ppt referat hanging.ppt

7/27/2019 PPT REFERAT HANGING.ppt

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HANGING

Ihsan Bayu 030.05.110 FK TRISAKTI

Indra Pratama 030.07.117 FK TRISAKTI

Kartika 030.08.134 FK TRISAKTILinta Isna 030.07.144 FK TRISAKTI

Regina Fristasari 030.07.212 FK TRISAKTI

Dosen Penguji: dr.Arista Hardinisa, Sp.F

Residen Pembimbing : dr.RP Uva Utomo


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Introduction

Hanging cases are the common cause of deathas result of asphyxia. Based on facts, hangingis one of suicidal methods which is often foundin many countries.

In England, there is more 2000 cases ofhanging each year.

In US, there was 279 accidental death by

hanging and strangulation. In Bali, there is 39 suicidal cases and hanging

is about 36 cases (in 2009).


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Introduction (2)

Hanging can occur in various ages.

Formerly, death punishment was established by

hanging.

It is important to know all about hanging because

hanging is very common manner of death which is

caused by asphyxia.

in medicolegal aspect, as doctor, we must ensure thatcase is hanging.


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Anatomy of the Neck


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Definition

Hanging is a form of ligature strangulation in

which the force applied to the neck is derivied

from the gravitational drag of the weight of

the body or part of the body


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Classification

A. Mechanism of death:

- Suicidal

- Accidental

- Homicidal

B. Victims position:

- Complete hanging

- Incomplete hanging (partial)

C. Place of knot:- Typical

- Atypical


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Type of Hanging

complete hangingPartial hanging

The victims

feet didnttouch the

ground

Some part

of the

bodytouching

the ground


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Type of Hanging

Typical Hanging Atypical Hanging

The hanging point is over the

occipital area.

The pressure of the carotid artery is

the heaviest

The hanging point located beside

the neck lateral flexion

This caused obstruction of the

carotid artery and vertebral artery


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Cause of Death


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Asphyxia


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Asphyxia

Tracheal obstruction can develop internally

(for example obstruction by foreign bodies), or

externally ( for example by rope ).

Airway obstruction influenced more in

unconsciousness than carotid obstruction


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Brain stem and spinal cord injury

This is associated with dislocation or fracture

of the cervical vertebrae, for example in

judicial hanging, usually occurred in cervical

vertebrae C2-3 or C3-4 because of the knot

position in the neck.

Upper medula spinalis is pulled, stretched, or

twisted and pressing the medulla oblongata


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Brain Ischemia

Occurred because of obstruction airway.

Tracheal obstruction can develop internally

(for example obstruction by foreign bodies), or

externally ( for example by rope ).

Airway obstruction influenced more in

unconsciousness than carotid obstruction


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Vagal Reflex

Pressure to ganglion nerve of carotid artery by

rope that caused vagal reflex, triggered heart

beat deceleration.

Vagal reflex caused slow arrythmia, then the

victim died because of cardiac arrest


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Anoxic Anemic

Stagnant Histotoxic

Anoxia


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Berat

(Lbs)

Berat

(Kilogram)

Ketinggian

(kaki)

Ketinggian

(meter)

14 stone

(196 lbs)

89 kg 8 ft 0 in 2,44m

13,5 stone

(189 lbs)

86 kg 8 ft 2 in 2,49m

13 stone

(182 lbs)

83 kg 8 ft 4 in 2,53m

12,5 stone

(175 lbs)

79 kg 8 ft 6 in 2,58m

12 stone

(168 lbs)

76 kg 8 ft 8 in 2,63m

11,5 stone

(161 lbs)

73 kg 8 ft 10 in 2,68m

11 stone

(154 lbs)

70 kg 9 ft 0 in 2,73m

10,5 stone

(147 lbs)

67 kg 9 ft 2 in 2,78m

10 stone

(140 lbs)

64 kg 9 ft 4 in 2,83m

9,5 stone

(133 lbs)

60 kg 9 ft 6 in 2,88m

9 stone

(126 lbs)

57 kg 9 ft 8 in 2,93m

8,5 stone

(119 lbs)

54 kg 9 ft 10 in 2,98m

8 stone 51 kg 10 ft 0 in 3,03m

N i i l i P i


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No intravital sign Postmortem sign

1.

2.

3.

4.

5.

6.

7.

8.

9.

non continous circular noose mark and located at

upper neck

usually single knot, on the side of the neck

Ecchymosys is clearly visible on one side of the

noose mark

livor mortis is clearly visible above the noose mark

and on lower extremities

Parchmentisation (parchment sensation on the

noose mark when palpated)

Cyanotic face, lips, ear, etc is very clearly visible

especially if the cause of death is asphyxia

Swollen face, congestion and protrusion of the

eyes, accompanied with visible veins on forehead

Tongue could be sticking out

Penis erection with semen discharge is usually seen

on male victim. Faeces discharge may also occured

Dribbling saliva on the side of the mouth, vertically

to the chest. This is an absolute sign of antemortem

hanging

Continous circular noose mark, located not too high on

the neck

Usually multiple knot, wrapped tightly and located in

front of the neck.

Ecchymosis on one side of the noose mark is not present

or visible

Livor mortis is located on hanged body part fitting with

the corpse position after death

Parchimentisation is not present or clearly visible

Cyanotic face, lips, ears, etc depend on the cause of

death

Tongue is not sticking out, unless the cause is

strangulation

Penis erection, semen discharge, and faeces discharge

are not present

Dribbling saliva is not present on cases other than

hanging cases


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External examination finding

Noose mark- Clear and deep

- Diagonal line

- Dark brown colored and parchment paper

sensation when touched

- On the knot area, triangular shape can be seen

- The perimeter of the borderline is clearly visible

Asphyxia signs- Cyanotic

- Vein congestion

- oedema

Livor mortis on lower

part of the body

Secretion of urine and

faeces


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Hangmark

Ropes widht ParchmentisasiNoose

groove


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SIGN OF ASPHIXIA

Cianotic

face

Pale &

Oedema

face

Protusionof eye

Tardieu spot


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Neck

positionProtrusion

of tongue

Dribbled

down of

saliva

Livormortis

Discharge of sperm, urine, feces, and menstrual blood


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Internal examination finding


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HEAD

Brain

congestionand

oedema

hemorrhagic

spots on

meningens

INTERNAL

EXAMINATION


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NECK Tissueundernoose

mark

Platisma

and neck

muscle

Red line

Larynx and

trachea

congestion

Hangman fracture

Hyoid cartilage

fracture


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THORAX ,

ABDOMEN, and

BLOOD

Tardieus

spots on

pleura,

pericard or

peritoneum

Organ

congestion

Blood in the heart is

darker and more

dilute


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Hangman Fracture

Hangmans fracture results from

hyperextension of the upper cervical spine.

The axis breaks symmetrically across its

pedicles or lateral masses, and the fracturemay extend across the posterior part of the

body.


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In the second book of Penal Code at Chapter

XIX :

Matter 338

Matter 339

Matter 340

Matter 344 Matter 345


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ppt referat hanging.ppt

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