1. Asphyxia and Anoxia Dr. Abdulmonem Al-Hayani MBChB, DipFMS(Lon), PhD(Aber) Dr. Al-Hayani

2. Dead at Fire • The body of a 32 years old female Nurse (Fiona) was recovered from her house, after a huge fire that destroyed the whole hose. Police investigations revealed that the fire was not an accident. • What Questions you would like to ask more? • How did Fiona Passed Away? Dr. Al-Hayani

3. Outcome=Aims=Goals • Why this lecture? • Definitions of Asphyxia and Anoxia? • Signs of Asphyxia? • Types of Asphyxia (Causes) • Common examples of Anoxia and Asphyxia Dr. Al-Hayani

4. Why this lecture? As GPs, we will see many cases of Asphyxia Dr. Al-Hayani

5. Definition of Asphyxia • Situations in which there is an obstruction to breathing • Body will be deprived to O2 • Either no air or insufficient air getting into the body Dr. Al-Hayani

6. Definition of Anoxia • Anoxia = Hypoxia Oxygen already present in the body Dr. Al-Hayani

7. Definition of Anoxia • Failure of O2 which is already in the body to get into the tissues • Causes of anoxia: • Shock • Anemia • CO poisoning • Heroin intoxication Dr. Al-Hayani

8. Signs of Asphyxia Congestion Petechail Hemorrhage Cyanosis Dr. Al-Hayani

9. Types (causes) of Asphyxia • Environmental • Crush Asphyxia • Suffocation/Smothering • Positional Asphyxia • Chocking • Compression of the Neck • Hanging/Strangulation Dr. Al-Hayani

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19. Example of Asphyxia Drowning Dr. Al-Hayani

20. Drowning • Where? • Sea • River • Canal • Bath • others Dr. Al-Hayani

21. Drowning • Body recovered dead? • Death before entering water (concealment of homicide) • Immersion • True drowning • Death in water from other causes (heart diseases, trauma) • Hypothermia Dr. Al-Hayani

22. True drowning (Asphyxia) • Phases of drowning: • Breath holds • Inhalation of water, coughing, vomiting and loss of consciousness • Convulsions, respiratory arrest then cardiac arrest Dr. Al-Hayani

23. Drowning • Types? • Fresh water • Sea water Dr. Al-Hayani

24. Autopsy signs of Drowning • Classical signs only in 35% of cases • Froth in nose and mouth • Pulmonary edema • Overdistention of lungs • Dry drowning Dr. Al-Hayani

25. Autopsy signs of Drowning 5. Middle ear hemorrhage 6. Chemical tests (unreliable) 7. Non-specific changes of immersion Dr. Al-Hayani

26. Autopsy signs of Drowning • The best sign is: Diatom Test Dr. Al-Hayani

27. Example of Anoxia Fire Fumes Inhalation Dr. Al-Hayani

28. Fire Fumes • Commonest cause of death in fires • Autopsy signs of fire fumes inhalation: • Burns to air passages • SOOT • Pulmonary edema • Toxins in blood e.g. cyanide, plastics chemicals etc… Dr. Al-Hayani

29. The most useful sign is Carbon Monoxide Level in Blood Dr. Al-Hayani

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31. Summary Dr. Al-Hayani

32. Key Lesson As a GP you will see many cases of Asphyxia and Anoxia, so please think about a possibility of crime when you see such cases Dr. Al-Hayani

33. Questions & Comments Dr. Al-Hayani