Mechanisms of Traumatic Asphyxia

Severe compression or crushing of the chest, upper abdomen, and/or back interferes with thoracic respiratory movement (441,450). Rarely, a "jackknife" injury occurs when the victim's chest is in contact with the thighs and knees, or "accordion" pressure is inflicted on a child (441). Typically, there is a weight disparity between the compressing force and victim (usually > 1000 kg or 500 lb [441,444,445]). The length of compression time before death varies depending on force severity. An individual can die in seconds if there is considerable weight, but usually at least 2 to 5 min elapse before death ensues (441,446).

Fig. 65. Subtle signs of traumatic asphyxia. Man run over and pinned under vehicle that contained three occupants and had poor suspension. (A) Victim's jacket. Dirt impression from tire tread. (B) Tire tread. (C) Cutaneous petechiae in nonlivid areas of back. (D) Conjunctival petechiae, lower eyelids (retracted).

Fig. 65. Subtle signs of traumatic asphyxia. Man run over and pinned under vehicle that contained three occupants and had poor suspension. (A) Victim's jacket. Dirt impression from tire tread. (B) Tire tread. (C) Cutaneous petechiae in nonlivid areas of back. (D) Conjunctival petechiae, lower eyelids (retracted).

Survivors, in one series, were extricated within 15 min, but the decedents were pinned within or under their vehicles from 5 to 15 min (443,446). Victims can be crushed slowly (441). Information regarding the minimum threshold weight to cause death is scarce. The large loads described in the literature imply that at least five times body weight is involved. Experimental work on guinea pigs showed a three times weight differential resulted in death of some subjects in 10 min (452). One case report described a 13-kg child pinned by the legs of a 60-kg adult, who had a 0.7-kg leg cast, for 40 min (weight differential about 1.8 times, if the adult's legs and cast are equivalent to 40% of the perpetrator's body weight, i.e., 24 kg [49,453]).

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