The location of the knot of the hanging rope is a major factor in determining the mechanics of cervical spine injury, with a submental knot or Hangman's knot under the chin being the only location capable of producing the sudden, straightforward hyperextension injury that causes the classic "Hangman's fracture”. The cause of death in hanging depends on the conditions related to the event. When the body is released from a relatively high position, the major cause of death is severe trauma to the upper cervical spine. However, the injuries produced are highly variable. A hanging may induce one or more of the following medical conditions leading to death:
• Closure of the airways/closure of carotid arteries causing cerebral ischemia/closure of the jugular vein causing apoplexy are the main causes of death in hanging along with the induction of carotid reflexes, which reduces heartbeat and may result in cardiac arrest.
• Breaking of the neck/cervical fracture causes traumatic spinal cord injury or decapitation. Judicial hanging fractures the cervical spine. However, in some cases, the classic hangman fracture (bilateral fractures of the pars interarticularis of the C2 vertebra) is seen.
• Death from a "hangman's fracture" occurs mainly when the applied force is severe enough to also cause a severe subluxation of the C2 and C3 vertebra that crushes the spinal cord.
• When cerebral circulation is compromised by any mechanism, arterial or venous, death occurs in 4 to 5 minutes from cerebral hypoxia, although the heart may continue to beat for some period after the brain can no longer be resuscitated.
• The time of death in such cases is a matter of convention. In judicial hangings, death is pronounced at cardiac arrest, which may occur at times from several minutes up to 15 minutes or longer after hanging.
• Closure of the airways/closure of carotid arteries causing cerebral ischemia/closure of the jugular vein causing apoplexy are the main causes of death in hanging along with the induction of carotid reflexes, which reduces heartbeat and may result in cardiac arrest.
• Breaking of the neck/cervical fracture causes traumatic spinal cord injury or decapitation. Judicial hanging fractures the cervical spine. However, in some cases, the classic hangman fracture (bilateral fractures of the pars interarticularis of the C2 vertebra) is seen.
• Death from a "hangman's fracture" occurs mainly when the applied force is severe enough to also cause a severe subluxation of the C2 and C3 vertebra that crushes the spinal cord.
• When cerebral circulation is compromised by any mechanism, arterial or venous, death occurs in 4 to 5 minutes from cerebral hypoxia, although the heart may continue to beat for some period after the brain can no longer be resuscitated.
• The time of death in such cases is a matter of convention. In judicial hangings, death is pronounced at cardiac arrest, which may occur at times from several minutes up to 15 minutes or longer after hanging.
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