Mom24
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"It’s important to remember that often in strangulation cases there are no visible external injuries."<modsnip - quoted post removed>
"Sober and conscious victims of strangulation will first feel terror and severe pain. If strangulation persists, unconsciousness will follow. Before lapsing into unconsciousness, a strangulation victim will usually resist violently, often producing injuries of their own neck in an effort to claw off the assailant, and frequently also producing injury on the face or hands of their assailant. These defensive injuries may not be present if the victim is physically or chemically restrained before the assault. Victims may lose consciousness by any one or all of the following methods: blocking of the carotid arteries in the neck (depriving the brain of oxygen), blocking of the jugular veins (preventing deoxygenated blood from exiting the brain), and closing off the airway, making breathing impossible."
https://www.pottstown.org/DocumentCenter/View/211/Strangulation-Information-for-Victims
"Even in fatal strangulation cases, there is often no external evident injury (confirming the findings regarding the seriousness of non-fatal, no-visible-injury strangulation assaults).1"
"Strangulation is more serious than professionals have realized. Loss of consciousness can occur within 5–10 seconds, and death within 4–5 minutes."
"Jurors expect to see visible injuries. But the fact that strangulation often leaves no marks, combined with its terror value, makes it a favorite tactic of experienced batterers."
"Studies are confirming that an offender can strangle someone nearly to death with no visible injury, resulting in professionals viewing such an offense as a minor misdemeanor or no provable crime at all."
https://evawintl.org/wp-content/uploads/California-Strangulation-Manual_web3.pdf
"Domestic violence strangulation can be fatal without any external evidence of injury on the skin of the neck. Police homicide investigators are frequently posed a difficult problem, wherein the victim of a domestic violence situation is found dead, often reported by the assailant, with a vague history of substance abuse or depression, and no injuries evident on the body. If no suspicion of domestic violence is developed during the scene investigation, there may be little or no suspicion of criminal harm when the victim presents for autopsy examination. Without external evidence of skin injury, an autopsy will be conducted to rule out drug overdose, and the injury of strangulation will not be found until the neck dissection is carried out, ordinarily at the end of the case."
https://bloomington.in.gov/sites/default/files/2017-09/Review of 300 attempted Strangulation Cases_Part III.pdf
The long and short is that there can be fingernail marks, but not always. The loss of consciousness can be within seconds, or it may be longer. I do believe Dr. Baden may have been trying to alleviate some of the pain the Petito's were going through, or he may have also read something or seen something that would make him believe that in this case it was over very quickly.