Deaths Associated with Choking in San Diego County
ABSTRACT Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.
Article: Foreword by Dr Ruth Hussey OBE[Show abstract] [Hide abstract]
ABSTRACT: Obesity and the use of alcohol are two of the major threats to the public's health. Both are linked to cancer, heart disease and a variety of other major killers that prematurely end many people's lives and create years of poor health. All too often we address these issues in silos with expertise in food and in alcohol but with the overlap between the two being poorly understood by professionals and consequently under-utilised in the pursuit of improving the public's health. Little professional understanding means the public are not in possession of the information they need to make healthy choices about food and alcohol. Encouraged by advertisements and marketing, consumers can adopt poor food and high alcohol diets without realising both will contribute to their risks of long term disease. Individuals may also skip food in order to get drunk more quickly or try to eat certain food types in order to delay inebriation but have little understanding of the health consequences of either action. It is essential that we consider food and alcohol together; improve our understanding of the substantial overlaps between these two issues; and ensure the public are aware of the dangers and benefits that food and alcohol together represent. This report is a first step in this process and, while it is far from comprehensive, outlines much shared territory which we need to understand. I hope people working on food, alcohol and generic public health issues find it of interest and that it leads to new opportunities to tackle the burden of ill health created by the widespread over consumption of food and drink.
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ABSTRACT: Objectives To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations.DesignSystematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation.SettingCross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents.MeasurementsInformation was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations.ResultsThirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings.Conclusion This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.Journal of the American Geriatrics Society 07/2014; · 4.22 Impact Factor
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ABSTRACT: In the present study, a 42 y.o. woman lethal case by aspiration of a foreign body is reported. During the autopsy, a large chewing-gum piece was found above the aditus ad laringem, so as to completely obstruct its access, causing a lethal respiratory insufficiency. The anatomopathological exam of the lungs showed the signs of acute asphyxia. The toxicological analyses of blood and urine samples were negative for drugs and/or ethanol. An accurate literature study allowed to show that this case represents the second lethal event related to the aspiration of a chewing gum in an adult subject, and the first related to the complete obstruction of the aditus ad laringem. 33 A s widely known, asphyxia by choking is caused by the introduction of a foreign body into the respiratory tract, able to obstruct the air passage. Asphyxia by choking is widely discussed in literature [1-2]. It regards mainly food (death by cud), or foreign bodies inhaled by infants (i.e.: buttons, coins, balls, etc.) or by elderly subjects (i.e.: partial denture), although it can occur at any age [3-7]. Though being a dangerous event, the obstruction of the airways by foreign body is rarely mentioned in current medical textbooks or journals, and remains a largely uninvestigated cause of lethal asphyxia in adults. In this respect, specific risk factors have been identified, such as neurological and/or psychiatric diseases, consumption of central depressant drugs or inhibiting the pharyngeal or coughing reflex, age, irregularities of the teeth, loss of consciousness, cranial or facial trauma [8-10]. The diagnosis of death by choking is based on the detection of the generic signs of asphyxia, on the identification of the foreign body obstructing the airways and on the exclusion of other causes of death. The context of the event is needed to give a coherent explanation. In the present study, a lethal asphyxial event by aspiration of a piece of chewing-gum is reported. The accurate analysis of Literature shows that cases of choking by chewing-gum are very rare [3-4]: Njau described a fatality resulted from the partial obstruction of the extent of the trachea ; the study of Haftoura et al. regards a non-lethal case of choking by a pre-operative piece of chewing-gum adhering to a well-functioning endotracheal tube . The case here reported regards a singular case of complete obstruction of the aditus ad laringem due to the accidental aspiration of a large piece of chewing-gum.