Zur Pathophysiologie und Pathomorphologie bei Tod durch Druckstauung

Abstract

A literature review of traumatic asphyxia is given. The most important presuppositions for the development of traumatic asphyxia are: a) thoracic compression, b) warning of impending disaster just prior to trauma leading to inspiration and closing of the glottis.These mechanisms result in an increase of the intrathoracic pressure with subsequent reflow of blood into the cranio-cervical veins which are not protected by valves. -Independently the prevention of thoracic breathing leads to severe asphyxia. Death occurs only in prolonged thoracic compression and is either due to pulmonary congestion or to asphyxia.Morphological and biochemical examinations were performed systematically with four fatalities of asphyxia and three cases who had died of both, asphyxia and polytraumao The autopsy findings corresponded to the well-known picture of traumatic asphyxia: edema, cyanosis and hemorrhages in the region of the upper v. cava, excessive pulmonary congestion and signs of suffocation.Histological changes were felt to be due to three major pathomechanisms: a) Changes of hypoxidosis due to asphyxia: vacuolisation and edema of hepatocytes, the renal tubular epithelium and the heart muscle cells, mobilization of alveolar cells with formation of multinucleated giant-cells, b) Intermediate or severe degrees of pulmonary microembolism mainly consisting of fat droplets and bone marrow and additionally of smaller quantities of free megacaryocytes, c) Interstitial and intraalveolar edema of the lungs and interstitial edema of the heart muscle mainly due to the haemodynamic disturbances. Biochemically the serum catecholamine concentrations were moderately or strongly elevated pointing to asphyxial pathomechanisms. -Fatal termination is supposed to be due to a combined action of haemodynamic dysregulation, asphyxia and pulmonary microembolism.

The Analysis of the Cause-Effect Relation between Tractor Overturns and Traumatic Lesions Suffered by Drivers and Passengers: A Crucial Step in the Reconstruction of Accident Dynamics and the Improvement of Prevention

“…Another type of injury is that caused by the victim being trapped under the wheels of the still-moving tractor: significant lesions in the affected parts of the body, here we see serious damage to internal organs, bone fractures and severe surface wounds (lacerated and contused wounds, ecchymosis, patterned excoriations, tissue loss which may mirror the shape of tractor tyres or treads); such wounds are normally caused by the crushing action of a rubber tyre or continuous track [16,[29][30][31].…”

“…If the chest is immobilized but not crushed, the discoloration of the skin associated with crush asphyxia will be absent since there will be no increase in venous capillary pressure; but because the breathing movements and alveolar ventilation will be obstructed, arterial hypoxaemia will occur and lead rapidly to death by cardiac arrest [18,[29][30][31]33,34].…”

“…In such cases, external post-mortem examination may reveal the "ecchymotic mask" phenomenon, characterized by conjunctival and facial petechiae, and intense purple congestion and swelling of the head, face, neck, upper chest and sometimes the upper limbs [16,[29][30][31][32].…”

“…The presence of cutaneous and mucous petechiae, purple congestion and swelling of the upper body is caused by: (a) an increase in venous capillary pressure owing to the reduced return flow to the right chambers of the heart (this increase is facilitated by the absence of valves in the main veins of the neck and head); (b) persistent arterial flow towards neck and head, c) the crush victim performing an involuntary Valsalva manoeuvre, which produces a further increase in intrathoracic pressure and a further reduction in the return flow to the left heart chambers [16,[29][30][31][32].…”

“…It is also important to distinguish, during the post-mortem examination, between injuries caused when the body of the victim is thrown to the ground and those which follow in rapid succession when the victim, already on the ground, is crushed by part of the tractor: there will be superficial wounds caused by the impact with the ground (which may be flat or irregular with stones, rocks, branches or tree-trunks) and both superficial and deep wounds produced by crushing under the tractor and by contact with specific structural parts of the vehicle [12,16,[29][30][31].…”