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Medical World Oct 1947
Topics: Asphyxia; Humans
PubMed: 20267399
DOI: No ID Found -
The Western Journal of Emergency... Feb 2022Our goal was to investigate the frequency of specific signs and symptoms following sexual assault-related non-fatal strangulation (NFS) and to explore the interaction... (Observational Study)
Observational Study
OBJECTIVE
Our goal was to investigate the frequency of specific signs and symptoms following sexual assault-related non-fatal strangulation (NFS) and to explore the interaction between assault characteristics and physical exam findings.
METHODS
This retrospective observational study included all adults (>18 years) reporting strangulation during sexual assault who presented for a forensic sexual assault exam at one of six urban community hospitals contracted with a single forensic nurse agency. Demographic information, narrative elements, and physical exam findings were abstracted from standardized sexual assault reporting forms. We analyzed data with descriptive statistics and compared specific variables using chi-square testing.
RESULTS
Of the 580 subjects 99% were female, with a median age of 27 (interquartile range 22-35 years). The most common injury location was the neck (57.2%), followed by the mouth (29.1%). We found that 19.1% of the victims had no injuries evident on physical exam and 29.8% reported a loss of consciousness. Eye/eyelid and neck findings did not significantly differ between subjects who reported blows to the head in addition to strangulation and those who did not. The time that elapsed between assault and exam did not significantly correlate with the presence of most head and torso physical exam findings, except for nose injury (P = 0.02).
CONCLUSION
Slightly more than half of the victims who reported strangulation during sexual assault had visible neck injuries. Other non-anogenital findings were present even less frequently, with a substantial portion of victims having no injuries documented on physical exam. The perpetrators' use of blows to the head may account for many of the non-anogenital injuries observed, but not for the neck and eye/eyelid injuries, which may be more specific to non-fatal strangulation. More research is needed to definitively establish strangulation as the causal mechanism for these findings, and to determine whether any long-term neurologic or vascular sequelae resulted from the observed injuries.
Topics: Adult; Asphyxia; Crime Victims; Female; Humans; Male; Neck Injuries; Physical Examination; Retrospective Studies; Sex Offenses; Symptom Assessment; Young Adult
PubMed: 35302463
DOI: 10.5811/westjem.2021.2.50919 -
BMJ (Clinical Research Ed.) Jun 1989
Review
Topics: Apnea; Asphyxia; Child Abuse; Child, Preschool; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Sudden Infant Death
PubMed: 2503121
DOI: 10.1136/bmj.298.6687.1572 -
Journal of Forensic Sciences Sep 2022We postulate that most atraumatic deaths during police restraint of subjects in the prone position are due to prone restraint cardiac arrest (PRCA), rather than from...
We postulate that most atraumatic deaths during police restraint of subjects in the prone position are due to prone restraint cardiac arrest (PRCA), rather than from restraint asphyxia or a stress-induced cardiac condition, such as excited delirium. The prone position restricts ventilation and diminishes pulmonary perfusion. In the setting of a police encounter, metabolic demand will be high from anxiety, stress, excitement, physical struggle, and/or stimulant drugs, leading to metabolic acidosis and requiring significant hyperventilation. Although oxygen levels may be maintained, prolonged restraint in the prone position may result in an inability to adequately blow off CO , causing blood pCO levels to rise rapidly. The uncompensated metabolic acidosis (low pH) will eventually result in loss of myocyte contractility. The initial electrocardiogram rhythm will generally be either pulseless electrical activity (PEA) or asystole, indicating a noncardiac etiology, more consistent with PRCA and inconsistent with a primary role of any underlying cardiac pathology or stress-induced cardiac etiology. We point to two animal models: in one model rats unable to breathe deeply due to an external restraint die when their metabolic demand is increased, and in the other model, pressure on the chest of rats results in decreased venous return and cardiac arrest rather than death from asphyxia. We present two cases of subjects restrained in the prone position who went into cardiac arrest and had low pHs and initial PEA cardiac rhythms. Our cases demonstrate the danger of prone restraint and serve as examples of PRCA.
Topics: Animals; Asphyxia; Death, Sudden; Delirium; Heart Arrest; Humans; Prone Position; Rats; Restraint, Physical
PubMed: 35869602
DOI: 10.1111/1556-4029.15101 -
Pediatric Nephrology (Berlin, Germany) Apr 2023Acute kidney injury (AKI) remains common among infants with hypothermia-treated hypoxic-ischaemic encephalopathy (HIE). Little is known about long-term kidney outcomes...
BACKGROUND
Acute kidney injury (AKI) remains common among infants with hypothermia-treated hypoxic-ischaemic encephalopathy (HIE). Little is known about long-term kidney outcomes following hypothermia treatment. We recently reported that 21% of survivors of hypothermia-treated HIE had decreased estimated glomerular filtration rate (eGFR) based on plasma creatinine in early adolescence. Here, we assessed kidney functions more comprehensively in our population-based cohort of children born in Stockholm 2007-2009 with a history of hypothermia-treated HIE.
METHODS
At 10-12 years of age, we measured cystatin C (cyst C) to estimate GFR. Children with decreased cyst C eGFR also underwent iohexol clearance examination. We measured urine-albumin/creatinine ratio, blood pressure (BP) and kidney volume on magnetic resonance imaging. Fibroblast growth factor 23 (FGF 23) levels in plasma were assessed by enzyme-linked immunosorbent assay (ELISA). Outcomes were compared between children with and without a history of neonatal AKI.
RESULTS
Forty-seven children participated in the assessment. Two children (2/42) had decreased cyst C eGFR, for one of whom iohexol clearance confirmed mildly decreased GFR. One child (1/43) had Kidney Disease Improving Global Outcomes (KDIGO) category A2 albuminuria, and three (3/45) had elevated office BP. Subsequent ambulatory 24-h BP measurement confirmed high normal BP in one case only. No child had hypertension. Kidney volume and FGF 23 levels were normal in all children. There was no difference in any of the parameters between children with and without a history of neonatal AKI.
CONCLUSION
Renal sequelae were rare in early adolescence following hypothermia-treated HIE regardless of presence or absence of neonatal AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Humans; Adolescent; Hypoxia-Ischemia, Brain; Creatinine; Hypothermia; Asphyxia; Iohexol; Kidney; Asphyxia Neonatorum; Acute Kidney Injury; Cysts; Hypothermia, Induced
PubMed: 35976440
DOI: 10.1007/s00467-022-05705-z -
Maternal and Child Health Journal Nov 2020The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS)...
OBJECTIVES
The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden.
METHODS
Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR).
RESULTS
In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044).
CONCLUSIONS FOR PRACTICE
In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.
Topics: Adult; Asphyxia; Cesarean Section; Chi-Square Distribution; Cohort Studies; Female; Humans; Infant Health; Infant, Newborn; Odds Ratio; Pregnancy; Pregnancy Complications; Prospective Studies; Sweden; Vitamin D Deficiency
PubMed: 32844359
DOI: 10.1007/s10995-020-02999-z -
Chinese Journal of Traumatology =... Apr 2018Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional...
PURPOSE
Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases.
METHODS
All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test.
RESULTS
Glasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome.
CONCLUSION
GCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.
Topics: Adult; Aged; Asphyxia; Emergency Service, Hospital; Female; Glasgow Coma Scale; Humans; Male; Middle Aged; Suicide
PubMed: 29454810
DOI: 10.1016/j.cjtee.2017.04.013 -
Journal of Cardiothoracic Surgery Mar 2022Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and...
BACKGROUND
Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.
METHODS
Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.
RESULTS
The average age of patients was 5.3 ± 2.9 (1.3-13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0-100.0%), 25 (49.0%, CI 34.8-63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8-70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6-20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4-88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.
CONCLUSION
TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.
Topics: Adolescent; Asphyxia; Child; Child, Preschool; Female; Hemorrhage; Humans; Infant; Male; Prognosis; Retrospective Studies; Spinal Cord Injuries
PubMed: 35282839
DOI: 10.1186/s13019-022-01773-2 -
Frontiers in Public Health 2022The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both...
BACKGROUND AND AIMS
The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.
METHODS
Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.
RESULTS
In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women "other" methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45-64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45-64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.
IMPLICATIONS
The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.
Topics: Male; Middle Aged; Humans; Female; Aged; Adolescent; Asphyxia; Mental Disorders; Mental Health; Linear Models; Demography
PubMed: 36466504
DOI: 10.3389/fpubh.2022.955008 -
Forensic Science, Medicine, and... Jun 2022Herein, we present an uncommon forensic case of death by asphyxia. The victim was a woman whose body at death scene investigation (DSI) was discovered beside an ottoman...
Herein, we present an uncommon forensic case of death by asphyxia. The victim was a woman whose body at death scene investigation (DSI) was discovered beside an ottoman storage bed. According to the rescue team, who had moved the body before our arrival, the body was originally found in the prone position and stuck with the neck, thorax and arms within the bed. Examination of the body showed hypostasis that was mainly distributed to the face and the lower chest while sparing the neck and the upper chest. The face was markedly swollen, and the eyes were congested with blood. Dissection and histology revealed pulmonary oedema and emphysema of both lungs. Integrating circumstantial, radiology and autopsy data, it was established that the victim, while trapped between the mattress and the edge of the ottoman storage bed, died by mechanical asphyxia due to cervical-thoracic compression and postural asphyxia acting simultaneously.
Topics: Asphyxia; Autopsy; Beds; Forensic Medicine; Humans; Pulmonary Edema
PubMed: 35320454
DOI: 10.1007/s12024-022-00473-6