Forensic Medicine · Asphyxial Deaths (Mechanical Asphyxia, Drowning, Smothering)

A 35-year-old man is found dead with petechial haemorrhages in the conjunctivae, cyanosis of the lips and fingertips, and florid petechiae over the face. These findings are LEAST likely in which of the following causes of death?

  • A Traumatic asphyxia (crush asphyxia)
  • B Carbon monoxide poisoning
  • C Smothering
  • D Drowning (dry drowning subtype)
Correct answer: B. Carbon monoxide poisoning

Explanation

Petechial haemorrhages in conjunctivae and facial skin (Tardieu spots) are a hallmark of mechanical asphyxia — they result from raised venous pressure rupturing small capillaries when venous outflow is obstructed but arterial inflow continues. Carbon monoxide poisoning causes death by chemical asphyxia (CO binding to haemoglobin) without venous obstruction, so Tardieu spots are not expected; instead, the classic finding is cherry-pink lividity. Traumatic asphyxia, smothering, and dry drowning can all produce classic asphyxial signs including petechiae.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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