Attempts to injure or kill a person by strangulation using one's hands, a ligature, or forearm, in a choke hold, may result in skin damage to the neck. For example, in manual strangulation, multiple bruises and scratches typical of contact with hands and fingernails will be seen on a victim's neck. On the other hand, if a ligature is forcefully wrapped around a victim's neck, a band of abrasion approximating the diameter of the ligature will be seen on the skin. Pinpoint hemorrhages, or petechiae, which are dramatically evident in the translucent conjunctival lining of the eyes, are important evidence of strangulation. These hemorrhages, which are the result of ruptured capillaries, occur when the buildup in pressure occurring when venous return from the head and face is obstructed. Since a period of 4 min is required for compression of the blood supply of the brain to result in irreversible neuronal damage and death, it is not surprising that so many attackers let go of their victim before death has occurred. If other force such as shooting, stabbing, or beating is not used, a victim may survive strangulation and appear in the ED, with evidence of neck injury and petechial hemorrhages in the eyes. Such victims should be examined for evidence of sexual assault, and vaginal swabs should be taken for identification with semen and DNA analysis.

The foregoing categories of injuries represent those most commonly seen in a trauma unit or a medical examiner office. However, readers who wish to become more familiar with the variety and details of injury are referred to several informative forensic medicine texts available in the medical library.

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