Peri- and post mortem hemorrhages in the anterior neck after chin-collar application.

Intense blunt compression trauma to the neck can result in subcutaneous, intramuscular or laryngeal mucosa bleedings of different intensity. While these findings can easily be detected through a layer-wise dissection of the neck muscles and soft tissue during autopsy, it can be difficult to distinguish between peri-/post- and ante mortem hemorrhages solely based on macroscopic findings. Especially when an initial preliminary diagnosis is required, possible artifacts have to be excluded. The study at hand examines possible peri- and post mortem hemorrhages in the anterior neck after NorMors™ chin-collar application. In routine clinical and forensic autopsy cases, where such a chin-collar has been placed around the neck of the deceased in close proximity after death, focus was directed to the soft tissue and muscles of the neck. The results of our analysis could prove that the use of chin-collar shortly within the first 1 ½ hours after death applies just enough pressure to the neck to be able to cause superficial hemorrhages within the surface of the sternocleidomastoid muscles, which can mimic vital compression trauma injuries. Based on location, morphological outlines and intensity of the injuries, it is possible to correlate them with the position of the applied collar. Together with histological analyses, asphyxia by a second party involvement can be excluded. However, the application of chin-collars should be prohibited in any case, where an autopsy might be performed.

Restraint-related asphyxia on the basis of a drug-induced excited delirium.

Cases of intoxication in combination with extreme agitation, physical exertion and restraint are mainly associated with restraint-related deaths (RRD) in the context of police use of force. In these cases, the mechanism of death usually mentioned is RRD associated with drug-induced excited delirium. To the best of our knowledge, there are no cases published on RRD that occurred during a physical encounter among civilians. We present a case of a 39-year old man, who died during a struggle with another person while being chokehold in a prone position with a knee on his back. Detailed witness testimonies as well as reliable blood parameters, which were taken immediately after his death, helped to define a most probable diagnosis. The deceased suffered from schizophrenia, consumed amphetamine and bupropion. He showed typical symptoms of an agitated delirious state, most likely induced by bupropion intoxication. The cause of death was restraint asphyxia by a second party on the basis of an excited delirium. The manner of death was concluded to be manslaughter.