benda yang digunakan untuk menekan leher biasanya meninggalkan bekas. Jika pengikatnya tipis seperti tali, tanda pada leher biasanya tampak dan polanya dapat dicocokkan. Jika benda untuk mengikatnya tebal, seperti handuk atau baju, tidak akan tampak pola yang terbentuk.Bintik perdarahan, atau petechiae, biasanya tampak pada mata setelah kompresi pada leher. Petechiae bisanya dapat pula ditemukan pada bola mata atau kelopak ataupun keduanya. Petechiae disebabkan oleh membesarnya tekanan vascular yang menyebabkan pecahnya kapiler.

2. Blokade jalan napasJika jalan napas dihambat, oksigen tidak dapat menuju paru-paru, dan menyebabkan asfiksia.