A detainee is found dead in a police van after being transported while restrained face-down with his wrists handcuffed to his ankles behind his back. Autopsy shows intense congestion and cyanosis of the face, conjunctival petechiae, pulmonary congestion, and no significant external injuries. Which is the MOST likely cause of death?

• A Traumatic asphyxia from thoracic compression
• B Vagal inhibition from neck compression
• C Aspiration of gastric contents
• D Positional (restraint) asphyxia from impaired respiratory excursions ✓

Explanation

Hog-tying with hands tied to flexed feet, especially prone, restricts movement of the diaphragm and chest wall so that ventilation fails progressively despite an open airway. Congestion, cyanosis and petechiae follow, with strikingly little injury, exactly as described here. Traumatic asphyxia requires direct heavy compression of the chest, such as a crowd crush, which did not occur, and neither aspiration nor neck pressure is suggested by the findings.

Reference: Knight's Forensic Pathology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.