자세성질식사: 여전히 어려운 진단인가?
Positional Asphyxia: Remains Hard to Diagnose?
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Positional asphyxia is a type of asphyxia where the position of an individual compromises the ability to breathe. It is commonly caused by accidents due to alcohol or drug intoxication, diseases, and/or being in a confined space. In this study, the authors reviewed autopsy cases at their institute over the past 5 years where positional asphyxia is suspected as a contributing factor or cause of death. The autopsy cases (n=24) were divided into three groups: positional asphyxia was the cause of death (n=15); unknown cause of death but positional asphyxia was considered (n=4); and positional asphyxia was suspected to be a contributing factor (n=5). All cases of group A included postures that could interfere with breathing, but the typical jackknife or head-down postures were seen in approximately half of the cases; “classic signs of asphyxia” were also observed in approximately half of the cases. They shared features such as high blood alcohol concentration, therapeutic levels of drugs, various disease, minor head trauma, and morbid obesity; however, no definite diagnostic criteria have been established for forensic practice. Positional asphyxia is a form of mechanical asphyxia which must be differentiated from traumatic asphyxia. In addition to a complete autopsy, thorough laboratory tests and understanding of the circumstances of the case and the situation at the death scene are required for diagnosis. Special attention is required for the diagnosis of special types of positional asphyxia such as death during institutional restraint or prone restraint.
Abstract
Positional asphyxia is a type of asphyxia where the position of an individual compromises the ability to breathe. It is commonly caused by accidents due to alcohol or drug intoxication, diseases, and/or being in a confined space. In this study, the authors reviewed autopsy cases at their institute over the past 5 years where positional asphyxia is suspected as a contributing factor or cause of death. The autopsy cases (n=24) were divided into three groups: positional asphyxia was the cause of death (n=15); unknown cause of death but positional asphyxia was considered (n=4); and positional asphyxia was suspected to be a contributing factor (n=5). All cases of group A included postures that could interfere with breathing, but the typical jackknife or head-down postures were seen in approximately half of the cases; “classic signs of asphyxia” were also observed in approximately half of the cases. They shared features such as high blood alcohol concentration, therapeutic levels of drugs, various disease, minor head trauma, and morbid obesity; however, no definite diagnostic criteria have been established for forensic practice. Positional asphyxia is a form of mechanical asphyxia which must be differentiated from traumatic asphyxia. In addition to a complete autopsy, thorough laboratory tests and understanding of the circumstances of the case and the situation at the death scene are required for diagnosis. Special attention is required for the diagnosis of special types of positional asphyxia such as death during institutional restraint or prone restraint.
참고문헌 (15)
- Madea B, "Handbook of forensic medicine", pp.538~540 (2022), John Wiley & Sons Ltd
- Saukko P, "Knight's forensic pathology", pp.366~367 (2015), CRC Press
- DiMaio VJ, "DiMaio’s forensic pathology", pp.244~245 (2022), CRC Press
- Spitz WU, "Spitz and Fisher’s medicolegal investigation of death: guidelines for the application of pathology to crime investigation", pp.450~459 (2020), Charles C Thomas Publisher
- Shkrum MJ, "Forensic pathology of trauma", pp.139~144 (2007), Humana Press
- Dolinak D, "Forensic pathology : principles and practice", pp.208~ (2005), Academic Press
- Hayashi T, "Positional asphyxia or diabetic ketoacidosis? A case report", Leg Med (Tokyo), 13, pp.196~200 (2011)
- Choi J, "Positional asphyxia after falling to backward in a drunken state", Korean J Leg Med, 43, pp.115~117 (2019)
- Sauvageau A, "Classification of asphyxia : the need for standardization", J Forensic Sci, 55, pp.1259~1267 (2010)
- Rutty GN, "Essentials of autopsy practice: reviews, updates and advances", pp.43~57 (2017), Springer
- Na JY, "A classification of asphyxia autopsy cases of the Korea in 2012 according to new classification of asphyxia", Korean J Leg Med, 38, pp.8~12 (2014)
- Chmieliauskas S, "Sudden deaths from positional asphyxia : a case report", Medicine(Baltimore), 97, pp.e11041~ (2018)
- deJong JL, "Positional asphyxia in opioid-related deaths : is it being overlooked?", J Forensic Sci, 65, pp.2008~2012 (2020)
- Behera C, "Fatal positional asphyxia following a fall in bathroom", Med Leg J, 88, pp.169~171 (2020)
- Byard RW, "The relationship between positional asphyxia and increasing body mass index", Leg Med(Tokyo), 43, pp.101678~ (2020)