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PubMed1995

Suffocation, choking, and strangulation in childhood in England and Wales: epidemiology and prevention.

The causes, classification, and prevention of mechanical asphyxial death in children were examined. The Office of Population Censuses and Surveys (OPCS) identified children, under 15 years of age, who had died as a result of choking, suffocation, or strangulation in England and Wales during the years 1990 and 1991. Cases in the International Classification of Diseases (ICD) codes of E911-3, E953, E963, and E983 were selected and case details from HM coroners' records and the death certificates were extracted. The OPCS identified 136 children (99 boys, 37 girls) in the two year period, 65% were under 3 years of age. The children were classified as dying from choking (21 cases), aspirating gastric contents (39 cases), suffocation (29 cases), strangulation (11 cases), and hanging (36 cases). The strangulation cases could be further subdivided into a group of 12 younger children who were suspended from ligatures around the home and a group of 21 boys (8-14 years) who died of self initiated hanging. Overall, 11 children were deliberately killed and 31 children died in beds or cots. Children whose deaths are classified as being due to aspiration of vomit appear to be cases of the sudden infant death syndrome or background medical conditions. This study suggests the need for advice on maintaining a safe sleeping environment. Only one child choked on a toy and European Standards for Toy Safety appear to have been successful. The prevention of hanging in the group of older boys needs further exploration.

Adolescent↗

PubMed1996

Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation.

A two year prospective study was performed to determine the epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation in the UK and the Republic of Ireland. Cases were notified to the British Paediatric Association Surveillance Unit from September 1992 to August 1994 if a formal case conference had been held for the first time during that period to discuss any of the above conditions. A total of 128 cases were identified: 55 suffered Munchausen syndrome by proxy alone, 15 poisoning, and 15 suffocation; 43 suffered more than one type of abuse. The majority of children were aged under 5 years, the median age being 20 months. On 85% of occasions the perpetrator was the child's mother. In 42% of families with more than one child, a sibling had previously suffered some form of abuse. Eighty five per cent of notifying paediatricians considered the probability of their diagnosis as virtually certain before a case conference was convened. The commonest drugs used to poison were anticonvulsants; opiates were the second commonest. Sixty eight children suffered severe illness of whom eight died. The combined annual incidence of these conditions in children aged under 16 years is at least 0.5/100,000, and for children aged under 1, at least 2.8/100,000.

Adolescent↗

PubMed1993

Plastic bag suffocation.

Suffocation by plastic bag is not common. The finding of a body at the scene of death with a plastic bag in situ could be diagnostically valuable to the pathologist. Otherwise the pathologist may be hard put to arrive at a firm opinion as to how the deceased met his/her death; in fact, in three of the cases reported in this paper, the local pathologist could not give a cause of death when the initial autopsy was performed. Plastic bags could be accidentally placed over the head; put there to help in the inhalation of volatile substances; with homicidal intention; or simply as an effective suicidal method. The object of this paper is to study the cases where bodies were found with a plastic bag over the head, and in particular the cases where the cause of death was due to plastic bag suffocation.

Adult↗

PubMed1998

An accidental suffocation by a rubber balloon.

This report presents an autopsy case of a 10-year-old child, who was accidentally suffocated by a rubber balloon that adhered tightly to the epiglottis, occluding air entry. Suffocation by rubber balloon is not uncommon, but the mechanism in this case was unique. The post-mortem findings are given and the conclusion is drawn that such death could have been avoided.

Airway Obstruction↗

PubMed2003

Suction-type suffocation incidents in infants and toddlers.

OBJECTIVES: To describe the danger of upper airway obstruction associated with semirigid hollow objects in infants and toddlers and to define a minimum frequency with which episodes involving these products have occurred and propose a model defining the potentially hazardous characteristics of these objects. METHODS: A retrospective study of incidents reported to the US Consumer Product Safety Commission from January 1983 to March 2000, involving children younger than 5 years, was conducted. The medical literature (Medline) was searched for similar cases. The resulting case series was analyzed. RESULTS: A total of 17 incidents were identified in which a semirigid, hollow hemispherical/ellipsoidal object was described as having "cupped" the face, simultaneously covering the nose and the mouth. Of the 17 incidents, 13 involved toys; the remaining 4 incidents involved 2 different consumer products. All of these incidents involved children aged 4 to 36 months. Eight incidents resulted in death; 9 were nonfatal because of parental intervention. In all cases investigated, the infant was found with the semirigid object strongly adhering to his or her face. In 16 incidents, significant physical effort reportedly was required to remove the objects from the child's face. The fatal incidents involved children aged 4 to 24 months, whereas the age range of the children in nonfatal incidents was 7 to 36 months. In all but 1 of the fatal cases, the victim was found dead in a crib or playpen. The cross-sectional diameter of the products involved in suffocation incidents was in the range of 6.4 to 9.7 cm. The depths of the products ranged from 4.2 to 5.1 cm. The approximate volume of containers ranged between 100 and 170 mL. These dimensions are compatible with the range of anthropometric measurements that allow the product to fit snugly over the mouth and the nose of a young child, resulting in complete airway obstruction. CONCLUSIONS: Children between the ages of 4 and 36 months are at risk from suffocation by hollow, semirigid hemispherical/ellipsoidal objects through suction formation and complete airway obstruction. Shallow containers with dimensions ranging from approximately 6.0 to 11.0 cm seem to be especially hazardous. Several recommendations may be proposed to lessen the hazard to young children. These include product design changes that limit the amount of contact with the perimeter and reduce the chance of forming a seal between the container and the face and ventilation holes to prevent a seal from forming. Although design change alone may be very helpful in products that are intended for use by children who are younger than 3 years, products that have similar dimensions and are not intended for infants present additional challenges. Thus, a very important additional prevention strategy is education. Pediatricians and other health care providers should alert parents and caregivers to the dangers of leaving such products in an infant's crib or playpen or allowing infants to play with these objects while unattended.

Airway Obstruction↗

PubMed2004

A simple treatment for head lice: dry-on, suffocation-based pediculicide.

OBJECTIVES: The emergence of drug-resistant lice has created the need for new therapies. This study assesses a new method without neurotoxins, extensive household cleaning, or nit removal. METHODS: One hundred thirty-three subjects participated in 2 open clinical trials. In the first trial, 93 subjects completed treatment using a nontoxic, dry-on, suffocation-based, pediculicide lotion, minimal household cleaning measures, and physical removal of the nits. In the second trial, 40 subjects completed treatment using an identical protocol except that the nits were not removed. Head lice infestation was defined as a wet combing test showing lice. Cure was defined as a wet combing test showing no lice, with an absence of symptoms. Subjects were contacted 6 months later, for assessment of their disease status. RESULTS: Cure was achieved for 97% of the patients in the first trial and 95% in the second trial. Remission at the follow-up assessment was reported for 77 of 82 subjects (94%) in the first trial and 36 of 38 subjects (95%) in the second trial. There was no statistical difference in cure rates or remission rates between the protocols with and without nit removal. The overall cure rate was 96%, with a remission rate of 94%. There were no adverse effects. CONCLUSIONS: Dry-on, suffocation-based, pediculicide lotion effectively treats head lice without neurotoxins, nit removal, or extensive house cleaning. These results are comparable or superior to the results previously reported for treatments with permethrin, pyrethrin, and malathion.

Administration, Topical↗

PubMed2006

Child mortality due to suffocation in Europe (1980-1995): a review of official data.

This report outlines the current status of the official statistical data available concerning mortality rates for suffocation in children <15 years of age, stratified according to sex and country in Europe, in the years 1980-1995. The data source is the WHO Mortality Database, which comprises deaths registered in national vital registration systems, with underlying cause of death as coded by the relevant national authority. To assess the impact of the problem of suffocation, the total potential years of life lost have been calculated. In addition, for Italy, and for the years 1999-2000, data related to deaths and hospitalizations for foreign body in the pharynx and larynx are presented. In Italy, in the years 1999-2000, the ratio between the number of hospitalizations and the mortality rates is approximately one death every 10 hospitalizations (x 100,000). The European mortality rate exceeds nearly one death per 100,000 persons. No evidence of any geographical pattern or cyclic trend emerged from the analysis of this official data.

Adolescent↗

PubMed1993

Hysteria, or "suffocation of the mother".

OBJECTIVE: To understand or explain the surprising adherence of prominent physicians throughout the centuries to terms suggesting that the womb could move and cause suffocation, choking or difficulty in swallowing. DATA SOURCES: Hippocratic writings on hysterical symptoms and the views of subsequent authors and contexts surrounding such views. DATA SYNTHESIS: Physicians who followed Hippocrates repeatedly related difficulties in breathing or choking and difficulties in swallowing to the uterus, although most recognized that the womb did not rise out of the pelvis, except partially, when enlarged by pregnancy. Respiratory and gastrointestinal symptoms were often associated with anxiety. The effects may have been attributed to the womb, because it was recognized that the womb, when enlarged, can cause difficulty in breathing. Anxiety was also reported more often in women and may have been attributed to the womb for that reason. CONCLUSION: The suffocation of the mother can be understood as anxiety with dyspnea, and globus hystericus reflects anxiety with a choking sensation or difficulty in swallowing.

Anxiety↗

PubMedDate not supplied

[Discrepancies in homicide statistics by suffocation].

Elucidating the estimated number of undetected murders by suffocation is difficult. Leaving aside criminalistical reasons it is worth to reflect about this problem from the viewpoint of forensic pathologists. 6 unknown cases of homicides from the last 15 years which occurred in Hamburg, Germany, are analysed. In five cases forensic pathologists were involved by postmortem examination, four times an autopsy was performed. In spite of questionable findings none of these fatalities could be elucidated by the investigations until the offenders addressed to the police in order to make unexpected confessions. Homicides had been performed by strangulation, suffocation or drowning. Another case demonstrates the problematic nature of false confessions.

Adult↗

PubMed1976

[On the problem of capability to act during mechanical suffocation (author's transl)].

On a case of mechanical suffocation the problem of persistent "capability to act" during continuing insufficient blood perfusion of the brain is discussed. This means a form of manifestation exhibiting a certain aim, but which cannot be related to voluntary human behaviour. As an explanation reflex-like stimulus-reaction connexions often repeated during life-time are suggested. Similarly, verbal expressions not compatible with the actual situation at the point of death after severe injuries of the frontal lobe cannot be explained conclusively. Those manifestations can probably be attributed to engram-like or life-style forming impressions.

Aged↗

PubMed2004

Suffocation and poisoning--the hard-hitting side of Munchausen syndrome by proxy.

Munchausen syndrome by proxy (MSBP) is a severe and difficult to diagnose form of child abuse characterised by the simulation, aggravation or production of symptoms of illness in a child by an adult. MSBP often leads to multiple hospitalisations and has a high mortality and long-term morbidity. This study describes the cases of 5 families with 8 children affected who presented with unexplained neurological or gastrointestinal symptoms or even loss of consciousness. All were victims of poisoning or suffocation by their mothers. Two of those children died and were initially diagnosed as SIDS or natural death, respectively. They were only recognised as MSBP victims after another sibling had fallen ill with similar symptoms. The cases are discussed in consideration of the relevant literature. In addition warning signs of this forensically relevant syndrome and a strategy for the management of suspected MSBP cases are described.

Asphyxia↗

PubMed1996

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

We investigated predictors of response to carbon dioxide challenge (i.e. breathing deeply and rapidly into a paper bag for 5 min) in college students. Zero-order correlations indicated that scores on both the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986) and the Suffocation Fear Scale (SFS: Rachman & Taylor, 1994), predicted anxious response to challenge, whereas a behavioral measure of carbon dioxide sensitivity (i.e. maximum breath-holding duration) and scores on the State-Trait Anxiety Inventory--Trait form (STAI-T: Spielberger, Gorsuch, Lushene, Vagg & Jacobs, 1983) did not. Multiple regression revealed that all four variables remained in the model, entering in the following order: ASI, breath-holding duration, SFS, and STAI-T. These data suggest that psychological variables reflecting fears of bodily sensations are better predictors of response to challenge than either behavioral sensitivity to carbon dioxide or general trait anxiety.

Adult↗

PubMed1996

Suffocation and related problems.

Experiments were carried out on rats, rabbits and dogs to investigate the course of respiration and circulation during various types of suffocation. From the results of dogs, the course of respiration on obstructive asphyxia consists of three stages; the stage of dyspnea, of apnea, and of terminal respiration. The respirations in the stage of dyspnea and the stage of terminal respiration are generally inspiratory. In typical hanging, the course of respiration is characterized by shorter stages of dyspnea and apnea and a longer stage of terminal respiration as compared with that in obstructive asphyxia. In non-obstructive asphyxia, the course of respiration has the initial stage before the stage of dyspnea. The results of experiments simulating deficiency of oxygen in the external atmosphere suggested that the lethal oxygen percentage is approximately 2.2%. In drowning, the course of respiration consisted of four stages: initial stage (surprise-respiration and initial apnea), stage of dyspnea, stage of apnea and stage of terminal respiration. The surprise-respiration is suggested to be induced by the contact of water with the mucus membrane of larynx or trachea. The respirations during the stage of dyspnea are essentially inspiratory, and do not always have a convulsive character. In a few dogs, the precipitous fall of blood pressure and flat electroencephalogram appeared immediately after aspiration of water. This seemed to be caused by the reflex vagal inhibition of the heart, which was induced by the contact of water with the mucus membrane of larynx or trachea. It is suggested that the reflex vagal inhibition of the heart is one of the causes of loss of consciousness and drowning during swimming.

Animals↗

PubMed2004

Respiratory symptoms and panic in the National Comorbidity Survey: a test of Klein's suffocation false alarm theory.

According to suffocation false alarm theory (Arch. Gen. Psychiatry 50 (1993) 31), respiratory symptoms are the symptoms that best distinguish the panic attacks of individuals with panic disorder (PD) from those of individuals without PD. Using National Comorbidity Survey data from those 609 respondents who had lifetime histories of panic attacks or PD, we tested this prediction. Neither respiratory symptom (smothering; dyspnea) strongly differentiated between respondents with PD and those with only panic attacks. Respiratory symptom endorsement was unrelated to PD when the number of other symptoms endorsed was controlled; furthermore, respiratory symptoms had slight effect sizes and were not included in a multivariate context. In contrast, fear of dying had the largest effect size, an association with PD that persisted after control for other symptom endorsement, and a continuing importance in multivariate analyses. Strikingly, panic attack respondents who reported having had only one panic attack were as likely as PD respondents to report respiratory symptoms during panic. These findings, although based on retrospective self-report and thus subject to recall bias, are inconsistent with the hypothesis that respiratory symptoms during panic have diagnostic significance.

Adolescent↗

PubMed2004

Analytical investigations in a death case by suffocation in an argon atmosphere.

A 31-year-old engineer was found dead in a reaction vessel (diameter 0.8 m, height 1.8 m) of a bulb factory some minutes after he had entered it for repair work. Resuscitation attempts with artificial respiration were unsuccessful. Despite autopsy and usual toxicological analyses, no cause of death could be found. Since in the normal production process, argon was used as a protecting gas, the possibility of suffocation in an argon atmosphere was investigated. This was rendered more difficult because of the natural content of 0.93 vol.% argon in air and since the excessive argon could have been removed by the resuscitation attempts. Gas samples from larynx, esophagus, bronchi, and stomach, separated blood samples from both ventricles of the heart and from the vena iliaca externa as well as tissue samples from lung and liver were collected during autopsy into headspace vials in such a way that the loss of gas and a dilution by surrounding air was avoided as far as possible. The samples were analyzed by headspace GC-MS. The abundance of Ar+ (m/z = 40) was used for quantification with N2(2+) (m/z = 14) as internal standard. The following argon concentrations were measured (mean values, case under investigation/comparison cases): gas from larynx 1.79/0.96 vol.%, stomach gas 1.58/0.89 vol.%, heart blood (left ventricle) 7.2/2.7 microg/mL, heart blood (right ventricle) 5.8/2.7 microg/mL, blood from vena iliaca externa 3.6/2.7 microg/mL. A clearly increased concentration was also found in lung tissue, whereas in liver tissue no significant difference in comparison to other cases was measured. From the results, it follows that the deceased inhaled an increased amount of argon a short time before death. The concentrations are consistent with asphyxia and subsequent resuscitation attempts. They cannot be explained by a long-term inhalation of an atmosphere enriched with argon before the incident as it is likely to have occurred in this factory hall.

Administration, Inhalation↗

PubMed1997

Voluntary breath holding: not a suitable probe of the suffocation alarm in panic disorder.

Voluntary breath-holding duration was investigated in patients with panic disorder, patients with a mood disorder, and normal controls. There were no differences in mean breath-holding durations, but the pattern of scores was different among groups. Furthermore, the scores were influenced by motivational and cognitive factors. It is argued that voluntary breath-holding is not a suitable test to measure carbon dioxide sensitivity or suffocation alarm threshold in panic disorder.

Adolescent↗

PubMed1993

Unintentional suffocation by rebreathing: a death scene and physiologic investigation of a possible cause of sudden infant death.

As part of a 1-year study of sudden unexpected infant deaths in St. Louis, we performed both a specialized death scene investigation and, in selected cases, a physiologic reconstruction of the death scene with a rabbit model. Those cases in which the infant was found face down with nose and mouth covered by bedding were chosen for the physiologic testing; our goal was to assess the potential for lethal rebreathing of expired air. The physiologic studies reconstructed the infants' premortem ventilatory environment by using the head from an infant mannequin positioned on the actual bedding on which an infant had died and a rabbit breathing through the mannequin's nares. The specialized scene investigation was carried out in 31 of 32 deaths from sudden infant death syndrome, diagnosed by the usual methods. Of 31 infants, eight died with their faces downward and covered by bedding, and the bedding was obtained for further study in seven of eight cases. The bedding had low resistance to airflow (6.25 to 22.6 cm H2O/L per second), and caused considerable rebreathing that was lethal to the rabbits in five of seven cases. We conclude that items of bedding in common use are capable of causing lethal rebreathing by prone-sleeping infants whose nose and mouth become covered; suffocation by rebreathing was the probable mechanism of death in a substantial number of these deaths that had been attributed to sudden infant death syndrome.

Animals↗

PubMedDate not supplied

Relationships between the anxiety sensitivity index, the suffocation fear scale, and responses to CO2 inhalation.

Interest in documenting ways to predict anxious responding in panic disorder (PD) patients has proliferated recently in the literature. In the current study, two self-report measures were assessed to determine their relative utility in predicting responses to a panicogenic challenge. The Anxiety Sensitivity Index (ASI) and the Suffocation Fear Scale (SFS) were evaluated by correlating scores on these measures with reactions to inhalation of 35% carbon dioxide (CO2), assessed via anxiety ratings, panic symptom intensity, tidal volume (VT) and respiratory rate (RR). A sample of 14 PD patients and 14 matched control (MC) participants demonstrated that the relationship between ASI scores and responses to 35% CO2 were stronger than the relationship between SFS scores and responses to CO2. Specifically, both respiratory responses (VT and RR) and self-reported reactions (anxiety and symptom intensity) were significantly correlated with scores on the ASI. In contrast, scores on the SFS were significantly correlated with only one measure of respiratory change (VT). Although preliminary, these data indicate that the ASI may be a more useful tool than the SFS in predicting self-reported and respiratory responses to CO2 challenges.

Adult↗