A Man Died While Operating a Tractor!

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The body found with arms stretched out to the sides.

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.

Postural asphyxia:

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.

Reference:

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

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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