DEPARTMENT OF FORENSIC MEDICINE - Hillsborough ...

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DEPARTMENT OF FORENSIC MEDICINE
GUY’S HOSPITAL
(UNIVERSITY OF LONDON)
O, i e . WEST. M.B., CUJB.. F.R.C.Pith., D.MJ.
Dr- R.T. SHEPHERD B-Sc,. M-8.. B.S_ MR.C.P«h.. D M X
D if act Telephone tine 07M 0? 037g /0 7 l-i0 3 1118)
(F«: 071-103 7292)
UNITED MEDICAL AND DENTAL SCHOOl-S
GUTS AND ST. THOMAS'S HOSPITAL
LONDON BRIDGE. SEl 9RT
TELEPHONE. 011-955 5000 Ext: 3118/3119
Unfortunately it has become a habit for pathologists to call all such
deaths traumatic asphyxia and it may well be correct in one sense in as
much as trauma to the chest has resulted in the mechanical obstruction
of respiration- In pathological terms there is probably little relevance
in distinguishing between the two mechanisms as the term merely implies
that death has resulted from a mechanical obstruction to respiration
resulting from pressure being applied to the torso.
In clinical terms however there does seem to be a difference in the two
different types of traumatic asphyxia with a much graver prognosis being
•
present in those where there has been evidence of a sudden and acute
severe rise in the venous pressure in the upper part of the body. In fact
most of the individuals who suffer from this classic form of traumatic
asphyxia do not survive if they are severely affected and not rescued
rapidly.
R . G> -•»
where the individual suffers primarily an obstruction to his movements
of respiration death will occur as the result of hypoxic damage to the
brain. This may take a much longer time than in individuals who have J,
}?een crushed so impedence of the venous return to the heart occurred, yi
Indeed some individuals will survive but remain permanently r
neurologically damaged as a result of suffering severe anoxic cerebral
injury.
It is probable that a period of at least some 10 minutes or so would be
necessary before one would be able to state categorically that absent .#
respiratory movement would lead to death- Consciousness may be lost quite LJ
rapidly but where the obstruction has not been complete consciousness may /»
take a considerable time to be lost. I have experience of cases where
individuals have died through anaesthetic accidents whereby no oxygen was
zin g supplied to the lungs whilst they were paralysed during surgery,
two of the cases in e x c e s s of 10 minutes elapsed before the surgeon
noticed that the heart action was in the terminal stages of failure.
It is also known that individuals who have suffered severe hypcxic damage
may not die immediately. They may be recovered unconscious with an
active circulation but the circulation rapidly fails despite all attempts
at x’esuscitation. This roav well represent concomitant damage to the heart
muscle leading to what is in effect a heart attack (anoxic myocardial
infarction). severe hypoxia of several minutes duration would be
necessary for this tc occur- It is therefore possible that a young man
who had been asphyxiated by being crushed, would be capable, after being
removed from danger, of some conscious activity but could still die as
a result of hypoxia in the ensuing minutes.