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PubMed1995

Clinical versus nonclinical panic: a test of suffocation false alarm theory.

Klein's suffocation false alarm theory of panic implies that suffocation sensations should distinguish clinical from nonclinical panic attacks better than should other symptoms. To test this theory, we conducted phenomenologic comparisons between attack patterns of patients with panic disorder and community subjects who had experienced unexpected panic. Effect size and multivariate analyses revealed that three cognitive symptoms best discriminated clinical from nonclinical panic (fears of dying, heart attack, and loss of control). These findings are consistent with cognitive theories of panic. Although lacking the discriminative power of cognitive symptoms, suffocation sensations had the largest effect size of any physiological symptom. Accordingly, suffocation sensations may be especially likely to give rise to the catastrophic thoughts that best discriminate clinical from nonclinical panic.

Adolescent↗

PubMedDate not supplied

Imagined risk of suffocation as a trigger for hyperventilation.

OBJECTIVE: Although hyperventilation has been hypothesized to play a role in many pathologies, its critical triggers remain poorly understood. The present experiment aimed to test whether stronger hyperventilation responses occur in response to suggested risk of suffocation compared with other fearful situations in high- and low-trait anxious women. METHODS: Fractional end-tidal CO2-concentration (FetCO2), respiratory frequency, and inspiratory volume were measured nonintrusively in high- (n = 24) and low- (n = 24) trait anxious women during imagery of 3 fear, 1 tension, 1 depressive, and 3 relaxation scripts. The fear scripts were equal in ratings of unpleasantness and arousal but differed regarding the inclusion of suggested risk of suffocation and entrapment. After each imagery trial, participants rated the emotional dimensions of pleasantness, arousal, and dominance and the vividness of their imagery. RESULTS: Decreases in FetCO2 occurred in all fear scripts. High-trait anxious women showed a stronger reduction in FetCO2 compared with low-trait anxious women during the fear script suggesting risk of suffocation but not during the other fear scripts. This effect was unrelated to any of the self-reported fear ratings. Self-reported fear of entrapment was associated with an overall lower FetCO2 but not with enhanced reactivity to imagined entrapment. CONCLUSION: High-trait anxiety is associated with stronger respiratory responsivity to imagined risk of suffocation and may constitute a specific vulnerability factor for the development of panic disorder and claustrophobia.

Adolescent↗

PubMed2005

[Suffocation, an important lethal factor for otorhinolaryngological disease].

OBJECTIVE: To study the importance of supervision in respiratory tract for otorhinolaryngological disease. METHOD: Nine cases died of suffocation were reported and the causes were analyzed. In the 9 cases there were 3 cases with the foreign body in bronchus, 2 cases with the trachea bleeding, 2 cases with laryngopharyngeal tumor and 2 cases with bleeding from nasopharyngeal carcinoma. RESULT: All cases were died of suffocation. CONCLUSION: Suffocation is an important lethal factor for many otorhinolaryngological disease. Tracheotomy is a prompt and effective management for the suffocation resulting from upper respiratory tract obstruction. Tracheoscopy is the first choice for patients with lower respiratory tract obstruction. And the continuous inflating pressure with intubation in cases with trachea bleeding should be avoided.

Adolescent↗

PubMedDate not supplied

Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation.

Unintentional deaths from suffocation and strangulation account for about 20 percent of all nontransport-related infant and child fatalities in the United States. In the late 1950s, some preventive countermeasures were introduced to reduce the number of deaths resulting from refrigerator or freezer entrapment. A few years later, countermeasures were introduced to prevent deaths resulting from suffocation by plastic bags, inhumation, and mechanical strangulation from wedging in infant cribs. For three of these major causes of suffocation and strangulation deaths among infants and children (refrigerator or freezer entrapment, suffocation by plastic bag, and inhumation at construction sites), there appears to have been a significant decline in incidence; however, there is no evidence of a significant reduction in deaths from mechanical strangulation in cribs. The impact of current countermeasures is discussed, and some suggestions for new or modified approaches are made.

Accident Prevention↗

PubMed1996

Suffocations in grain bins--Minnesota, 1992-1995.

Suffocation in flowing grain is the most common cause of death associated with grain storage structures in the United States: during 1985-1989, suffocation accounted for 49 grain- and silage-handling-associated fatalities. During 1992-1995, nine persons in Minnesota died in separate incidents from asphyxiation after becoming engulfed in flowing grain within a grain storage structure. The Minnesota Fatality Assessment and Control Evaluation program (FACE), a program sponsored by CDC's National Institute for Occupational Safety and Health (NIOSH), was notified of the incidents by the state Occupational Safety and Health Administration (MN-OSHA), Minnesota Extension Services, and a newspaper clipping service. This report describes the investigation of three of these incidents by FACE, summarizes surveillance for grain bin suffocations during 1992-1995, and provides recommendations to prevent suffocations associated with grain storage bins.

Accidents, Occupational↗

PubMed2000

Fatal suffocation by rubber balloons in children: mechanism and prevention.

This paper presents five autopsy cases of children who died as a result of an accidental choking on latex (rubber) balloons. All of the investigated cases suffocated by an intact (non-broken), pear-shaped and medium-sized balloon of less than 9 cm in length and 4 cm in width. The mouthpieces of all the involved balloons were upward and above the vocal cords, while the nosepieces were downward in the larynx and the trachea. The application of continuous suction forces to uninflated or partially air-filled balloon is considered the most crucial factor in causing asphyxiation by rubber balloon. An uninflated balloon is usually placed outside the mouth cavity where the child sucks the balloon into the mouth, either during a repeated trial of inverting the balloon inside-out or during the application of a direct suction to their bulb. A partially air-filled balloon is usually placed inside the mouth cavity then it is pushed further inside by movements like sucking or chewing. Other important factors are a sudden slippage of the mouthpiece from the fingers or teeth of the child, as well as the panic of the suffocation. The process of suffocation is also facilitated by the counterforce, which results from a sudden pressure of the mouth cavity over the bulb of the balloon, and the consistency of the balloons as pliable objects. Once the balloon enters the airway, it is less likely to be expelled. Supervision of children by adults and proper education programs are needed to decrease this problem.

Airway Obstruction↗

PubMed1996

Biological challenge manipulation of PCO2 levels: a test of Klein's (1993) suffocation alarm theory of panic.

D.F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO2 levels (e.g., hyperventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO2 levels (e.g., inhalation of 35% CO2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO2 challenge.

Adult↗

PubMed2000

Fall and suffocation injuries associated with in-home use of car seats and baby carriers.

OBJECTIVE: This paper examines two hazard patterns associated with in-home use and placement of car seats and baby carriers: 1) fall injuries resulting from placement on elevated surfaces and 2) suffocation resulting from seat overturn on soft surfaces. DESIGN: Emergency department data reporting on falls suffered by infants aged 6 months and younger, and associated with car seats and baby carriers, were provided by the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System for 1997. National estimates were based on 396 incidents. Additionally, 15 cases of suffocation resulting from car/infant seat overturn on soft surfaces were identified through the Commission's Death Certificate and Investigation Files. RESULTS: In 1997, it is estimated that approximately 8700 infants were treated in emergency departments as a result of fall injuries suffered while using a car seat or baby carrier. More than one third of estimated falls were specifically attributed to the seat being placed on an elevated surface in the home, such as a counter or table. A search of suffocation incidents resulting from seat overturn on a soft surface produced 15 incidents. The majority of incidents occurred when the seat had been placed on a bed or waterbed. CONCLUSIONS: Many parents are unaware of hazards associated with common placement scenarios for infant car seats and baby carriers. These hazard patterns and their potential consequences need to be conveyed to new parents by pediatricians. At the same time, manufacturers have an obligation to pursue design alternatives that will reduce the likelihood of seat overturn.

Accidental Falls↗

PubMed1998

Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation.

OBJECTIVES: To investigate outcome, management, and prevention in Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. DESIGN: Ascertainment through British Paediatric Surveillance Unit and questionnaires to responding paediatricians. SETTING: The UK and Republic of Ireland, September 1992 to August 1994. SUBJECTS: Children under 14 years diagnosed with the above. MAIN OUTCOME MEASURES: Placement and child protection measures for victims and siblings; morbidity and reabuse rates for victims; abuse of siblings; prosecution of perpetrators. RESULTS: Outcome data for 119 with median follow up of 24 months (range 12 to 44 months). No previously diagnosed factitious disease was found to have been caused by genuine disease. Forty six children were allowed home without conditions at follow up. Children who had suffered from suffocation, non-accidental poisoning, direct harm, and those under 5 years were less likely to go home. Twenty seven (24%) children still had symptoms or signs as a result of the abuse at follow up; 108/120 were originally on a child protection register and 35/111 at follow up. Twenty nine per cent (34/118) of the perpetrators had been prosecuted and most convicted; 17% of the milder cases of Munchausen syndrome by proxy allowed home were reabused. Evidence in siblings suggests that in 50% of families with a suffocated child and 40% with non-accidental poisoning there would be further abuse, some fatal. CONCLUSIONS: This type of abuse is severe with high mortality, morbidity, family disruption, reabuse, and harm to siblings. A very cautious approach for child protection with reintroduction to home only if circumstances are especially favourable is advised. Paediatric follow up by an expert in child protection should also occur.

Adolescent↗

PubMed2002

A case of suffocation by an advertising balloon filled with pure helium gas.

We encountered a rare case of suffocation by an advertising balloon filled with pure helium gas. Suffocation caused by inhalation of atmosphere lacking in oxygen is not exceptional, but reports of death by suffocation due to a pure inert gas such as helium are very rare. In this case, the balloon mooring on the ground was enclosed, warning signs were displayed, and it was clear that entering the balloon filled with an atmosphere lacking in oxygen was extremely dangerous and should not be done; the accident did, however, occur. Accidents of this kind may occur in the future unless appropriate education and countermeasures are taken.

Accidents↗

PubMedDate not supplied

[Asphyxiation by suffocation and strangulation in children younger than 15 years of age].

OBJECTIVE: Our aim was to describe non-intentional strangulation or suffocation suffered by children under 15 years of age. METHODS: Records from the Medical Examiner's Office showed child death by non-intentional strangulation or suffocation from January 1, 1991 to December 31, 2001. RESULTS: A total of 44 suffocations or non-intentional strangulations were registered. Overall mortality was 3.62/1,000,000 persons-year (27.57/1,000,000 in children < 1 year of age, 1.94/1,000,000 in older children); 63.6% were males. Most frequent mechanisms included neck entrapment between bars 18.2%, facial obstruction by bed clothes 15.9%, being covered by rubble, sand, or garbage 15.9%, strangulation by cord, chain, or strip 11.4%, and strangulation by dress or bed clothes 9.1%. CONCLUSIONS: Nearly all registered deaths could be prevented by education, supervision, or structural modifications. Strategies should also include obligatory standards for manufacturing and for warnings on labels.

Accidents↗

PubMed2005

[Study on oxygen consumption rate and suffocation point of Whitmania pigra].

OBJECTIVE: To study the oxygen consumption rate and suffocation point of Whitmania pigra. METHOD: Using the method of respiratory chamber, the oxygen consumption rate, oxygen consumption volume and suffocation point were obtained. RESULT: The oxygen consumption rate(OCR) ranged from 0.049 to 0.094 mg x g(-1) x h(-1), the oxygen consumption volume(OCV) from 0.44 to 0.67 mg x p(-1) x h(-1), and suffocation point(SP) from 0.9 to 1.51 mg x L(-1), when the average weight of W. pigra was 10 g and the water temperature varied from 15 to 35 degrees C. OCR ranged from 0.044 to 0.058 mg x g(-1) x h(-1), OCV from 0.19 to 0.77 mg x p(-1) x h(-1) and SP from 1.4 to 1.57 mg x l(-1) when water temperature was 20 degrees C. CONCLUSION: OCR rose when the water temperature and weight increased, but SP was justly opposite. The weight was negatively correlated with OCR and positively with OCV. OCR had little difference from day to night.

Animals↗

PubMed1985

[Suffocation death by occlusion of the airways with sand].

Eleven cases are reported in which death occurred because of suffocation as a result of occlusion of the respiratory tract by sand (without thoracic compression: 3 cases) or being buried alive (8 cases). Two tables demonstrate the findings and circumstances in the events. Three cases are described in detail. A 22-year-old woman was manhandled by blows and kicks to the head and neck. She became unconscious and her head and neck were covered by a layer of sand so that she suffocated. A 42-year-old man was smothered, while unconscious, in a prone position with his face in the sand, after hard blows to the head by two culprits. A 17-year-old girl finally died by chocking. Previously the culprit had pressed her face into the ground, so that she aspirated particles of soil. The question of vital reactions during aspiration of sand was investigated by microscopic examination of the content of the air passage and by destroying parts of the lungs by sulphuric acid. Minimal aspiration of sand occurred in all cases. Although the postmortal remains were left in the ground, there was no postmortem penetration of sand into the air passage. Histological examinations were carried out to support the diagnosis of violent suffocation. In some cases, there were remarkable findings (mobilization of alveolar cells, hepatocelullar hydropic degeneration), but there were no typical or unanimous findings that pertained to all cases.

Adolescent↗

PubMed1994

Testing the suffocation false alarm theory of panic disorder.

The need for hypotheses concerning the nature of those functions that have been impaired in stereotyped psychiatric syndromes is emphasized. With regard to panic disorder, the key role of the spontaneous panic attack became apparent from several viewpoints. However, panics seem to be a type of misreleased fear, which guided the thinking concerning the nature of possible psychological or physiological malfunctions. We indicate that spontaneous panic cannot be fear, but must represent some other malfunction and suggest that the spontaneous panic is a suffocation false alarm. The development of this idea is outlined, and attempts to develop tests of this hypothesis are indicated. In particular, studies of children with congenital central hypoventilation syndrome, patients with Chronic Obstructive Pulmonary Disease, dyspnea, field measures of panic, pregnancy, childbirth and the postpartum period, as well as the premenstrual syndrome afford pointed opportunities, new information and potential tests of the theory. A recent challenge to the theory from acetazolamide infusion is discussed. Developing a possible antecedent for the pathologically depressed threshold for the suffocation alarm, in the form of a phasic endorphinergic deficiency, is presented.

Adult↗

PubMed1996

Auditory brainstem responses in infants and children with anoxic brain damage due to near-suffocation or near-drowning.

We studied auditory brainstem responses (ABRs) of sixteen infants and children with brain damage after anoxic accidents due to near-suffocation or near-drowning. The patients manifested cerebral palsy, mental retardation and/or epilepsy and showed poor responses in the behavioral audiometry. Auditory brainstem responses were abnormal in five of the patients in the near-drowning group (waves I, II and III only were present in three patients and the amplitudes of waves IV and V were low in two patients) but normal in most of the patients in the near-suffocation group. This difference in the ABRs between the two groups suggest that in infants and children anoxic brain damage due to near-drowning might involve not only the cerebral cortex and subcortical white matter but also the upper brainstem and midbrain.

Brain Injuries↗

PubMed1999

Evidence for fear of restriction and fear of suffocation as components of claustrophobia.

Recent investigations of the aetiology and treatment of specific phobias have focused on clarifying the concerns underlying phobic anxiety. It has been proposed that claustrophobic fear is comprised of separable confinement and suffocation components. This paper presents data from 78 general medical outpatients undergoing magnetic resonance imaging (MRI) scans in two major teaching hospitals. The findings support the two factor structure of claustrophobia, in that exposure to confinement reduced confinement subscale scores, but did not influence suffocation scores.

Adult↗

PubMed1996

Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge.

Predictors of response to carbon dioxide challenge (i.e., breathing deeply and rapidly into a paper bag for 5 min) were evaluated in 78 college students. Zero-order correlations revealed that scores on the Suffocation Fear Scale (SFS; S. Rachman & S. Taylor, 1994) and the Anxiety Sensitivity Index (S. Reiss, R. A. Peterson, D. M. Gursky, & R. J. McNally, 1986) predicted anxiety and self-reported bodily sensations, whereas a behavioral measure of carbon dioxide sensitivity (i.e., maximum breath-holding duration) did not. Multiple regression analyses revealed that the SFS was the only significant predictor of anxiety and bodily sensations. Just as anxiety sensitivity is a better predictor than trait anxiety of the response to biological challenges in general, suffocation fear is a better predictor than anxiety sensitivity for challenges that increase carbon dioxide.

Adolescent↗

PubMed1997

Intra-alveolar pulmonary siderophages in sudden infant death: a marker for previous imposed suffocation.

Staining for iron showed previously overlooked intra-alveolar siderophages widely distributed in the lungs of two pairs of siblings, all of whom had hospital admissions for apparent life-threatening events (ALTEs) before dying suddenly at home. A mother and babysitter were convicted of their murder and manslaughter respectively. There were no siderophages in the lungs of a fifth infant whose death was included in the murder charge but who had no ALTEs. Bleeding from mouth or nose was observed during six of ten previous ALTEs suffered by these children and three unrelated infants in the same care. Such external hemorrhage is well described in imposed infant suffocation which may be one aspect of "Munchausen syndrome by proxy" child abuse. Our findings imply that there may also be intrapulmonary hemorrhage and that intra-alveolar siderophages can be a marker for previous abuse. Retrospectively we found diffusely distributed intra-alveolar siderophages in the lungs of seven of 158 infants with diagnoses of SIDS. Siderophages in such numbers demand an explanation and if this is not provided by clinical history or other necropsy findings should cause suspicion of previous imposed suffocation and infanticide and require further enquiry. The lungs should be stained for iron in all cases of sudden infant death.

Asphyxia↗