A POWER POINT PRESENTATION

BY
DR.SANGEETA CHOWDHRY &
DR.SUNIL SHARMA
DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY
GOVT. MEDICAL COLLEGE, JAMMU

ASPHYXIAL
CONDITIONS

DEFINITIONS

Asphyxia
(Greek,
'pulsenessness' or
'absence of pulse')
means restriction of
oxygen
due
to
mechanical
interference
with
respiration.

ASPHYXIAL CONDITIONS-DEFINITIONS

Suicide
(Latin
suicidium, to kill
oneself) is the
act
of
intentionally
causing
one's
own death.

ASPHYXIAL CONDITIONS-DEFINITIONS
Failed
suicide
attempt
(Latin:
tentamen suicidii)
refers to a suicide
that did not result in
death. Some are
regarded as not
true attempts at all,
but
rather
parasuicide.

ASPHYXIAL CONDITIONS-DEFINITIONS
Hanging
or
'selfsuspension' is a form of
asphyxia
caused
by
suspension of the body
by a ligature which
encircles the neck, the
constricting force being
at least part of the
weight of the body. It
may be either complete
(feet are not touching the
ground) or partial (feet
are touching the ground).

ASPHYXIAL CONDITIONS-DEFINITIONS
Strangulation is a form
of asphyxia caused by
mechanical disruption
of blood flow through
the vessels of the neck
and/or blockage of air
passage through the
trachea by means of a
ligature or by any
means
other
than
suspension
of
the
body.

CLASSIFICATION OF STRANGULATION
Ligature
strangulation:
When
ligature
material is used to
compress the neck.
It includes the use
of any type of cordlike object, such as
an electrical cord or
purse strap.

CLASSIFICATION OF STRANGULATION

Manual
strangulation or
throttling:
When
human
fingers,
palms or hands are
used to compress
the neck.

CLASSIFICATION OF STRANGULATION
Mugging:
Strangulation
caused by holding
the neck of the
victim in the bend
of elbow (i.e. the
sleeper hold) or
knee
of
the
assailant.

CLASSIFICATION OF STRANGULATION
Garroting:
Strangulation is caused
by compression of the
neck by a ligature
which
is
quickly
tightened by twisting it
with a lever (rod, stick
or ruler) known as
Spanish windlass which
results in sudden loss
of consciousness and
collapse.

ASPHYXIAL CONDITIONS-DEFINITIONS

Drowning
is
the
process
of
experiencing
respiratory
impairment
from
submersion/immersi
on in liquid.

ASPHYXIAL CONDITIONS-DEFINITIONS
Suffocation is a form
of asphyxia caused
by
mechanical
obstruction to the
passage of air into
the respiratory tract
by
means
other
than constriction of
neck or drowning.

CLASSIFICATION OF SUFFOCATION
Smothering is
caused
by
mechanical
occlusion of external
air passages from
outside,
i.e.
the
nose and mouth by
hand, cloth, pillow,
plastic bag or other
material

CLASSIFICATION OF SUFFOCATION
Choking is caused
by an obstruction
within the trachea,
either partially or
completely,
from
inside by a foreign
body, like coin, fruit
seed,
toffees,
candies, fish or any
other material.

CLASSIFICATION OF SUFFOCATION
Gagging results
from pushing a gag
(rolled up cloth or
paper balls) into the
mouth,
sufficiently
deep to block the
pharynx. It combines
the
features
of
smothering
and
choking.

CLASSIFICATION OF SUFFOCATION

Overlaying results
from
compression
of the chest, nose
and mouth, so as to
prevent breathing.

CLASSIFICATION OF SUFFOCATION
Traumatic
asphyxia
results
from
respiratory
arrest
due
to
mechanical fixation
of chest, so that the
normal movements
of chest wall are
prevented.

CLASSIFICATION OF SUFFOCATION
Confined space
entrapment
occurs when there
is
inadequate
oxygen
in
the
enclosed space due
to consumption or
displacement
by
other gases.

CLASSIFICATION OF SUFFOCATION

Burking
is
a
combination
of
homicidal
smothering
and
traumatic asphyxia.

EPIDEMIOLOGY
The

rate of suicide is far higher

in men than in women (3-4: 1)
with suicidal hangings more
common.
However,
recent
trends suggest that women are
gradually using hanging than
other methods of suicide.
Women are more likely than
men
to
be
victims
of
strangulation
(domestic
violence or sexual assault).
Nearly all reported autoerotic
strangulation incidents involve
men.
Accidental strangulation may
occur in both men and women.

CAUSES
Several

populations
are at risk of hanging
or strangulation.
Toddlers: The neck
may get caught and
strangled
in
illconstructed cribs as
they put their heads
out. Window cords
have
also
been
implicated in such
deaths.

CAUSES
Adolescents:

Incidence of
accidental
hanging,
throttling
or
strangulation
due
to
choking
game
(voluntary asphyxia in
order to enjoy the altered
sensations
due
to
cerebral
hypoxia).
Playground slide tie rope
has been implicated in
accidental strangulation.
Emulating TV shows and
depression can also lead
to hanging.

CAUSES
Adults:

Autoerotic
accidents, assaults, and
suicidal depression are
common
causes
(e.g.
prisons, where hanging is
easier
and
available
method).
Accidental
strangulation from scarfs
and chunni (in females)
and
by
cotton
cloth
entangled in the rotor of a
machine (in males) have
been reported.
Elderly:
Depression can
lead to hanging.

CAUSES
Isadora
Duncan
syndrome:
The
world
famous dancer Isadora
Duncan
died
on
14
September 1929 as a
result of her long scarf
which she was wearing got
caught in the wire wheels
of her Buggati car. She
died at the scene and was
later
found
to
have
sustained
a
fractured
larynx and carotid artery
injury.

PATHOPHYSIOLOGY
The
proposed
mechanisms
of
the
observed features seen
in most of the asphyxial
conditions (whether by
hanging,
manual
strangulation,
application of ligature,
or
postural
asphyxiation
(in
children whose necks
are caught in an object
such as a crib) includes
the following:

PATHOPHYSIOLOGY
Venous

obstruction

leading
to
cerebral
congestion, hypoxia and
unconsciousness, which in
turn, produces loss of
muscle tone leading to
airway obstruction, occurs
if ligature is made up of
broad and soft material.
For manual strangulation
and suicidal near-hanging
victims, it is a significant
factor that produces loss
of consciousness.

PATHOPHYSIOLOGY
Arterial
blockage due to
pressure on carotid
artery, leading to
cerebral
anemia
and collapse due to
low cerebral blood
flow occurs when
ligature is made of
thin cord.

PATHOPHYSIOLOGY
Reflex
vagal
inhibition caused
by pressure to the
carotid sinuses and
increased
parasympathetic
tone
leading
to
sudden
cardiac
arrest
(less
common)

PATHOPHYSIOLOGY
Most
experts
agree
that
regardless
of
the
events
occurring in any given hanging
or
strangulation,
death
ultimately occurs from cerebral
hypoxia and ischemic neuronal
death. Notably, none of the
proposed
mechanisms
advocates airway compromise
as the immediate cause of signs
and symptoms observed in such
cases.
In
fact,
although
mechanical airway compromise
occurs
and
ultimately
complicates
patient
management, it appears to play
a minimal role in the immediate
death of victims.

CLINICAL EFFECTS OF ASPHYXIA

Asphyxia

Decreased
oxygen tension
and reduced Hb

Cyanosis

Unconscious
ness
Loss of
muscle
power

Sphincter
relaxation

Voiding of
urine, stools,
semen

Capillary
endothelium
damage

Increased
capillary
permeability

Pulmonary
edema
Capillary
stasis and
engorgement

Increased
intracapillary
pressure

Tardieus
spots

Capillary
rupture

Triad of asphyxial stigmata may be seen

Cyanosis:
Bluish
discoloration
of
skin,
face
(particularly
in
the lips, tip of
nose,
ears
lobules), nailbeds
and
mucous
membranes

Triad of asphyxial stigmata may be seen

Petechial
hemorrhages
(Tardieus spots) are
found in those parts
where capillaries are
least supported, e.g.
conjunctiva,
face,
epiglottis, on the
face. They tend to
be better made out
in
fair
skinned
persons.

Triad of asphyxial stigmata may be seen

Congestion and
edema of the face
due
to
raised
venous pressure.

EVALUATION AND
DOCUMENTATION
HISTORY
In practice, it has been observed
that
manually
strangled
or
garroted
or
suicidal
hanging
victims are brought to the hospital
in unconscious state for the
purposes of treatment. Such cases
are brought to the emergency
department after being found by
strangers,
friends,
family
members or sometimes police. On
many occasions the exact history
may not be disclosed by the
relatives. The history in such
cases is lacking, vague or cooked
up. In such cases, the doctor must
try to extract the history from
different sources available.

EVALUATION AND
DOCUMENTATION

Even if the victim is conscious,

she may not always report the
attempted
strangulation
episode. As is common with
cases of domestic violence, the
victim may be hesitant to fully
describe what happened or will
minimize the severity of the
attack.
Moreover,
visual
evidence of force applied to the
neck during such incident is
often absent or minimal on
initial medical evaluation. The
lack of physical findings may
lead authorities to discount the
patients report. Hence, specific
questions often are required to
elucidate the history.

EVALUATION AND
DOCUMENTATION
The victim should be asked about
the
method
or
manner
of
strangulation,
whether
hands,
elbow and forearm, knee, ligature
or any other method was used.
Whether the victim attempted
hanging? The number of such
episodes, whether single, multiple
or
repeated
with
different
methods.
Other
circumstances
should also be enquired like
whether
the
victim
also
smothered, shaken, knocked or
pounded into a wall or the
ground? Was the victim also hit or
physically sexually or assaulted?
Whether the victim has consumed
any alcohol, drug or any other
poison (any smell from breath)?

EVALUATION AND
DOCUMENTATION
The practitioner has to
enquire about specific
symptoms
like
whether the victim lost
consciousness, if there
is any neck pain, any
difficulty in breathing
or
swallowing,
any
change
of
voice,
headache, and if there
was any urinary and/or
fecal incontinence.

EVALUATION AND
DOCUMENTATION

Hanging victims are

more likely to arrive in
the
emergency
department
with
a
depressed
level
of
consciousness than are
victims
of
manual
strangulation.
This
is
presumably due to the
more
intensive
and
prolonged
compressive
force applied to the neck
due to hanging than is
typically
seen
with
manual pressure.

CLINICAL PRESENTATION
The victim may present with
deceptively harmless signs and
symptoms with no or minimal
external signs of soft tissue
injury because of the slowly
compressive nature of forces
involved
in
non-lethal
strangulation. The upper airway
may also appear normal beneath
intact mucosa, despite hyoid
bone or laryngeal fractures. It
takes time for hemorrhage and
edema
to
develop
after
compressive injuries (may take
36 hours after the episode), and
the patient can develop edema
of
the
supraglottic
and
oropharyngeal
soft
tissue,
leading to airway obstruction.

SIGNS AND SYMPTOMS

The
clinical
presentations
can
vary according to
the method, force
and
duration
of
asphyxiation.
The
following
specific
clinical
manifestations are
possible
in
asphyxiation
victims:

SIGNS AND SYMPTOMS

Dysphonia

or
hoarseness
of
voice
is
commonly seen.
Patient
may
sometimes
present
with
aphonia.

SIGNS AND SYMPTOMS

Dysphagia

or
swallowing difficulty
may occur due to
injury to larynx or
hyoid bone which is
not common symptom
on initial assessment,
but may be reported
subsequently
in
2
weeks. Sometimes it
may
be
painful
(odynophagia).

SIGNS AND SYMPTOMS

Dyspnea

is
very
common, but often a late
development. Respiratory
distress is seen in 2
weeks which may be due
hyperventilation
or
psychogenic
(anxiety,
fear,
depression).
Difficulty breathing can
also be due to laryngeal
edema or hemorrhage,
although those injuries
are
less
common
in
surviving victims.

SIGNS AND SYMPTOMS

Pain and swelling in
the throat or neck is
common
after
attempted
strangulation. The patient may
be able to localize it to a
specific area of injury, or it may
be diffuse and poorly localized.
Edema may be caused by
internal hemorrhage, injury to
underlying neck structures or
fracture of the.
Laryngeal
fracture can manifest as severe
pain on gentle palpation of the
larynx
or
subcutaneous
emphysema over or around the
laryngeal cartilage.

SIGNS AND SYMPTOMS

Altered
status:

mental

Restlessness,
confusion, loss of
orientation
or
combativeness due
to cerebral hypoxia
or from concomitant
intracranial
injury
or
ingestion
of
drugs or ethanol.

SIGNS AND SYMPTOMS

Neurologic
symptoms

include
changes in vision, tinnitus,
ptosis,
facial
droop,
or
unilateral weakness, paralysis
or loss of sensation. In many
patients, the findings are
transient and believed to be
caused
by
focal
cerebral
ischemia produced by the
strangulation process that
resolves with time. In rare
cases, damage to the internal
carotid artery may induce
thrombosis with a delayed
neurologic presentation.

SIGNS AND SYMPTOMS

Petechiae

can occur at or
above the area of compression
and are most frequently seen
on the face, periorbital region,
eyelids, scalp and conjunctiva.
Facial
and
conjunctival
petechiae are evidence of
prolonged elevated venous
pressure. It has been found
that the jugular vein needs to
be occluded for at least 15-30
seconds for the development
of
facial
petechiae.
Subconjunctival hemorrhage is
usually seen after a vigorous
struggle between the victim
and assailant.

SIGNS AND SYMPTOMS

Neck:

Injury to the soft

tissues in the neck may
manifest with abrasions
(scratches), hyperemia,
ecchymoses and edema.
The hyperemia may be
transient and not visible
by
the
time
of
assessment. Ecchymoses
and swelling may take
time to develop and may
not be visible on initial
assessment.

SIGNS AND SYMPTOMS

Attempted
throttling: Fingertips may
produce faint oval or round
bruises 1.5-2 cm in size (may be
more
in
case
of
continued
bleeding). A grip from right hand
produces a bruising due to bulb of
pressing thumb over the cornue of
hyoid/thyroid
on
anterolateral
surface of right side of victim's
neck and several fingertip bruising
marks and overlying nail scratch
abrasions over left side. A single
bruise on the victims neck is most
frequently
caused
by
the
assailants thumb as bruises made
by tips of thumbs are more
prominent than with other fingers.

SIGNS AND SYMPTOMS

Multiple abrasions
on the neck may
be defensive in nature
from use of victim's
own fingernails in an
effort to dislodge the
assailant's
grip
but
commonly
are
a
combination of lesions
caused by both the
victim
and
the
assailants fingernails.

SIGNS AND SYMPTOMS

Chin

abrasions

may also occur

from
the
defensive actions
as the victim tries
to protect their
necks from the
manual
strangulation
of
the assailant.

LIGATURE MARK (FURROW) IN ATTEMPTED

HANGING AND STRANGULATION
S. No.

Features

Hanging

Strangulation

1.

Direction

Oblique

2.

Continuity

Non-continuous

Continuous

3.

Level in the neck

Above thyroid

4.

Base

Pale, hard,
parchment-like

At or below
thyroid
Soft and reddish

Transverse

SIGNS AND SYMPTOMS

Attempted
throttling: Fingertips may
produce faint oval or round
bruises 1.5-2 cm in size (may be
more
in
case
of
continued
bleeding). A grip from right hand
produces a bruising due to bulb of
pressing thumb over the cornue of
hyoid/thyroid
on
anterolateral
surface of right side of victim's
neck and several fingertip bruising
marks and overlying nail scratch
abrasions over left side. A single
bruise on the victims neck is most
frequently
caused
by
the
assailants thumb as bruises made
by tips of thumbs are more
prominent than with other fingers.

SIGNS AND SYMPTOMS

Lungs:

Aspiration
pneumonitis may occur due to
inhalation of vomitus during
the episode.
Pulmonary
edema is a seen generally in
comatose
hanging
victims.
The cause of the pulmonary
edema can either be due to
anoxic injury to the central
nervous system (neurogenic
pulmonary edema) or from the
large negative intrathoracic
pressures seen when the
victim struggles to breathe in
against an occluded airway
(obstructive
pulmonary
edema).

SIGNS AND SYMPTOMS

Involuntary
urination
or
defecation,

expulsion
fetus
pregnant)
occur.

of
(if
may

SIGNS AND SYMPTOMS

Fractures of the
thyroid cartilage or
hyoid
bone
in
victims of accidental
strangulation
and
direct injury to the
trachea is rare with
strangulation. Carotid
artery injury is also
uncommon
after
attempted
hanging
and strangulation.

SIGNS AND SYMPTOMS

Injury to other organ systems
from strangulation is uncommon.
Case
reports
of

diaphragmatic
injury, multiple

organ
failure, and thyroid storm after
attempted
strangulation;
cricotracheal
separation
and
common
carotid
artery
dissection, and laryngotracheal
separation
after
attempted
hanging; and laryngeal rupture
and carotid artery stenosis after
accidental strangulation have
appeared
in
the
medical
literature.

SIGNS AND SYMPTOMS

Examination for other
associated injuries in

cases female

patients
regarding
injuries
on
lips,
face,
cheeks,
abdomen, back, genital
organs and breast (if
there
is
any
history
suggesting
sexual
abuse). In such cases
complete examination of
genital organs is of vital
importance.

Diagnosis
The majority of the victims present
with some common features, a
combination
of
these
findings
should be taken into consideration
for diagnosis:
Hyperemia and/or ecchymosis
Facial or conjunctival petechiae
Change of voice or difficulty in
breathing
Marks on the neck
Loss of consciousness or altered

DIAGRAMS AND PHOTOGRAPHS

It is important to document the injuries
through diagrams and photograph that may be
seen at the time of examination for evidence
purpose. The injuries should be mentioned in
the pictograph given along with the medicolegal report. The following photographs may
also be taken:
Distance photo: Full body photograph to
identify the victim and location of injury.
Close-up photo: Photographs of injuries along
with a ruler from different angles to maximize
visibility and to document the size.
Follow-up photo: As the injuries may take time
to develop, taking follow-up photographs at
different time intervals will document injuries
as they evolve.

LABORATORY AND
IMAGING
Arterial blood
gases

(ABGs)

analysis
should
be done in all
patients
who
require
intubation,
for
subsequent
ventilator
management.

LABORATORY AND
IMAGING

Pulse oximetery

is
indicated
in
patients with altered
mental status and
respiratory distress.
It also makes ABGs
unnecessary
in
patients who do not
require endotracheal
intubation.

LABORATORY AND
Neck X-rayIMAGING

should be
done in nearly all strangulation
victims and patients with a
mechanism
consistent
with
hanging. It is useful to detect
fractured hyoid bone and for
evaluation
of
subcutaneous
emphysema due to fractured
larynx. Fractures of the cervical
vertebrae are extremely rare in
strangulation
injuries
unless
there has been a hanging with a
free-fall drop of the body.
Generally, a fractured hyoid
bone indicates a severe, occult
soft-tissue injury, even in a
patient whose medical condition
is otherwise stable.

LABORATORY AND
IMAGING
Chest X-ray
is
indicated
after
endotracheal
intubation
for
placement
confirmation,
diagnosis
of
pulmonary
edema,
aspiration
pneumonitis and acute
respiratory
distress
syndrome (ARDS).

CT

LABORATORY AND
IMAGING
scan is indicated
to

detect hyoid bone and

laryngeal fractures, injury
to carotid arteries and
other
soft-tissue
abnormalities that may not
be
apparent
on
plain
radiographs. CT head is
done
to
evaluate
neurological status. CT is
more sensitive for bony
injuries,
subcutaneous
emphysema,
soft-tissue
edema,
and
internal
hemorrhage.

LABORATORY AND
IMAGING
Doppler vascular
imaging,

CT
angiography
or
arteriography is useful
to detect injury to the
carotid
arteries
(in
patients with unilateral
neurological findings).
The
current
gold
standard
for
blunt
carotid artery injury is
four-vessel
selective
angiography.

LABORATORY AND
MRI is theIMAGING
most
useful
imaging
modality for the
majority of such
victims because of
its
highest
sensitivity
for
deep
soft-tissue
injury
including
the
larynx
and
vessels.

LABORATORY AND
IMAGING
Fiberoptic
laryngoscopy is
indicated
for
visualization of the
laryngeal
structures
(vocal
cords)
and
adjacent
structures
for
edema
and
hemorrhage.

MANAGEMENT
Like any other traumatic
injuries,
the
management
of
a
strangulation
victim
starts with the

ABCs

Airway
Breathing

Circulation

Fluid
resuscitation must be
done judiciously as there
is risk of subsequent
ARDS
and
cerebral
edema.

MANAGEMENT
The
choice
and
sequence of imaging is
dependent on patients
clinical
condition,
suspected injuries and
availability
of
the
specific modalities in

An ENT
consultation
can
that set-up.

establish both the need

for, and the timing of,
these studies.

MANAGEMENT
Like
any
other
traumatic injuries, the
management
of
a
strangulation
victim
starts with the ABCs
airway,
breathing,

Fluid
resuscitation must
circulation.

be done judiciously as
there
is
risk
of
subsequent ARDS and
cerebral edema.

MANAGEMENT
Orotracheal
intubation should be
done
preferably
by
an
anesthetist. It can be difficult if
laryngeal edema is present or if
direct traumatic disruption of
the
larynx
has
occurred.
Cricothyroidotomy is indicated
for any patient with severe
respiratory
distress
and
completely obstructed airway. If
associated neck injuries render
cricothyroidotomy
difficult,
percutaneous
translaryngeal
ventilation may be used to
temporarily
oxygenate
a
patient.

MANAGEMENT
The definitive
airway
management
is

laryngotomy
which must be
done
at
the
earliest

COMPLICATIONS
Respiratory
system:
Both
aspiration
pneumonia
and
ARDS
may
develop; tracheal
stenosis in case
of rupture.

COMPLICATIONS
Neurologic sequelae
including
muscle
spasms,
transient
hemiplegia,
central
cord syndrome and

Longterm paraplegia
or quadriplegia
seizures.

and
short-term
autonomic dysfunction
may be seen in spinal
cord injury.

COMPLICATIONS
Psychiatric
symptoms:
Encephalopathy,

insomnia,
nightmares and anxiety
and an inclination for
violence are seen in
such victims. Psychosis,
depression,
suicidal
ideation,
Korsakoff
syndrome, amnesia and
progressive
dementia
may develop.

PROGNOSIS
The prognosis for survivors of
hanging and strangulations arriving
to the emergency department is
widely variable. The outcome is
determined by the presence of
cardiopulmonary
arrest
(as
indicated by a requirement for
cardiopulmonary
resuscitation
and/or
invasive
airway
management) and degree of anoxic
brain injury (as correlated with a

Glasgow
Coma
Score and cerebral edema on
low

initial CT scan). In general, the

emergency room disposition of such
victims is primarily determined by
their clinical condition and evidence
of injury to their deep neck
structures.

MEDICO-LEGAL FORMALITIES WHILE DEALING WITH

ATTEMPTED STRANGULATION OR HANGING

Medical
practitioners
who
examine
such
cases
in
the
emergency
have
to
follow
a
protocol
regarding
the
documentation
of
medico-legal
formalities;
besides
imparting
treatment in order to save the life
of patient. Injuries due to assault
are required to be informed to the
police
(if
police
is
not
accompanying) to ensure safe
disposition of the patient. In case
of suspected child abuse, child
protective
agency
should
be
notified.
The
preparation
of
medico-legal report is guided as
per the protocol .

LEGAL PROVISIONS
In India, attempt to
commit
suicide
is
an

punishable
under Sec. 309
IPC. It states that
offence

whoever
attempts
to
commit suicide and does
any
act
towards
the
commission
of
such
offence, shall be punished
with simple imprisonment
for a term which may
extend to 1 year or with
fine, or with both.

Attempt to commit
suicide is an offence
punishable under Sec.
309 IPC

LEGAL PROVISIONS
Abetment of
suicide: As per
Sec. 306 IPC, any
person who abets the
commission of suicide
shall be punished for
a term which may
extent to 10 years
imprisonment
and
shall also be liable to
fine.

GOPAL KANDA, THE SIRSA MLA

IS THE MAIN ACCUSED OF A CASE
UNDER SECTION 306 IPC

The Protection of Women from Domestic

Violence Act, 2005
Salient features of the
Act:
The
term
'domestic
violence'
covers
all
forms
of
physical,
sexual,
verbal,
emotional and economic
abuse that can harm,
cause
injury
to,
endanger the health,
safety, life, limb or wellbeing, either mental or
physical
of
the
aggrieved person.

The Protection of Women from Domestic

Violence Act, 2005
Salient features of the Act:
Aggrieved' person' is not
just the wife but a woman
who is the sexual partner
of the male irrespective of
whether she is his legal
wife or not. It includes
daughter, mother, sister,
child (male or female),
widowed relative, or any
woman residing in the
household who is related
in some way to the
respondent.

The Protection of Women from Domestic

Violence Act, 2005
Salient features of the
Act:
Respondent is any
male, adult person who
is, or has been, in a
domestic
relationship
with
the
aggrieved
person that includes his
mother, sister and other
relatives; the case can
also be filed against
relatives of the husband
or male partner.

THE PROTECTION OF WOMEN FROM

DOMESTIC VIOLENCE ACT, 2005

Information to
Protection Officer: The
information
regarding
any acts of domestic
violence
does
not
necessarily have to be
lodged by the aggrieved
party but by any person
who has reason to believe
that such an act has been
or is being committed.
Any
medical
officer,
neighbors, social workers
or relatives can all take
initiative on behalf of the
victim.

THE PROTECTION OF WOMEN FROM

DOMESTIC VIOLENCE ACT, 2005
Duties of medical
facilities:
If
an
aggrieved person or a
Protection Officer or a
service
provider
requests the medical
practitioner to provide
any medical aid to the
victim,
the
doctor
should provide medical
aid to the aggrieved
person in the medical
facility.

THE PROTECTION OF WOMEN FROM

DOMESTIC VIOLENCE ACT, 2005

Penalties: The magistrate

can impose a penalty up
to 1 year of imprisonment
and/or a fine up to Rs.
20,000/- for an offence
under
this
Act.
The
offence is also considered
cognizable
and
nonbailable. The decision can
be taken under the sole
testimony
of
the
aggrieved
person;
the
court may conclude that
an
offence
has
been
committed
by
the
accused.

THE PROTECTION OF WOMEN FROM

DOMESTIC VIOLENCE ACT, 2005
The magistrate can impose
monetary relief and monthly
payments of maintenance.
The respondent can also be
made to meet the expenses
incurred and losses suffered
by the aggrieved person as a
result of domestic violence
and can also cover loss of
earnings, medical expenses,
loss or damage to property
and can also cover the
maintenance of the victim.
The Act also allows the
magistrate to make the
respondent
pay
compensation and damages
for injuries including mental
torture
and
emotional
distress caused by acts of
domestic violence.

KEY ELEMENTS OF STRANGULATION AND

SUFFOCATION STATUTE
The Strangulation and Suffocation Law in the
Unites States defines and provides penalties
for a person who engages in intentional
strangulation and suffocation. The states of
Iowa, South Dakota, California, Wisconsin,
Tennessee, Virginia and New York have
passed laws making it a felony (a crime
punishable by death or imprisonment in
excess of 1 year) under certain conditions to
knowingly impede someones breathing.

 Dangerous weapon means any firearm, whether

loaded or unloaded; any device designed as a weapon
and capable of producing death or great bodily harm;
any ligature or other instrumentality used on the
throat, neck, nose, or mouth of another person to
impede, partially or completely, breathing or
circulation or blood; any electric weapon, or any other
device or instrumentality which, in the manner it is
used or intended to be used, is calculated or likely to
produce death or great bodily harm.
Substantial bodily harm means bodily injury that
causes a laceration that requires stitches, staples, or
a tissue adhesive; and fracture of a bone; a broken
nose; a burn; a petechia; a temporary loose of
consciousness, sight or hearing; a concussion; or a
loss or fracture of a tooth.

SAMPLE CASE REPORT

Domestic violence: A lady 29 years was admitted in Medicine
unit in emergency as a suspected case of poisoning with history
of found unconscious at her residence; alleged by her husband to
have taken some drugs at her home. On examination, the lady
was cyanosed. She was managed and treated as a case of
suspected poisoning. Next day, the department of Forensic
Medicine was approached for review of the case and on thorough
examination, a ligature mark was found all around the neck
which was circular, and horizontally placed below the level of
thyroid cartilage (Fig. 1). The patient was immediately shifted to
ICU where it was confirmed that the patient had developed
pulmonary edema. On detailed investigation by the investigating
officer, it was confirmed that the husband had tried to
strangulate her over some dispute but could not succeed.

SAMPLE CASE REPORT

Sexual assault with manual strangulation: A young girl
aged 13 years was found from an abandoned street in
semi-unconscious condition. She was shifted to Govt.
Medical
College
Jammu
for
treatment.
During
examination, cresentric abrasions along with multiple
oval shaped bruises were found over the neck and nasal
region. Two days after, when she regained her
consciousness fully; her statement was recorded by the
police. It was revealed in the statement that she was
kidnapped by her close relative and then taken to
abandoned street and was sexually assaulted there and
when she tried to cry, she was throttled and smothered
by the accused, thereafter she fell unconscious.

SAMPLE CASE REPORT

Traumatic asphyxia: A truck conductor was brought to
the emergency in Govt. Medical College Jammu in semiconscious condition with labored breathing, intense
cyanosis, and tachycardia. The history revealed by the
police that he was helping the driver by standing at the
back side of truck for the purpose of parking. However,
the driver could not control the truck while reversing
the same that lead to fixation of the conductor in
between the backside of truck and the wall resulting in
traumatic asphyxia. On examination, multiple bruises
and contusions over the chest with fracture of ribs were
found. Patient was immediately shifted to ICU but could
not survive and died after two days.

THANKX FOR Y0UR PATIENCE...

IT IS A SUZY
WORK...................