E-News: Five Facts About Petechiae 
Dear Friends,
Welcome to another edition of the Strangulation Prevention E-News. The Training Institute on Strangulation Prevention launched E-News to share important information about non- and near-fatal strangulation assaults. Each E-News focuses on one subject, highlights one organization or individual, and/or shares one featured resource. 
For this E-News, we want to share five facts about petechiae from Assistant District Attorney Jerry Fineman (Retired), Dr. Green and Dr. Smock. 

Five Facts about Petechiae from
Assistant District Attorney Jerry Fineman (Retired) 
She must not have been strangled because she did not have petechiae.” -Defense Attorney (name omitted)
The above quote identifies a common myth surrounding strangulation. Petechiae, tiny red spots resulting from burst capillaries, does not always occur in strangulation. The presence or absence of petechiae in strangulation is widely misunderstood. Here are some facts about petechiae:
1.   Petechiae results from arterial pressure being built up faster than the body can accomplish venous return. (Blood is flowing into the area faster than it can flow out). In strangulation this results from blockage of venous blood flow.  
2.   Petechiae can result from activities other than strangulation, such as childbirth, skydiving, vomiting, vigorous coughing, any type of mechanism that results in the build-up of arterial pressure. I have some interesting photos from colleagues who experienced, childbirth, food poisoning, or sickness, and sent me their petechiae photos. 
3.   Petechiae characteristics:
  • Non-palpable (flat as opposed to a raised area on the skin, cannot be felt on exam)
  • Non-tender (no discomfort when touched)
  • Do not blanch when touched
  • Usually appear in crops or clusters (may be diffuse)
  • Petechiae occurs upstream from the area of compression.
4.   Petechiae, if present, represents a significant finding because it confirms neck compression for at least 20-30 seconds. This indicates compression for a life-threatening period of time. 
5.   While petechiae may be present, a victim can be fatally strangled without any petechiae. In studies, approximately 78% of strangled patients lacked
observable petechiae.
Dr. Green’s Chapter 5, pages 144-148, in Investigation and Prosecution of Strangulation Cases, produced by the California District Attorneys Association in partnership with the Training Institute on Strangulation Prevention (2020).
Thank you for all you do to help victims find hope and healing through your various responses in investigations, forensic exams, prosecutions, monitoring, counseling, and advocacy. Your work matters.
With Great HOPE,
Gael Strack, CEO and Casey Gwinn, President
Alliance for HOPE International
Upcoming Events:
May 25 – 27: Annual International Family Justice Center Conference in San Diego, CA
August 16 – 19: Advanced Course on Strangulation Prevention in San Diego, CA
August 29 – 31: Expert Course on Strangulation Prevention in Fort Worth, TX (Pending OVW Approval)
September 26 – 30: Leadership Summit in Denver, CO
October 25 – 28: Getting Away with Murder: The Challenges of Staged Crime Scenes in Allenspark, CO
Upcoming Webinars:
June 14: County Wide Protocols 
July 21: Strangulation Training for Defense Attorneys 
August 23: Advanced Course Reunion 
September 20: Updated Imaging Recommendations
October 4: Elevating the VOICES of Survivors - What Strangulation Survivors want others to Know
November 15: Pediatric Strangulation Part 1
November 17: Pediatric Strangulation Part 2
This project is supported all or in part by Grant No. 2016-TA-AX-K067 awarded by the Office on Violence AgainstWomen, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Department ofJustice, Office on Violence Against Women.
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