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