Death due to immobilization of the ribcage – A case report of a patient who died while operating a tractor.
A 51-year-old, otherwise healthy, man with average built and height, died while he was operating a tractor with a trailer. The deceased had not followed the safety protocol and he ducked under the trailer. This position led to the restriction of rib cage movement. The deceased got his clothes pulled and stuck in the rotating shaft, consequently immobilizing him.
When the police found the deceased, he was bent in a semi-kneeling position under the trailer. His clothing from the dorsal side was stuck in the axis with his arms stretched out to the sides.
The autopsy revealed loose and raised outerwear stuck at the upper back. After removing the outerwear, the deceased’s body showed subcutaneous haemorrhages, abrasions, and skin lesions on the shoulders and upper arms. Moreover, autopsy also revealed crush wound on the left upper arm’s posterior surface. In conclusion, the external injuries corresponded with the clothing creases and folds.
Internal examination supported the conclusion of sudden death. Cerebral and pulmonary oedema was evident. Moreover, abdominal viscera and other internal viscera were congested. However, the autopsy did not reveal any other remarkable findings. findings.
Toxicology was negative for alcohol or illicit drugs.
The restricted position of the deceased led to the impaired movement of the ribcage. It consequently led to asphyxia. Therefore, the autopsy results concluded positional asphyxia as the cause of death.
Positional or postural asphyxia is quite rare, i.e. only 1% of all the asphyxia deaths are due to posture. It occurs when a person is immobilized in a position where the respiratory movements are impaired. Thus, adequate ventilation cannot take place. Moreover, it also increases the intrathoracic pressure and may have a direct effect on the venous return to the heart, further exacerbating the hypoxia. Restriction of the neck can also lead to obstruction of the airway, thereby, leading to asphyxia.
Usually, postural asphyxia is accidental. However, there have been homicidal cases too. Other contributing factors or causes that should not be overlooked include intoxication, hyperthermia, trauma, exhaustion, or crush syndrome.
Since it is a rare cause of sudden death and it is difficult to diagnose, healthcare professionals should exclude other potential causes and should also be aware of the criteria of diagnosis.
Chmieliauskas, Sigitas PhD; Mundinas, Eimantas MD; Fomin, Dmitrij PhD; Andriuskeviciute, Gerda MD, Laima, Sigitas PhD; Jurolaic, Eleonora MD; Stasiuniene, Jurgita PhD; Jasulaitis, Algimantas PhD, Sudden deaths from positional asphyxia, Medicine: June 2018 – Volume 97 – Issue 24 – p e11041. DOI: 10.1097/MD.0000000000011041