Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations

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Abstract

In contrary to “physical restraint”, describing a fixed body position due to external devices, “positional restraint” is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. Autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon’s sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and thererfore, aggravated the potentially lethal impact of positional restraint.

Section snippets

Case report

A 23 year old male was found dead at 6:00 a.m., in a grotesquely fixed prone body position in the corner of a staircase (Fig. 1, Fig. 2). The decedent’s left leg was outstretched adjacent to the stair-rail, whereas the right leg was inflected and wedged on another stair-rail. The left hand was found on the corner’s wall in 90° retroflection, whereas the cyanotic right hand was hanging down loosely. The decedent’s cyanotic head was retroflected in a maximum position, the nose and lips were

Autopsy findings

On external examination, the body showed marked petechial haemorrhages of the conjunctivae (Fig. 3) and the oral mucosa, moreover large area impact abrasions and perpendicular parallel scratch marks on the left cheek and zygomatic region, respectively. In the forehead skin, 3 cm above the left eyebrow, numerous subtle brown-reddish abrasions were observed in a 3 cm × 3 cm area. There was a 1.5 cm (vertical) and 0.5 cm (horizontal) brown-reddish impact abrasion on the external margin of the left

Toxicological investigations

Blood alcohol concentration was determined to be 2.60 g/l; urine alcohol concentration 3.26 g/l. Toxicological assays of autopsy specimens for drugs of abuse applying routine methods revealed negative results.

Positional asphyxia after blunt head trauma under the influence of alcohol was determined as cause of death.

Discussion

The term “physical restraint”, describes a fixed (prone) body position due to external devices (handcuffs, etc.) and is commonly used with regard to measures for custody of prisoners, transport of agitated psychiatric patients in ambulances, etc. [3], [4]. On the contrary, “positional restraint” is defined as a fixation in an abnormal body position, resulting just from accidental fixation of the body in unfortunate circumstances [5]. The cause of death due to both, positional and physical

Acknowledgements

The authors are indebted to R. Bauer, Bonn Criminal Investigation Bureau for the constructive discussion and his support. J. Brünig and A. Fuchs, Department of Legal Medicine, University of Bonn for technical assistance.

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    Presented at the 82nd Annual Meeting of the German Society of Legal Medicine (DGRM), Münster, September 2003.

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    Present address: Department of Legal Medicine, University of Cologne, Melatengürtel 60-62, D-50823 Cologne, Germany.

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