The Choking Game All players lose.

Transcription

1 The Choking Game All players lose. Carlos Flores, RN, MICN, Trauma Coordinator ABC 30 Action News Story on the Choking Game July 2007 Hyperventilation Followed by: Valsalva Chest Pressure Carotid Occlusion High risk activity in which single, pairs, or groups of youth induce an altered level of consciousness by restriction of the supply of oxygen to the brain. 1

2 The game that s s not Pass out The Scarf game The fainting game Knock out Black out game Flatline Choke out Airplaning America dream game Breath play Bum rushing Dream game Space monkey Dying game Dreaming game Elevator Flat Flat Liner Funky Chicken Harvey Wallbanger Space Cowboy Trip to Heaven California High Headrush Knockout Choke Dreaming A picture is worth a thousand words. What it is not AEA Auto Erotic Asphyxiation Choking game has no sexual component. Primarily Pre-adolescent and adolescent age groups 2

3 Hyperventilation excessive rate and depth of respiration leading to abnormal loss of carbon dioxide from the blood. Strangulation excessive or pathological constriction or compression of a bodily tube. Syncope loss of consciousness resulting from insufficient blood flow to the brain. Choking to keep from breathing in a normal way by compressing or obstructing the trachea or by poisoning or adulterating available air. Asphyxiation to kill or make unconscious through inadequate oxygen, presence of noxious agents, or other obstruction to normal breathing. Activity is played in schoolyards, summer camps, neighborhoods, homes. Jesse 12 yr Kyle 13 yr Shawntae 14 yr Braden 12 yr Stephan 16 yr Dylan 11 yr Death from the choking game is estimated between 250 to 1000 in U.S. Hard data is not available. CA, TX, PA, OH, FL top 5 incident states. Victims are mostly juvenile males but there are also female and adult victims of both genders. Often, Medical Examiners indicate the manner of death as suicide. 3

4 CDC Report Shows Largest One- Year Increase in Youth Suicide Rate in 15 Years (2004) Suicide rates for year-old females and year-old males increased significantly in 2004 Significant increase in suicide by hanging/suffocation CDC 10 Leading Causes of Death Suicide is the 3 rd leading cause of death in the year age groups. Hanging was most common method among females. 71.4% in age group. (2004) Unintentional asphyxia is sometimes misclassified as suicide, however, these deaths are unlikely to account for the substantial increase. (Pharmalive.com news archive) Multi-generational & World-wide - some accounts as early as the 1930 s with multiple countries reporting cases (France, Canada, Israel, England, Australia, Ireland). No research data on it s prevalence. Kids know about these games while their parents do not. Methods vary hyperventilation, compression of chest and/or carotid arteries. Compression accomplished with arms, hands, or ligatures. 4

5 Ligatures are used in it s most extreme form. Often played as a dare. Induces brief sense of euphoria. Euphoric effect may lead to addiction or obsessive behavior. It s a drug in itself Amusing for some to watch others lose consciousness. It s free & legal. appears innocuous to those who don t understand the mechanisms involved. Stress relief? Pathophysiology Hyperventilation Hypocapnea & Alkalosis Hemodynamic Depression Carotid Occlusion Accidental Asphyxia 5

6 Mechanism Hyperventilation x 1 minute or longer hard breath holding w/ forced exhalation and no air escape Valsalva maneuver Self induced increase in lung air pressure Bear hug, pressure added to the chest. Occlusion of the carotid arteries by hands, arms, or ligatures. Hyperventilation, Hypocapnea, & Alkalosis Generally timed for over 1 minute Decrease in partial pressure of alveolar & arterial CO2 Increase in blood ph (Respiratory alkalosis) Vasoconstriction of blood vessels supplying the brain. Pooling of the blood present in the brain. Brain rapidly uses up O2 available in pooled blood. O2 concentration in the brain drops. Unconsciousness from hypoxia of cerebral tissue. Hemodynamic depression & Carotid Artery Occlusion Vagal Nerve Stimulus = Decreased blood pressure Decreased preload Decreased cardiac output Baroreceptor / Carotid Sinus bodies stimulus = Decreased heart rate 6

7 Effects Numbness Tingling Light headedness & dizziness see colored lights and stars Giddiness Euphoria Neuromuscular irritability Muscular spasm Global brain hypoxia Ligatures Most extreme version Most lethal May be played alone Suicide by hanging vs accidental axphyxia by hanging Rope, scarf, belt, necktie, plastic coated bike chain, cloth towel dispenser, bed sheets, t-shirts, t shoe laces, plastic bags, leashes, bungee cords, Bunk beds, closet door, swing set, closet rods, basement pipe Addictive Behavior is a possible result due to euphoria. Repeated asphyxial events cumulative neurological damage 7

8 Opthalmological France 12 yr boy decreased visual acuity right eye Dense preretinal hemorrhage in the right eye After rule out of other factors, detailed history revealed boy played scarf game some hours prior to loss of vision 2 months post injury, full recovery of vision. Signs & Symptoms physical findings Syncopal events Scleral hemorrhage Headaches Conjunctival redness Bloodshot eyes Short term memory Markings on neck loss linear abrasions Seizures Hoarseness Retinal hemorrhage Petechia Stroke Facial flushing Unexplained bruises Disorientation or lacerations to head Grogginess Hypoxic brain injury, brain death Markings on neck / linear abrasions ligature marks 8

9 Petichiae To face or neck Blood Shot Eyes Scleral or conjunctival hemorrhage Signs & Symptoms psychosocial Change in personality or behavior. Aggressiveness and agitation Questions about effects, sensations, or dangers of strangulation Unusual need for privacy Signs & Symptoms Environment Ligatures, ropes, belts lying about or found with knots in unusual fashion Elusive reponse to questions about behavior or findings thud heard in the bedroom, against a wall, or behind closed doors Clothes covering neck abrasions Locked bedroom doors Wear marks on bunk beds, closet rods or dowels Visiting blogs,, chat rooms, or websites, internet use Increased alone time in room 9

10 Prevention Let s s talk about it awareness, education Question the child if S&S are recognized Let your child educate you Discuss concerns being open and honest Warn the child about the dangers of accidental death or permanent disability Advocate for education and other efforts to add in safety curricula, such as D.A.R.E. programs Supervision cell phone, internet use, alone time, school and social gatherings If discovered or suspected Discuss with health care provider Professional counseling Verify siblings are not involved Alert school officials Alert parents of friends Gabriel, Samuel, and Sarah May

11 Websites the-choking-game.comgame.com VIDEO bibliography Self-inflicted accidental strangulation: the choking game. Nativio, DG. D American Journal for Nurse Practitioners, June The choking game: important information for camp nurses. Martin, A. CompassPoint, June Self-strangulation by hanging from cloth towel dispensers in Canadian schools. Le, D. Injury Prevention, Sep The choking game or suffocation roulette in adolescence. Urkin, J. International Journal of Adolescent Medicine and Health, Apr-Jun The choking game: self-strangulation strangulation with a belt and clothes rack. Senanayake, M. Ceylon Medical journal, Sept Suffocation Roulette: a case of recurrent syncope in an adolescent boy. Shlamovitz, G. Annals of Emergency Medicine, The choking game or suffocation roulette in adolescence. Urkin, J. Editorial, International Journal of Adolescent Medicine and Health Wikipedia Ophthalmological complications of the asphyxiophilic scarf game in a 12 year old child. Gicquel, JJ. Journal French Ophthalmology, Dec G.A.S.P. website CDC Report Shows Largest One-year Increase in Youth Suicide Rate in 15 Years. Pharmalive.com 11