In traumatic asphyxia (crush asphyxia, e.g., crowd crush), the petechial haemorrhages are MOST prominently located in:

• A Lower extremities and sacrum — below the level of compression
• B Upper trunk, neck, face, and conjunctivae — above the level of compression ✓
• C Uniformly distributed throughout the body
• D Only in subendocardial locations as a result of raised intracardiac pressure

Explanation

In traumatic (compressive) asphyxia, sustained compression of the thorax raises intrathoracic pressure dramatically. This transmits pressure retrogradely through the great veins, causing a sudden and extreme venous hypertension above the level of compression. Capillaries in the face, conjunctiva, neck, and upper chest rupture under this pressure (Tardieu spots/petechiae). The skin in these areas classically appears cyanosed and congested. Petechiae are not seen in the lower body, which is below the thoracic compression.

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

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Written and medically reviewed by the StethoPrep medical team.