Toxicology Suffocation and Smothering

If the circumstances are not suspicious, then toxicological testing may not be done. Toxicology testing in "suspicious" deaths determines whether the victim was incapacitated and vulnerable to a homicidal assault (22,269,296,308).

Fig. 54. Smothering (see Fig. 53). Small abrasion on right upper lip (arrow) from lower tooth.

In plastic bag suicides, ethanol is present in about one-fifth to one-third of cases (257,307,309). Certain drugs (benzodiazepines, diphenhydramine, antidepressants) are commonly found (307). Above-therapeutic concentrations and toxic and fatal levels of medications occur (307,309).

Analysis for volatiles in a plastic bag requires retention of postmortem blood preserved with fluoride, sampling of tissue (e.g., lung, liver, brain), and submission of the bag in an airtight can or glass jar, which is refrigerated until testing (257,269,314, 316,321,331). Some gases (e.g., helium) cannot be tested, emphasizing the importance of investigation of the scene and circumstances surrounding the death (312).

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