Non-Fatal Strangulation Documentation Toolkit
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Choking Game” Awareness and Participation Among 8Th Graders — Oregon, 2008
Morbidity and Mortality Weekly Report Weekly / Vol. 59 / No. 1 January 15, 2010 “Choking Game” Awareness and Participation Among 8th Graders — Oregon, 2008 The “choking game” is an activity in which persons strangu- based on the CDC’s Youth Risk Behavior Survey (YRBS) and late themselves to achieve euphoria through brief hypoxia (1). It includes questions on physical and mental health, sexual activ- is differentiated from autoerotic asphyxiation 2,3( ). The activity ity, substance use, physical activity/nutrition, and community can cause long-term disability and death among youths (4). In characteristics. In 2008, all 647 Oregon public middle and high 2008, CDC reported 82 deaths attributed to the choking game schools were part of the sampling frame, which was stratified and other strangulation activities during the period 1995–2007; into eight regions. Schools were sampled randomly from within most victims were adolescent males aged 11–16 years (4). To each region, with a total of 114 schools being sampled. The data assess the awareness and prevalence of this behavior among were weighted to achieve a statewide representative sample. 8th graders in Oregon, the Oregon Public Health Division Weighting was based on the probability of school and student added a question to the 2008 Oregon Healthy Teens survey selection, and a post-stratification adjustment for county par- concerning familiarity with and participation in this activity. ticipation. Schools use an active notification/passive consent This report describes the results of that survey, which indicated model with parents, who may decline their child’s participation. that 36.2% of 8th-grade respondents had heard of the choking In 2008, the survey contained a total of 188 questions, which game, 30.4% had heard of someone participating, and 5.7% had were designed to be completed in the course of a class period. -
The Neuropsychological Sequelae of Attempted Hanging
546 Journal ofNeurology, Neurosurgery, and Psychiatry 1991;54:546-548 SHORT REPORT J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.54.6.546 on 1 June 1991. Downloaded from The neuropsychological sequelae of attempted hanging Alice A Medalia, Arnold E Merriam, John H Ehrenreich Abstract by paranoid delusions, thought blocking and Only one report on the neuropsycho- suspiciousness. At that time he had a gross logical sequelae of attempted hanging impairment in recent memory. Psychological exists in the English language. Two cases testing carried out three weeks after the hang- of attempted hanging with subsequent ing found severe memory deficits on the recall isolated memory deficits are reported. portion of the Bender Gestalt Test, a measure Possible mechanisms for induction of of nonverbal memory. IQ testing revealed a this amnesia are discussed. In these two sharp drop in intelligence from the prehang- cases it is most likely that circulatory ing level (Performance IQ = 82; Verbal IQ = disturbance produced by the ligatures 80; Full Scale IQ = 80). A neurological caused ischaemic hippocampal damage, examination three months after the hanging which in turn led to amnesia. was unremarkable except for the memory impairment. Contrast CT was normal. Seven- Every year approximately 4000 people in the teen months after the hanging his psychosis United States commit suicide by hanging.' had remitted and mental status was remark- While no precise figures are available, it is safe able only for persistent memory deficits. to assume that additional thousands Neuropsychological testing performed two unsuccessfully attempt suicide by this years after the hanging when he was non- method. -
CPAP Titration AHI (Events/Hour) 49.8 51 ODI 33.0 45.8 CAI 1.6 48 Minimum Spo2 % 72 85
GENERAL SESSION MATERIALS Sunday, June 4, 2017 © American Association of Sleep Technologists 1 AAST 39th Annual Meeting Sunday, June 4 – Tuesday, June 6, 2017 This section of the course book contains materials to be presented in general sessions on Sunday, June 4, 2017. THIS COURSE BOOK IS ONLY INTENDED FOR REVIEW BY THE INDIVIDUAL WHO ATTENDED THE COURSE. PHOTOCOPYING AND DISTRIBUTION TO OTHERS IS PROHIBITED. © American Association of Sleep Technologists 2 © American Association of Sleep Technologists 3 Can we use physiology to understand and treat obstructive sleep apnea? Exploring the Possibility of Performing Research in Your Sleep Center Robert L. Owens, MD Scott A. Sands, PhD University of California San Diego Brigham and Women’s Hospital and [email protected] Harvard Medical School [email protected] © American Association of Sleep Technologists 4 The Big Ideas • Is all OSA the same? • Are two people with the same AHI the same? • If we knew the underlying cause of OSA, could we treat people differently? • Can we do all this in the clinic? © American Association of Sleep Technologists 5 Outline • Why might different people get OSA? • Can we measure the causes in an individual? • Is that useful? © American Association of Sleep Technologists 6 What happens when you fall asleep: normal Wake Sleep Ventilation Ventilatory Demand Time © American Association of Sleep Technologists 7 What happens when you fall asleep: normal or OSA Wake Sleep Ventilation Ventilatory Ventilation ≠ Demand Demand Because of poor anatomy Time © American Association of Sleep Technologists 8 What happens when you fall asleep: normal or OSA Hypoventilation leads to increased ventilatory demand, which will activate upper airway Wake Sleep muscles to improve Ventilation ventilation. -
Techniques Frequently Used During London Olympic Judo Tournaments: a Biomechanical Approach
Techniques frequently used during London Olympic judo tournaments: A biomechanical approach S. Sterkowicz,1 A. Sacripanti2, K. Sterkowicz – Przybycien3 1 Department of Theory of Sport and Kinesiology, Institute of Sport, University School of Physical Education, Kraków, Poland 2 Chair of Biomechanics of Sports, FIJLKAM, ENEA, University of Rome “Tor Vergata”, Italy 3 Department of Gymnastics, Institute of Sport, University School of Physical Education, Kraków, Poland Abstract Feedback between training and competition should be considered in athletic training. The aim of the study was contemporary coaching tendencies in women’s and men’s judo with particular focus on a biomechanical classification of throws and grappling actions. 359 throws and 77 grappling techniques scored by male and female athletes in Olympic Judo Tournaments (London 2012) have been analyzed. Independence of traits (gender and weight category by technique classes) was verified via c2 test. Comparison between frequency of each subsequent technique class and rest/inconclusive counts was made in 2×2 contingency tables. The significance level was set at p£0.05. Throwing technique frequencies grouped in the seven biomechanical classes were dependent on gender. A significant difference was found between frequencies of variable arm of physical lever technique scored by males (27.09%) and females (16.67%) as compared to the rest/inconclusively techniques counts. Significant differences between men who competed in extra lightweight and heavy weight concerned the frequency of the techniques used with maximum arm or variable arm of physical lever and a couple of forces applied by trunk and legs. In females, a tendency to higher frequency of techniques that used couple of forces applied by arm or arms and leg was observed in extra lightweight compared to the heavy weight. -
Catch ‘Em • Validating Voices • Linking the Chain Before They Kill • Coordinated Taskforce ‘Em • Keeping Track!
8/31/2017 Desensitized to Website & Resources www.mckaytrainingconsulting.com Death [email protected] Strangulation Assessment & Prosecution Resources Presented by Articles Kelsey McKay McKay Training & Consulting Calendar of Training [email protected] Testimonials Challenges in How is strangulation Strangulation/Suffocation DIFFERENT than other types • Lack of visible injury of assault, abuse and • Lack of investigation violence? • Lack of understanding • Lack of victim • Lack of concern Overcoming Obstacles My Philosophy • Developing a Protocol • Implementing Training • Utilizing a Strangulation Supplement Catch ‘em • Validating Voices • Linking the Chain before they kill • Coordinated Taskforce ‘em • Keeping Track! 1 8/31/2017 Strangulation represents an Lethality & Fatality escalation of force Continuum of Violence 90% prior history of DV After ONE non-fatal strangulation... 7-9 x 43% Women who were more likely to be murdered had been killed strangled in the last year 2 8/31/2017 Catch ‘em while It takes a certain they are killing kind of rage… Haruka Weiser Loyalty Before Betrayal •“He didn’t look like himself, it wasn’t him in his eyes” • Clenching teeth; Gritting teeth; • Squeezing so hard veins were coming out of his head; • Bulging eyes; • Bugged out eyes, angry; • Mad face Trust no bitch, Love no bitch • He had black in his eyes 3 8/31/2017 David Adams • If you had access to a gun… • Only 1 of the 8 stranglers said And a certain he would have used a gun (vs 4/6 stabbers) kind of • “I wanted to know what it felt like to kill someone” enjoyment… Source: D. Adams, Emerge “Whenever V was about to pass out, D would let go just enough to allow V to gasp for air, and then would continue strangling V. -
Definition Brain & Vascular Choke
4/27/17! The Choke Hold Submission Breakdown Don Muzzi MD & Larry Lovelace DO UFC Events 25% of fights end in submission anaconda! d’acre! 74% of submissions are result of choke hold Does not reflect opinions of the NYSAC, FL Boxing Commission, MN, & WI Office of Combative Sports, MMA121 July 2015 (UFC 189)! PA Athletic Commission, Ojibwe Tribal Commission, Fon du Lac Tribal Commission Brain & Vascular Choke Definition A grappling hold that critically reduces or prevents air (choking) and or blood (strangling) from passing through the neck. Neuro-vascular reflexes yield decrease in cerebral blood flow (CBF) • May result in unconsciousness, injury to larynx or trachea, airway compromise… significant morbidity or mortality • Vascular Choke vs Airway Choke 15% of Cardiac Output 1! 4/27/17! Blood Supply to Brain Mechanisms and Reflexes • Auto-regulation: (AR) Intrinsic ability of the cerebral vasculature to alter its resistance in order to maintain cerebral blood flow constant over a wide range of cerebral perfusion pressures • Baroreceptor Reflex (BRR): Mechanoreceptors (stretch) in carotid vasculature that sense BP and relay information to the brain in order to maintain a proper blood pressure Cerebral Baroreceptor Reflex Hemodynamics • CPP = MAP - ICP (or CVP whichever is greater) • CBF = CPP/CVR 2! 4/27/17! Baroreceptor Reflex Pathway… ⬇CBF Venous Compression Stretched “firing” ⬇ Sympathetic ⬆Parasympathetic CPP = MAP-ICP ⬆Peripheral vasodilatation ⬇MAP & ⬇CPP" ⬇HR, ⬇inotropic state of heart, ⬇CO Autoregulation of CBF Autoregulation of CBF CPP= -
Autoerotic Asphyxiation: Secret Pleasure—Lethal Outcome?
Autoerotic Asphyxiation: Secret Pleasure—Lethal Outcome? WHAT’S KNOWN ON THIS SUBJECT: Centuries old, AEA first AUTHOR: Daniel D. Cowell, MD, MLS, CPHQ appeared in medical literature in 1856. Etiology is speculative, Departments of Psychiatry and Behavioral Medicine and and the majority of reports deal with fatal cases. Distortions of Graduate Medical Education, Marshall University, Joan C. normal development on the basis of psychoanalytic theories are the Edwards School of Medicine, Huntington, West Virginia most prevalent understanding of the disorder. KEY WORDS asphyxiation, “choking games,” hypoxia/anoxia, lethal, WHAT THIS STUDY ADDS: AEA is little known beyond forensic masochism/sadism, sexual stimulation, suffocation, suicide medicine and is generally regarded as a curiosity rather than a ABBREVIATION medical disorder whose onset is in childhood or adolescence. AEA—autoerotic asphyxiation This study adds understanding of causation and provides guidance to www.pediatrics.org/cgi/doi/10.1542/peds.2009-0730 pediatricians on recognition and management. doi:10.1542/peds.2009-0730 Accepted for publication Jun 4, 2009 Address correspondence to Daniel D. Cowell, MD, MLS, CPHQ, Departments of Psychiatry and Behavioral Medicine, and Graduate Medical Education, Marshall University, Joan C. abstract Edwards School of Medicine, 1600 Medical Center Dr, Suite 3414, Huntington, WV 25701. E-mail: [email protected] OBJECTIVE: Voluntary asphyxiation among children, preteens, and ad- PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). olescents by hanging or other means of inducing hypoxia/anoxia to Copyright © 2009 by the American Academy of Pediatrics enhance sexual excitement is not uncommon and can lead to unin- FINANCIAL DISCLOSURE: The author has indicated he has no tended death. -
Indian Country Issues
Indian Country Issues In Tbis Issue . Jurisdictional Conflicts Between Tribes and States: Disputes Over Land Set Aside Pursuant to the Indian Reorganization Act and July Reservation Boundary Disputes .............................. 1 2014 By Gina Allery and Darou T. Carreiro Volume62 Number4 Protecting the Civil Rights of American Indians and Alaska Natives: The Civil Rights Division's Indian Working Group ............. 10 Uniled,States By Verlin Deerinwater and Susana Lorenzo-Giguere Department of1\lstice l!!:xeeutive Office fur United States Altom.y. Wubington, DC Reentry Programming in Indian Country: Building the Third Leg 20530 of the Stool ............................................... 16 Monty Wilkinson By Timothy Q. Purdon Director Contributors' opinions and statements Native Children Exposed to Violence: Defending Childhood in should not be considered an Indian Country and Alaska Native Communities ............... 22 endorsoment by EOUSA fur any poJicy1 program, or service By Amanda Marshall Tbe United Statos Altomeys' Bulletin is published plll'$uant to Investigating and Prosecuting the Non-Fatal Strangulation Case .. 28 28 CFR § 0 22(b) By Leslie A. Hagen Tbe United StaleS Altornoys' Bulletin ;. publilbed bJmonthly by the Executive Office fur United States Native American Graves Protection and Repatriation Act Attorney., Offico ofLegall!dueation, 1620Pendleto.IIStreet, (NAGPRA): The Law Is Not an Authorization for Disinterment . .41 Columbia, Seulh Carolina 29201 By Sherry Hutt and David Tarler Manaatn~ Editor The Investigation -
Strangulation Injuries
Strangulation Injuries Diana Emerson, NP, MSN [email protected] Manual Strangulation in Surviving Victims The first hint that manual strangulation injuries in surviving patients were underreported appeared in 1985 in the publication “Strangulation: A Full Spectrum of Blunt Neck Trauma” Most documentation of strangulation injuries until then have come from forensic pathologist Definition 1 Asphyxia Any process which deprives the tissue cells of oxygen – Mechanisms can include strangulation, choking, and suffocation Asphyxia, anoxia, hypoxia are virtually synonymous Mechanism of Injury in Strangulation Studied 116 cased of strangulation – 79 survivors with stigmata, 37 fatalities – One hand – Two hand – One/two hand behind – Ligature Caused by a ligature where body is not suspended – Two thumb – Other methods were not included in this study Ham and Rajs 1989 Statistics Manual strangulation makes up 80% strangulation cases Ligature 15% 1.5 million women per year are strangled 85% strangulation victims are female and usually strangled at home Only 10% seek medical attention 2 Uniform Crime Reporting FBI Statistics Strangulation and asphyxiation deaths represented 1.75% of total number of murder victims of the total number of 14,054 in the US Strangulation is the fourth most common cause of homicide in the US followed by sharp instrument, guns, and hitting. Pathophysiology of Strangulation Violent manual strangulation or ligature strangulation initially produces severe pain and panic. Initially the external force compress jugular veins that -
Phs 403 Accident and Emergency
COURSE GUIDE PHS 403 ACCIDENT AND EMERGENCY Course Team Dalyop .D.Mancha (Course Developer/Writer) - CHT, Pankshin Dr. Gideon I.A. Okoroiwu Ph.D. (Course Reviewer) - NOUN NATIONAL OPEN UNIVERSITY OF NIGERIA MAIN CONTENT CONTENTS PAGE Module 1 Accidents and Emergency ………… 1 Unit 1 Introduction…………………………. 1 Unit 2 Accidents…………………………… 5 Unit 3 Emergency Medical Services(Ems) Systems………………… 13 Module 2………………………………………… 24 Unit 1 Fall Related Injuries…………………… 24 Unit 2 Drowning…………………………….. 28 Unit 3 Stress…………………………………. 35 Unit 4 Physiology of Stress………………… 46 Unit 5 Anxiety, Death and Dying…………… 52 Module 3 Emergency Conditions(I)………….. 63 Unit 1 Violent Injuries……………………… 63 Unit 2 Poisoning……………………………. 67 Unit 3 Fluid And Electrolytes…………….. 83 Module 4……………………………………… 91 Unit 1 Shock……………………………….. 91 Unit 2 Cardiac Attack/Arrest……………… 103 Unit 3 Haemorrhage………………………… 135 Unit 4 Behavioural And Psychiatric Emergency…………………………… 143 Module 5 Common Emergency Conditions…….. 151 Unit 1 Head Injury………………………….. 151 Unit 2 Fracture……………………………….. 162 Unit 3 Pathogenesis of Infectious Diseases……………………………… 170 Unit 4 Emergency Respiratory Condition….. 178 Module 6…………………………… 190 Unit 1 Wound……………………… 190 Unit 2 Metabolic Emergency Diabetes… 195 Unit 3 Peptic Ulcer …………………… 201 Unit 4 Peritonitis……………………… 211 PHS 403 MODULE 1 MODUL E1 ACCIDENTS AND EMERGENCY Unit 1 Introduction Unit 2 Accidents Unit 3 Emergency Medical Services Systems UNIT 1 INTRODUCTION 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Definition of A&E 3.2 Triage 3.3 Resuscitation Area 3.4 Play Therapist 4.0 Conclusion 5.0Summary 6.0 Tutor-Marked Assignment 7.0 References/Further Reading 1.0 INTRODUCTION This is also known as emergency department(ED),Emergency Room (ER), or Casuality Department. -
Autoerotic Asphyxia and Asphyxial Games As Part of the Same Syndrome Andrés Rodríguez Zorro
Unintentional Asphyxial Deaths in Adolescence Autoerotic Asphyxia and Asphyxial Games as Part of the Same Syndrome Andrés Rodríguez Zorro William Harvey Research Institute MSc in Forensic Medical Sciences Unintentional Asphyxiation Deaths in Adolescents: Autoerotic asphyxia and asphyxial games as part of the same syndrome Forensic Pathology Andrés Rodríguez Zorro Student ID: 100511332 Monday, September 3th, 2012 Supervisor: Professor Peter Vanezis Word count: 19.575 Dissertation submitted to Queen Mary University of London in partial Fulfillment of the requirements for the Master of Science degree Beneficiario Colfuturo 2011. Unintentional Asphyxial Deaths in Adolescence Autoerotic Asphyxia and Asphyxial Games as Part of the Same Syndrome Andrés Rodríguez Zorro CONTENTS LISTE OF TABLES 3 ACKNOWLEDGMENTS 4 1.0 ABSTRACT 5 2.0 METHOD OF UNDERTAKING THE LITERATURE SEARCH 6 3.0 INTRODUCTION 7 3.1 Definition of autoerotic asphyxia 7 3.2 Definition of asphyxial games 8 3.3 History 9 3.4 Neurophysiology of neck compression asphyxias 12 3.5 Characteristics of autoerotic asphyxiation 16 3.6 Characteristics of asphyxial games 18 3.7 Aims 21 4.0 RESULTS 4.1 Who plays asphyxial games 23 4.2 Who are the victims of autoerotic asphyxia in general population 28 4.3 Who are the victims of autoerotic asphyxiation in adolescence 32 4.4 Who are the victims of asphyxial games 36 4.5 Comparative analysis of asphyxial games and autoerotic asphyxia 41 5.0 DISCUSSION 5.1 Etiologic theories 44 5.2 Sociological view: the ordeal or radical confrontation with death 46 5.3 Confrontation with risk in adolescence 48 5.4 Childhood rope syndrome 51 5.5 Part of same syndrome 52 5.6 Risk of death 61 5.7 Limitations 63 5.8 Recommendations 65 6.0 REFERENCES 67 Beneficiario Colfuturo 2011. -
The Year Michael Got His Own Page in the Yearbook by Nick Seagers
The Year Michael Got His Own Page in the Yearbook by Nick Seagers Some kids use a belt or a length of rope. Some kids use a dog leash. My brother, Michael Foley, chose to use a guitar strap looped over the metal track of the garage door. It was raining the day I opened that door and found him. One of his hands was caught between the strap and his neck, like he tried to change his mind too late. This was back when I was a sophomore and still thought life was something that was more ahead of me than behind me. What Michael did is sometimes mistaken for suicide. What we all learned is that it's really called Thrill Asphyxiation but you could call it Space Monkey or The Choking Game or Black-Out if it makes you more comfortable. Hundreds of kids die each year from it, but not many parents knew about it. After some investigations were done, the statistics showed some fourteen other teenagers died the same way in Vernon. You can use your shoelaces or an Ace bandage. Loop a belt around your neck and toss the loose end over a shower curtain or closet pole. Pull. Try to lift yourself off the ground. aitW until your vision gets starry and starts to shut down. Your face will get red and hot and you should be able to feel your pulse in your eyes. Now, let go. When the pressure is released, the blood flowing back into the brain creates a rush.