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Norii T, Igarashi Y, Yoshino Y, Nakao S, Yang M, Albright D, Sklar DP, Crandall C. The effects of bystander interventions for foreign body airway obstruction on survival and neurological outcomes: Findings of the MOCHI registry. Resuscitation 2024; 199:110198. [PMID: 38582443 DOI: 10.1016/j.resuscitation.2024.110198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes. METHODS We conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders. RESULTS We analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73-88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and the witnesses intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/407). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39-0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23-3.95). CONCLUSION Bystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, USA; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital Tokyo, Japan.
| | - Yudai Yoshino
- Department of Emergency Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan.
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - MingAn Yang
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - David P Sklar
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Bruna-Mejias A, del Villar-Valdebenito J, Roman C, Alcaíno-Adasme C, Sepulveda-Loyola W, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Becerra-Farfan A, Sanchis-Gimeno J, Valenzuela-Fuenzalida JJ. Hypoplastic and Congenital Absence of Coronary Arteries and Its Correlation with Clinical Implications of Cardiac Circulation: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3085. [PMID: 38892796 PMCID: PMC11173156 DOI: 10.3390/jcm13113085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.
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Affiliation(s)
- Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaiso 2360072, Chile;
| | | | - Camila Roman
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | - Catalina Alcaíno-Adasme
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | - Walter Sepulveda-Loyola
- Faculty of Health Sciences, Universidad de las Américas, Santiago 8320000, Chile; (W.S.-L.); (A.S.-S.)
| | - Mathias Orellana-Donoso
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Santiago 8420524, Chile;
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | | | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8320000, Chile;
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
| | - Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Abstract
Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.
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Affiliation(s)
- Vikram Saini
- Division of Infectious Disease (Drs Saini and Bhanot), Division of Pulmonary and Critical Care Medicine (Drs Saini and Ashraf), Department of General Surgery (Dr Babowice), and Division of Trauma Surgery and Surgical Critical Care (Ms Hamilton and Dr Khan), Allegheny Health Network, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND The oropharyngeal dysphagia is an underestimated symptom with various causes in the geriatric population. Clinical presentation is often insidious and dysphagia symptoms are seldomly mentioned by elderly patients although causing many life-threatening complications. The aim of this work was to introduce an easy applicable tool to be used by the caregivers and general practitioners for screening of dysphagia in geriatrics for early detection of at risk individuals. METHODS A sample of 200 Egyptian Arabic-speaking elderly patients (65 years or older) not complaining of dysphagia was recruited from nursing homes in Greater Cairo Area. They or their caregivers completed the designed screening tool, including; the designed questionnaires of dysphagia manifestations and eating habits. General, oral motor and bedside evaluation were also performed. In addition to filling in the EAT10 questionnaire and FEES that was performed for only suspected cases for the purpose of validation of the screening tool. RESULTS The dysphagia manifestations questionnaire was significantly correlated with EAT 10 with p value of 0.001. It was correlated in some of its aspects with FEES showing quite reliability with p values' range between 0.012 and 0.044. The Questionnaire of eating habits reliability of r- value of 0.568 slightly exceeding EAT10 reliability of r -value of 0.721 in the subjects under study. The cutoff point of total score of the dysphagia manifestations was > 5, with a sensitivity of 17.65% & a specificity of 94.20%. The cutoff point of total score of the bedside evaluation was ≤ 1 with a sensitivity of 66.9% & a specificity of 56.9%. CONCLUSION the use of this easy applicable screening tool managed to suspect and later on diagnose cases with oropharyngeal dysphagia in non-complaining aging subjects.
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Choking together with aspiration of gastric contents: rare form of maternal death. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
The common causes of early postpartum maternal deaths are cardiomyopathies, obstetric hemorrhage, hypertensive disorders, and sepsis. However, a maternal death from choking together with aspiration of gastric contents is a rare occurrence to be diagnosed at the autopsy examination.
Case presentation
A 27-year-old previously healthy lady developed breathlessness 48 h after delivery, while on supine position, 1 h after meals, and pronounced death on admission. Autopsy was insignificant except for large amount of gastric contents in the air ways. Microscopic examination revealed bronchioles filled with eosinophilic materials and a significant number of neutrophil infiltrations at the margin. Alveoli were free from edema fluid and inflammatory cells. Some alveoli were expanded with broken septae. Cause of death was airway obstruction due to choking together with aspiration of gastric contents.
Conclusions
Aspiration of gastric contents can cause sudden unexpected death at postpartum, and it is recommended to educate immediate and early postpartum mothers regarding the risk of aspiration.
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Corpus Alienum captured in Post Mortem Computed Tomography, death due to an accidental ingestion of “Momos (Dumpling)”. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Spontaneous retropharyngeal haematoma: a rare cause of upper airway obstruction. Forensic Sci Med Pathol 2022; 18:219-222. [PMID: 35352242 DOI: 10.1007/s12024-022-00462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
Extensive retropharyngeal haemorrhage is a rare event, which is occasionally encountered in clinical practice, but very seldom at autopsy. A 43-year-old woman who presented with difficulty breathing after a week's history of sore throat and coughing is reported. She collapsed at a medical centre and was not able to be resuscitated. Staff noted that she had 'swelling' of her throat. At autopsy, the major findings were in the anterior neck where there was extensive and diffuse retropharyngeal haemorrhage extending throughout the soft tissue planes resulting in marked stenosis of the laryngeal inlet. There was no evidence of external or internal trauma, and although no specific source of the retropharyngeal haemorrhage was identified, the haemorrhage clearly originated from the retropharyngeal space with diffuse extension Her past medical history included anticoagulation for atrial fibrillation and heart valve replacements, hepatic steatosis and sleep apnoea. This case demonstrates a significant complication of oral anticoagulation therapy with underlying comorbidities which may result in significant neck haemorrhage with critical upper airway narrowing and rapid clinical deterioration.
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Katabami K, Kimura T, Hirata T, Tamakoshi A. Risk Factors of Mortality from Foreign Bodies in the Respiratory Tract: The Japan Collaborative Cohort Study. Intern Med 2022; 61:1353-1359. [PMID: 35491176 PMCID: PMC9152875 DOI: 10.2169/internalmedicine.8437-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
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Liu F, Yin J, Wang J, Xu X. Food for the elderly based on sensory perception: A review. Curr Res Food Sci 2022; 5:1550-1558. [PMID: 36161227 PMCID: PMC9489541 DOI: 10.1016/j.crfs.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background The impairments of physiological functions caused by aging are common problems in the elderly, especially the impairments of sensory perception. Besides, close relationship between food sensory perception and nutritional status also suggests the importance of dietary management for the elderly population. The foods taking sensory perception into account are urgently needed by the elderly. Scope and approach This review analyzed sensory perception changes and their effects on food behaviors and nutritional status. Besides, sensory properties essential for aged-foods and acquisition methods, as well as current status of such foods were summarized. Key findings and conclusions Soft, smooth and moisty foods were more suitable for the elderly with chewing and swallowing dysfunction, which can be prepared by gelation, enzyme treatment, blade tenderization and other non-thermal technologies. Flavor enhancement/enrichment, irritant addition and packet sauces were recommended to compensate the impairment of chemical sensory. Molds, piping bag and 3D printing were suggested for refining appearance of pureed foods, and improving appetite of the elderly. Sensory perception changes of the elderly affect food behaviors and health. Soft, smooth, and moisty foods are more suitable for the elderly. Gelation and enzyme treatment are applied to modify the texture of aged food. Packet sauces may meet the heterogenetic flavor requirements of the elderly. Visually attractive food made by 3D printing can increase the appetite of elderly.
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Lee H, Lee S, Baek T, Cha JG, Yang KM. Natural Death. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Laryngeal oncocytic cystadenoma and sudden death. Forensic Sci Med Pathol 2022; 18:554-556. [PMID: 36136290 PMCID: PMC9636096 DOI: 10.1007/s12024-022-00530-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
An 86-year-old woman with Alzheimer disease collapsed in her nursing home and was not able to be resuscitated. At autopsy, the major findings were in the larynx where a pedunculated oncocytic cystadenoma had occluded the glottis. Oncocytic cysts or cystadenomas of the larynx are rare histologically benign lesions that account for only 0.1-1% of laryngeal lesions. While the usual presentation is of a sensation of a mass in the throat, hoarseness, or stridor, very occasionally, there may be acute airway compromise and sudden death. Oncocytic cystadenoma should, therefore, be included in the differential diagnosis of potentially lethal obstructive laryngeal lesions.
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Xu X, Cao C, Li M, Liu Z, Fang S, Chen G, Chen G, Ma T, Zhu X. A pregnant woman died of sudden cardiac death: Should esophageal foreign body be considered an inductive factor? A case report and literature review. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_77_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Batson IS, Serinelli S, Gitto L. Café coronary syndrome - case report and medicolegal implications. Med Leg J 2021; 89:264-269. [PMID: 34763548 DOI: 10.1177/00258172211031709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Café coronary syndrome is a term used to describe a sudden collapse of healthy subjects during meals in the absence of any sign of asphyxia, respiratory distress, or neurological symptoms. Risk factors are advanced age, poor dentition, alcohol intoxication, and dementia or psychiatric disorders. One of the main problems with this syndrome is that, even when witnessed, it is often confused with myocardial infarction due to the absence of asphyxia symptoms. This leads to misdiagnosis and potential delays in patients' treatment that can eventually have fatal outcomes. As a result of that, medico-legal litigation may arise. This paper presents a typical case of fatal café coronary syndrome misdiagnosed as a myocardial infarction. The legal authority that requested the autopsy asked about the potential professional negligence of the healthcare providers who took care of the patient. We discuss the clinical and medico-legal aspects of café coronary syndrome.
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Affiliation(s)
- Ian S Batson
- Department of Emergency Medicine, Sparrow Hospital/Michigan State University, Lansing, MI, USA
| | - Serenella Serinelli
- Department of Pathology, Upstate Medical University, State University of New York, Syracuse, NY, USA
| | - Lorenzo Gitto
- Department of Pathology, Upstate Medical University, State University of New York, Syracuse, NY, USA
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Landes SD, Turk MA, Bisesti E. Uncertainty and the reporting of intellectual disability on death certificates: a cross-sectional study of US mortality data from 2005 to 2017. BMJ Open 2021; 11:e045360. [PMID: 33518529 PMCID: PMC7853001 DOI: 10.1136/bmjopen-2020-045360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death. DESIGN National Vital Statistics System 2005-2017 US Multiple Cause-of-Death Mortality files. SETTING USA. PARTICIPANTS Adults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017. PRIMARY OUTCOME AND MEASURES Decedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70-79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the underlying cause of death. RESULTS Inaccurate reporting of intellectual disability as the underlying cause of death was associated with sociodemographic characteristics, death context characteristics and comorbidities indicative of an increased amount of uncertainty surrounding the death. Most striking were increased odds of having intellectual disability reported as the underlying cause of death for decedents who had a choking event (OR=14.7; 95% CI 12.9 to 16.6, p<0.001), an external cause of death associated with a high degree of uncertainty, reported on their death certificate. CONCLUSION It is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.
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Affiliation(s)
- Scott D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Erin Bisesti
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
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Hamasaki T, Hagihara A. Medical malpractice litigation related to choking accidents in older people in Japan. Gerodontology 2020; 38:104-112. [PMID: 33169853 DOI: 10.1111/ger.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse malpractice litigation cases in Japan and identify the factors related to choking accidents in older people. BACKGROUND Choking while eating is common in older people and has potentially severe consequences. METHODS This study analysed court decisions related to choking accidents occurring in Japan between 2000 and 2015 that involved the death of an older person or permanent severe choking-related injury. A database of court decisions (n = 23) was constructed according to patient and caregiver characteristics, and nursing services. An analysis was performed on caregiver liability, and to identify factors related to choking accidents. RESULTS The court ruled that the caregiver was liable in 10 of the 23 cases. Liability was related to appropriate food choices, failure to monitor of eating or the non-performance of resuscitation after an accident. Prior knowledge of aspiration (P < .001), inappropriate assistance during the meal (P < .001), and inappropriate emergency treatment (P = .028) were more likely to be present in cases in which caregivers were judged liable than in those in which they were not. CONCLUSIONS Lack of appropriate assistance during the meal was the factor most strongly associated with a court ruling of caregiver liability for choking accidents in older people.
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Affiliation(s)
- Tomoko Hamasaki
- Department of Nutrition Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Japan
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
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Gross S, Roller M, Haslob H, Grilo M, Lakemeyer J, Reckendorf A, Wohlsein P, Siebert U. Spatiotemporal accumulation of fatal pharyngeal entrapment of flatfish in harbour porpoises ( Phocoena phocoena) in the German North Sea. PeerJ 2020; 8:e10160. [PMID: 33150078 PMCID: PMC7583609 DOI: 10.7717/peerj.10160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
The evolution of a permanent separation of the upper respiratory and digestive tract is one of the adaptions cetaceans evolved for their aquatic life. Generally, it prevents odontocetes from choking on either saltwater or foreign bodies during ingestion under water. Nevertheless, several sporadic single case reports from different parts of the world show that this separation can be reversed especially by overly large items of prey. This incident can have a fatal outcome for the odontocetes. The German federal state of Schleswig-Holstein has a year-round, permanent and systematic stranding network that retrieves stranded marine mammals from its shorelines and constantly enables post-mortem examinations. In 2016, with nine affected animals, a high incidence of fatal pharyngeal entrapment of flatfish in harbour porpoises (Phocoena phocoena) occurred during spring and early summer on the German North Sea island of Sylt. All flatfish were identified as common sole (Solea solea). A retrospective post-mortem data analysis over a 30-year period from the North and Baltic Sea revealed similar yearly and seasonally case accumulations on the same island in the 1990s as well as several single case events over the whole timespan. All cases except one were caused by flatfish. When flatfish speciation was performed, only common sole was identified. From 1990 to 2019, of all examined harbour porpoises, 0.3% (2/713) from the Baltic Sea and 5.5% (45/820) from the North Sea died due to fish entrapped in the pharynx. On the North Sea coast, the occurrence of fatal obstruction shows high yearly variations from 0 to 33.3%. Years that stand out are especially 1990 to 1992, 1995, as well as 2016. The majority of all cases generally occurred between April and July, indicating also a seasonality of cases. This study evaluates the occurrence of fatal pharyngeal entrapment of fish in two geographically separated harbour porpoise populations. Additionally, common sole is clearly identified as a potentially risky item of prey for these small odontocetes.
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Affiliation(s)
- Stephanie Gross
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany
| | - Marco Roller
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany
| | - Holger Haslob
- Thünen-Institute of Sea Fisheries, Bremerhaven, Germany
| | - Miguel Grilo
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany.,CIISA-Centre for Interdisciplinary Research in Animal Health, University of Lisbon, Lisbon, Portugal
| | - Jan Lakemeyer
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany
| | - Anja Reckendorf
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Ursula Siebert
- Institute for Terrestrial and Aquatic Wildlife Research (ITAW), University of Veterinary Medicine Hannover, Foundation, Büsum, Germany
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18
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Dalrymple A, Gilbert JD, Byard RW. Delayed fatal upper-airway obstruction due to laryngopharyngeal burns and thermal epiglottis. MEDICINE, SCIENCE, AND THE LAW 2020; 60:223-226. [PMID: 32390501 DOI: 10.1177/0025802420918040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 48-year-old man complained of throat swelling and difficulty swallowing after eating hot food. Several hours later, he collapsed and was observed to be gasping for breath. Bystander and ambulance-initiated cardiopulmonary resuscitation was unsuccessful, and he was pronounced deceased at the scene. At autopsy, the aryepiglottic folds were markedly oedematous, with adjacent areas of mucosal inflammation and necrosis from a recent burn. Death was attributed to upper-airway obstruction due to glottic inlet oedema associated with epiglottic and laryngopharyngeal thermal injury. Although thermal epiglottitis not involving fire is an unusual injury and is rarely fatal, the reported case demonstrates a lethal episode arising from the ingestion of excessively hot food. Thermal epiglottitis therefore represents an uncommon cause of delayed upper-airway obstruction in adults that should be considered in individuals presenting with a sore throat and shortness of breath, particularly if there is a history of hot-food ingestion.
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Affiliation(s)
- Alice Dalrymple
- Flinders University, Australia
- Forensic Science SA, Australia
| | | | - Roger W Byard
- Forensic Science SA, Australia
- Adelaide School of Medicine, The University of Adelaide, Australia
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19
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Taniguchi Y, Iwagami M, Sakata N, Watanabe T, Abe K, Tamiya N. Epidemiology of Food Choking Deaths in Japan: Time Trends and Regional Variations. J Epidemiol 2020; 31:356-360. [PMID: 32536639 PMCID: PMC8021878 DOI: 10.2188/jea.je20200057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With increasing age globally, more people may become vulnerable to food choking. We investigated the nationwide epidemiology of food choking deaths in Japan. Methods Using Japanese Vital Statistics death data between 2006 and 2016, we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract) as a primary diagnosis. We assessed the demographics of people with food choking deaths; temporal trends of food choking deaths by the year (overall and by age group), the day of year; and prefecture variations. Results Overall, 52,366 people experienced food choking deaths (median age, 82 years, 53% were male, and 57% occurred at home). The highest numbers occurred January 1–3, and were lowest in June. Despite a stable total number of cases at around 4,000 yearly, from 2006 to 2016 the incidence proportion declined from 16.2 to 12.1 per 100,000 population among people aged 75–84 years. Among people ≥85 years, the incidence proportion peaked at 53.5 in 2008 and decreased to 43.6 in 2016. The number of food choking deaths varied by prefecture. Conclusions There are temporal and regional variations of food choking deaths in Japan, possibly due to the consumption of Japanese rice cake (mochi), particularly over the New Year’s holiday.
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Affiliation(s)
- Yuta Taniguchi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Kazuhiro Abe
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
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20
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Suebsaen K, Suksatit B, Kanha N, Laokuldilok T. Instrumental characterization of banana dessert gels for the elderly with dysphagia. FOOD BIOSCI 2019. [DOI: 10.1016/j.fbio.2019.100477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Moslehi MA. A rare case of massive foreign body aspiration mimic asthma. Respir Med Case Rep 2019; 28:100963. [PMID: 31720210 PMCID: PMC6839009 DOI: 10.1016/j.rmcr.2019.100963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/01/2022] Open
Abstract
Foreign Body Aspiration (FBA) remains as one of the leading causes of morbidity and mortality among pediatrics, especially in younger ones. Asphyxia caused by FBA is a main and common cause of this morbidity and mortality. Unfortunately, many FBAs may be misdiagnosed and an appropriate management becomes postponed specially in cases without any vivid evidence. Due to wide spectrum of signs and symptoms, FBA can be easily misdiagnosed with a recurrent pneumonia, asthma and immunodeficiency disorders. In this case report, the author presents the case of a 4-year-old girl who aspirated a massive amount of meat. She had been misdiagnosed with asthma and pneumonia for about 4 months, but eventually the problem was managed by an extraction using bronchoscopy cryoprobe.
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Affiliation(s)
- Mohammad Ashkan Moslehi
- Pediatric Interventional Pulmonology Division,Shiraz University of Medical Sciences, Namazi Hospital, Namazi Square, Shiraz, Iran
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22
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Hemsley B, Steel J, Sheppard JJ, Malandraki GA, Bryant L, Balandin S. Dying for a Meal: An Integrative Review of Characteristics of Choking Incidents and Recommendations to Prevent Fatal and Nonfatal Choking Across Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1283-1297. [PMID: 31095917 DOI: 10.1044/2018_ajslp-18-0150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia. Supplemental Material https://doi.org/10.23641/asha.8121131.
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Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Joanne Steel
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
- The University of Newcastle, NSW, Australia
| | - Justine Joan Sheppard
- Department of Biobehavioral Sciences, Teacher's College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Lucy Bryant
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Susan Balandin
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
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23
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Cichero JAY. Evaluating chewing function: Expanding the dysphagia field using food oral processing and the IDDSI framework. J Texture Stud 2019; 51:56-66. [PMID: 31269230 DOI: 10.1111/jtxs.12462] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 01/21/2023]
Abstract
The dysphagia field is still in relative infancy with a sophisticated knowledge base amassed since the early 1980's. The desire to identify aspiration and prevent life threatening pneumonia has resulted in a focus on the complexities of swallowing liquids. However, humans also ingest saliva, food, and oral medications, with the potential for these substances to incompletely clear the pharynx, be aspirated or block the airway. Safe swallowing of solid food in particular requires adequate chewing function, good oral control, and sufficient higher cortical function. Although screening and assessment for liquid swallowing safety is well established, the same cannot be said for the evaluation of safety to chew and swallow different food textures. While research into liquid swallowing physiology and its clinical application has largely come from the medical and allied health fields, our knowledge of chewing function for food textures comes from food texture research and food sensory science arenas. There is an exciting opportunity to bring the medical and food texture science fields together to expand our knowledge base on human chewing function, with clinical application to people with dysphagia. The development of the IDDSI Framework as an international standardized way of describing and labelling food texture and drink thickness allows the field to move toward management of texture modified food and thick liquids in a coordinated fashion, speaking the same language. This commentary will describe what we know of chewing function and how it is assessed clinically, proposing methods of assessment that utilize the IDDSI Framework.
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Affiliation(s)
- Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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24
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Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics (Basel) 2018; 3:geriatrics3040069. [PMID: 31011104 PMCID: PMC6371116 DOI: 10.3390/geriatrics3040069] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 12/02/2022] Open
Abstract
Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.
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25
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Nagata S, Kim SH, Mizushima Y, Norii T. Airway obstruction due to sticky rice cake (mochi): a case series and review of the literature. Int J Emerg Med 2018; 11:34. [PMID: 31179924 PMCID: PMC6333428 DOI: 10.1186/s12245-018-0194-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foreign body airway obstruction is a significant public health issue around the world. Mochi, a traditional sticky rice cake in Japan, has gained popularity in many countries including the USA. However, the associated aspiration danger has not yet been well recognized. CASE PRESENTATION We describe three cases of foreign body airway obstruction due to mochi. Case 1 was an elderly man who was brought to the emergency department by an ambulance after he choked on mochi. Despite extensive efforts to remove pieces of mochi including use of Magill forceps, bronchoscopy, and endotracheal intubation, he suffered severe hypoxia and died. Case 2 was a middle-aged man who was found unconscious in a park. The rhythm upon arrival was pulseless electrical activity. During intubation, large pieces of mochi were found in the oropharynx and removed with Magill forceps. He developed aspiration pneumonitis and hypoxic brain injury. The patient was discharged to a skilled nursing facility with severe neurological disability. Case 3 was an elderly man who choked while eating soup with mochi at home. His initial cardiac rhythm was asystole. During intubation, obvious foreign body was found in the oropharynx. Several pieces of mochi were removed by suctioning through the endotracheal tube. He suffered severe hypoxic injury and died. CONCLUSIONS All of our cases resulted in death or poor neurological outcome. As the popularity of mochi continues to increase, it is likely that cases of aspiration from mochi will also increase. Emergency physician should be aware of the potential danger of mochi and be familiar with the techniques to remove mochi from the airway.
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Affiliation(s)
- Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka city, Osaka, 543-0035, Japan.
| | - Sung-Ho Kim
- Department of Emergency Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka city, Osaka, 543-0035, Japan
| | - Yasuaki Mizushima
- Department of Emergency Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka city, Osaka, 543-0035, Japan
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
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26
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D'Ovidio C, Rosato E, Bonelli M, Carnevale A, Marsella LT. A particular case of accidental asphyxiation. MEDICINE, SCIENCE, AND THE LAW 2018; 58:55-57. [PMID: 29283003 DOI: 10.1177/0025802417747430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The case reported involved a 60-year-old man with psychiatric illness who was found dead at his home. He was almost naked and showed signs of death by violent asphyxiation, which led to the suspicion of homicide. Autopsy findings showed foreign material in the trachea and larynx. However, the partially digested content in his stomach, the study of the gastric content and the microscopic analysis of the airways made it possible to define this as accidental death due to inhalation of material from a diaper. Toxicological analysis detected the presence of phenytoin, valproic acid, and phenobarbital in his blood, with values within the therapeutic ranges. This is certainly a peculiar case, as particularly evident after careful review of the literature on deaths by asphyxiation in psychiatric patients. Furthermore, this study highlights the importance of a full autopsy and microscopic evaluation of any foreign bodies.
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Affiliation(s)
- Cristian D'Ovidio
- 1 Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Enrica Rosato
- 1 Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Martina Bonelli
- 1 Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Aldo Carnevale
- 1 Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Luigi T Marsella
- 2 Department of Biomedicine and Prevention, 60259 Section of Forensic Medicine, Social Security and Forensic Toxicology, Tor Vergata University of Rome, Italy
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27
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Kiyohara K, Sakai T, Nishiyama C, Nishiuchi T, Hayashi Y, Iwami T, Kitamura T. Epidemiology of Out-of-Hospital Cardiac Arrest Due to Suffocation Focusing on Suffocation Due to Japanese Rice Cake: A Population-Based Observational Study From the Utstein Osaka Project. J Epidemiol 2017; 28:67-74. [PMID: 29093354 PMCID: PMC5792229 DOI: 10.2188/jea.je20160179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Japanese rice cake (“mochi”) is a major cause of food-choking accidents in Japan. However, the epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood. Methods OHCA data from 2005 to 2012 were obtained from the population-based OHCA registry in Osaka Prefecture. Patients aged ≥20 years who experienced OHCA caused by suffocation that occurred before the arrival of emergency-medical-service (EMS) personnel were included. Patient characteristics, prehospital interventions, and outcomes were compared based on the cause of suffocation (rice cake and non-rice-cake). The primary outcome was 1-month survival after OHCA. Results In total, 46 911 adult OHCAs were observed during the study period. Of the OHCAs, 7.0% (3,294/46,911) were due to suffocation, with choking due to rice cake as the cause in 9.5% of cases (314/3,294), and of these, 24.5% (77/314) occurred during the first 3 days of the New Year. In crude analysis, 1-month survival was 17.2% (54/314) in those with suffocation caused by rice cake and 13.4% (400/2,980) in those with suffocation due to other causes. In the multivariable analysis for all-cause suffocation, younger age, arrest witnessed by bystanders, and earlier EMS response time were significantly related to better 1-month survival. Conclusion Approximately 10% of OHCAs due to suffocation were caused by rice-cake choking, and 25% of these occurred during the first 3 days of the New Year. Further efforts for establishing preventive measures as well as improving the early recognition of choking and encouraging bystanders to call EMS sooner are needed.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University
| | - Tomohiko Sakai
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science
| | | | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital
| | | | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
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28
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Aquila I, Gratteri S, Sacco MA, Nuzzolese E, Fineschi V, Frati P, Ricci P. Could the screening for correct oral health reduce the impact of death due to bolus asphyxia in adult patients? A forensic case report. Med Hypotheses 2017; 110:23-26. [PMID: 29317062 DOI: 10.1016/j.mehy.2017.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION "Bolus death" or "Café Coronary syndrome" refers to death due to asphyxia caused by an occlusion of the upper airways due to food. In this kind of asphyxia, the food bolus obstructs the larynx or the bronchial branches. This kind of event often affects subjects with acute intoxication due to alcohol or drugs, or with edentulism and with neurological or psychiatric diseases. CASE REPORT An elderly woman, suffering from schizophrenia, was found dead in her house due to food bolus asphyxia. The post-mortem toxicological analysis on the deceased's biological fluids revealed the presence of tricyclic antidepressants, antipsychotics and neuroleptics. Study of the oral cavity showed the presence of partial edentulism and periodontal disease. HYPOTHESIS We hypothesize that this kind of asphyxia in adults can be prevented. We believe that there are two major preventable factors: edentulism and salivation disorders in elderly and neuropsychiatric patients. The primary prevention of these pathologies would deal with the basic physician, similarly to other screenings already effectively in place. CONCLUSIONS It is possible to prevent fatal asphyxia in subjects who suffer from this kind of diseases through appropriate screening. This prevention strategy would greatly reduce the amount of choking deaths in adults.
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Affiliation(s)
- Isabella Aquila
- Chair of Legal Medicine, University "Magna Graecia" of Catanzaro, Italy.
| | - Santo Gratteri
- Chair of Legal Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Matteo A Sacco
- Chair of Legal Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Emilio Nuzzolese
- Chair of Legal Medicine, University "Magna Graecia" of Catanzaro, Italy
| | | | - Paola Frati
- Chair of Legal Medicine, University "La Sapienza" of Rome, Italy
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29
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Nour S, Carbognani D, Chachques JC. Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest. Artif Organs 2017; 41:E356-E366. [PMID: 28884833 DOI: 10.1111/aor.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
Sudden cardiac arrest (SCA) remains a major problem for health authorities worldwide. Insufficiencies of current cardiopulmonary resuscitation (CPR) are most probably related to an inappropriate concept and applied methods that still concentrate on heartbeat as priority, instead of blood circulation to maintain organs' perfusions. The aim of this works is to propose a new therapeutic approach for SCA in a more effective and secure manner compared with current CPR methods. It correlates to a non-invasive circulatory flow restoration (CFR) device composed of a multilayered thoracic and infradiaphragmatic compartments that will be pulsated alternatively and in fixed frequencies using a low-pressure pneumatic generator. Proof-of-concept studies with different prototypes and methods of SCA, showed restoration of hemodynamics (BP ≥ 100 mm Hg) and increased urine output after 20 min of cardiac arrest in pediatric dogs and piglets. In summary, a CFR device can induce shear stress-mediated endothelial function to restore microcirculation and cellular metabolism. This represents a cost-effective method, predisposes to return of spontaneous circulation in case of SCA, adaptable for all age groups, in public and hospital environments.
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Affiliation(s)
- Sayed Nour
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
| | - Daniel Carbognani
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
| | - Juan Carlos Chachques
- Biosurgical Research Laboratory, Alain Carpentier Foundation, Pompidou Hospital, University of Paris Descartes, Paris, France
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30
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Abstract
Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be sought at the time of autopsy is quite disparate. Deaths may occur from i) infectious agents including bacteria, viruses, protozoa, cestodes, nematodes and prions; ii) natural toxins including amanita toxins, tetrodotoxin, ciguatera and scombroid; iii) anaphylaxis; iv) poisoning; v) mechanical issues around airway and gut obstruction and/or perforation; and vi) miscellaneous causes. Food-related deaths are important in terms of global mortality, and thus autopsies need to be comprehensive with full ancillary testing. Medicolegal matters may involve issues concerning likely exposure to infectious agents, possible foods ingested, the declared content and possible components of food, the significance of toxicological analyses, and aspects of duty of care in cases of café coronary syndrome and gastroenteritis while in care.
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Affiliation(s)
- Roger W Byard
- School of Medicine, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, South Australia, 5005, Australia.
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31
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Pilla M, Langlois NEI, Byard RW. Causes of death in a series of decedents with cerebral palsy in a medicolegal context. AUST J FORENSIC SCI 2016. [DOI: 10.1080/00450618.2016.1259432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mark Pilla
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Neil E. I. Langlois
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Forensic Science SA, Adelaide, Australia
| | - Roger W. Byard
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Forensic Science SA, Adelaide, Australia
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32
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Postmortem computed tomography suggests the possibility of fatal asphyxiation by mochi, Japanese rice cakes: A case report of postmortem radiologic findings. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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33
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Affiliation(s)
- J.A.Y. Cichero
- School of Pharmacy, The University of Queensland; Brisbane QLD Australia
- The Wesley Hospital; Brisbane QLD Australia
- International Dysphagia Diet Standardisation Initiative; Brisbane QLD Australia
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34
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An autopsy approach to bolus deaths. J Forensic Leg Med 2016; 42:82-7. [PMID: 27289267 DOI: 10.1016/j.jflm.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/09/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The term "bolus death" or "cafe coronary" refers to a misplaced larynx or laryngeal inlet by foreign bodies, in most cases by unchewed pieces of food such as meat, sausage, or fruit. The pathophysiologic mechanism of death is still debatable - sudden reflex cardiac arrests and asphyxial suffocations are implicated. In particular, children, alcoholics, and persons with brain-related damages belong to this risk group. A defective dentition is also associated with the risk of bolus deaths. AIM The aim of the study was to supplement existing literature by evaluating cases of bolus deaths and determining the most likely mechanism of death in a large autopsy sample. MATERIAL Among 31,647 autopsies, 59 cases of cafe coronary syndrome were identified and evaluated: 38 male adults and 21 female adults between the ages of 26 and 89 years. METHODS A retrospective analysis of autopsies performed in the Institutes of Forensic Medicine in Rostock (1990-2014) and Munich (1990-1999) was conducted. Autopsy findings, circumstances of death, police investigations, preexisting conditions, dentition, and toxicological investigations were recorded. Then, based on the presence or absence of selected findings and surrounding circumstances, conclusions on the mechanism of death were drawn. RESULTS In eighty-six percent (86%), boluses of meat and sausage or meat-like chunks were observed. Of the forty-nine victims, 22 (42%) had elevated blood alcohol levels (>0.5‰) with blood alcohol concentration (BAC) levels of >0.73‰ to <3.99‰. Of the nonalcoholized decedents, 63% had neurological disorders and 11% had preexisting cardiac conditions. CONCLUSIONS Detecting potential bolus events upon autopsy and the resulting mechanism of nonnatural deaths are of great importance. Therefore, the medical history, resuscitation protocol, and detailed description of the scene of death are essential. Upon autopsy, the type and position as well as size and weight of the bolus and dental status of the victims should be documented in a standardized manner. Additional toxicological investigations are necessary.
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Wu WS, Sung KC, Cheng TJ, Lu TH. Associations between chronic diseases and choking deaths among older adults in the USA: a cross-sectional study using multiple cause mortality data from 2009 to 2013. BMJ Open 2015; 5:e009464. [PMID: 26563213 PMCID: PMC4654350 DOI: 10.1136/bmjopen-2015-009464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To examine whether the strengths of the associations between chronic diseases and overall choking differ from those of the associations between chronic diseases and only food-related choking. DESIGN This cross-sectional study used nationwide multiple cause mortality files. SETTING The USA. PARTICIPANTS Older adults aged 65 years or more died between 2009 and 2013. MAIN OUTCOME MEASURES Mortality ratio (observed/expected) of number of deaths from both causes (chronic diseases and choking) and 95% CIs. RESULTS We identified 76543 deaths for which the death certificates report choking (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes W78, W79 and W80 combined) as a cause of death and only 4974 (6.5%) deaths were classified as food-related choking (ICD-10 code W79). Schizophrenia, Parkinson's disease, Alzheimer's disease and oral cancer are four chronic diseases that had significant associations with both overall and food-related choking. Stroke, larynx cancer and mood (affective) disorders had significant associations with overall choking, but not with food-related choking. CONCLUSIONS We suggest using overall choking instead of only food-related choking to better describe the associations between chronic diseases and choking.
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Affiliation(s)
- Wen-Shiann Wu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Tain-Junn Cheng
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Neurology, Occupational Medicine, Management in Medical Records and Information, Chi Mei Medical Center, Tainan, Taiwan
- Department of Occupational Safety/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Edwards GA. Mimics of child abuse: Can choking explain abusive head trauma? J Forensic Leg Med 2015; 35:33-7. [PMID: 26344456 DOI: 10.1016/j.jflm.2015.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/29/2015] [Accepted: 06/13/2015] [Indexed: 11/17/2022]
Abstract
Choking is one of the alternative explanations of abusive head trauma in children that have been offered in courtroom testimony and in the media. Most of these explanations - including choking - are not scientifically supported. This article highlights four points. (1) The origins of choking as an explanation for intracranial and retinal hemorrhages are speculative. (2) Choking has been used in high profile court testimony as an explanation for the death of a child thought to have been abused. (3) A case report that proposes choking as an alternative explanation for the death of a child diagnosed with abusive head trauma includes omissions and misrepresentations of facts. (4) There was a decision by the editor of the journal that published the case report that it was not necessary to include all the facts of the case; moreover, the editor indicated that facts are not required when presenting an alternative explanation. The use of scientifically unsupported alternative explanations for abusive head trauma based on inaccurate and biased information constitutes further victimization of the abused child and represents a travesty of justice.
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Affiliation(s)
- George A Edwards
- Dell Children's Medical Center, Department of Pediatrics, UT, Austin, Dell Medical School, 4900 Mueller Blvd, Austin, TX 78723, USA.
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Langlois NEI, Byard RW. Dentures in dementia: a two-edged sword. Forensic Sci Med Pathol 2015; 11:606-8. [PMID: 26013678 DOI: 10.1007/s12024-015-9683-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Neil E I Langlois
- Discipline of Anatomy and Pathology, Level 3 Medical School North Building, School of Medical Sciences, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.,Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia
| | - Roger W Byard
- Discipline of Anatomy and Pathology, Level 3 Medical School North Building, School of Medical Sciences, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia. .,Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
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Byard RW, Gilbert JD. Lethal Laryngopyocele. J Forensic Sci 2014; 60:518-20. [DOI: 10.1111/1556-4029.12676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Roger W. Byard
- School of Medical Sciences; The University of Adelaide; Adelaide SA Australia
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The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2014; 30:2-26. [PMID: 25343878 PMCID: PMC4342510 DOI: 10.1007/s00455-014-9578-x] [Citation(s) in RCA: 310] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/10/2014] [Indexed: 10/28/2022]
Abstract
Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration-aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.
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Hifumi T, Kiriu N, Kato H, Koido Y, Kuroda Y. Survival from cardiac arrest due to sushi suffocation. World J Emerg Med 2014; 5:154-6. [PMID: 25215168 DOI: 10.5847/wjem.j.issn.1920-8642.2014.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 03/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published. METHODS A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire basket. RESULTS Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological complications. CONCLUSION Emergency physicians should consider sushi suffocation, including its clinical features and management.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan ; Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, 190-0014, Japan
| | - Nobuaki Kiriu
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, 190-0014, Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, 190-0014, Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, 190-0014, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa, 761-0793, Japan
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Sakai T, Kitamura T, Iwami T, Nishiyama C, Tanigawa-Sugihara K, Hayashida S, Nishiuchi T, Kajino K, Irisawa T, Shiozaki T, Ogura H, Tasaki O, Kuwagata Y, Hiraide A, Shimazu T. Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City. Scand J Trauma Resusc Emerg Med 2014; 22:53. [PMID: 25182381 PMCID: PMC4156961 DOI: 10.1186/s13049-014-0053-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. METHODS We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. RESULTS A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023). CONCLUSIONS From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO.
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Affiliation(s)
- Tomohiko Sakai
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan.
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Kennedy B, Ibrahim JE, Bugeja L, Ranson D. Causes of death determined in medicolegal investigations in residents of nursing homes: a systematic review. J Am Geriatr Soc 2014; 62:1513-26. [PMID: 25040024 DOI: 10.1111/jgs.12929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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. DESIGN Systematic 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. SETTING Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. MEASUREMENTS Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. RESULTS Thirteen 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.
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Affiliation(s)
- Briohny Kennedy
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
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Byard RW. A Review of the Forensic Implications of Pica. J Forensic Sci 2014; 59:1413-6. [DOI: 10.1111/1556-4029.12520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/04/2013] [Accepted: 09/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Roger W. Byard
- The University of Adelaide Medical School; Frome Road Adelaide SA 5005 Australia
- Forensic Science SA; 21 Divett Place Adelaide SA 5000 Australia
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Byard RW. Endobronchial/Tracheal Metastasis and Sudden Death. J Forensic Sci 2014; 59:1139-41. [DOI: 10.1111/1556-4029.12431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 06/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Roger W. Byard
- School of Medical Sciences; The University of Adelaide; Frome Rd. Adelaide SA Australia
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Cichero JAY, Steele C, Duivestein J, Clavé P, Chen J, Kayashita J, Dantas R, Lecko C, Speyer R, Lam P, Murray J. The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013; 1:280-291. [PMID: 24392282 PMCID: PMC3873065 DOI: 10.1007/s40141-013-0024-z] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Conservative estimates suggest that dysphagia (difficulty swallowing) affects approximately 8 % of the world's population. Dysphagia is associated with malnutrition, dehydration, chest infection and potentially death. While promising treatments are being developed to improve function, the modification of food texture and liquid thickness has become a cornerstone of dysphagia management. Foods are chopped, mashed or puréed to compensate for chewing difficulties or fatigue, improve swallowing safety and avoid asphyxiation. Liquids are typically thickened to slow their speed of transit through the oral and pharyngeal phases of swallowing, to avoid aspiration of material into the airway and improve transit to the esophagus. Food texture and liquid modification for dysphagia management occurs throughout the world. However, the names, the number of levels of modification and characteristics vary within and across countries. Multiple labels increase the risk to patient safety. National standardization of terminology and definitions has been promoted as a means to improve patient safety and inter-professional communication. This article documents the need for international standardized terminology and definitions for texture-modified foods and liquids for individuals with dysphagia. Furthermore, it documents the research plan and foundations of a global initiative dedicated to this purpose.
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Affiliation(s)
- Julie A. Y. Cichero
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Brisbane, QLD 4102 Australia
| | | | | | - Pere Clavé
- Unitat d’Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Mataró, Barcelona Spain
| | - Jianshe Chen
- Food Science, University of Leeds, West Yorkshire, UK
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Roberto Dantas
- Departmento de Clinica Medica, Faculdade de Medecina de Ribeirao Preto, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Renee Speyer
- Speech Pathology Discipline, James Cook University, Townsville, QLD Australia
| | - Peter Lam
- Peter Lam Consulting, Vancouver, BC Canada
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Virtopsy versus autopsy in unusual case of asphyxia: Case report. Forensic Sci Int 2013; 229:e1-5. [DOI: 10.1016/j.forsciint.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/25/2012] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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Anđelić S. Heimlich Maneuver on Self: From Theory to Practice. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Heimlich maneuver is an emergency procedure for management of foreign body obstruction of the airway. We reported an emergency physician who had airway obstruction due to a large chunk of orange. He applied Heimlich maneuver on himself to remove the foreign body that could have caused suffocation. This case illustrated that a timely and appropriately performed Heimlich maneuver could help remove a foreign body obstructing the airway for self-salvation.
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Dysphagia is a common and serious problem for adults with mental illness: a systematic review. Dysphagia 2011; 27:124-37. [PMID: 22120763 DOI: 10.1007/s00455-011-9378-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 11/15/2011] [Indexed: 12/24/2022]
Abstract
Adults with mental illness may experience a higher incidence of dysphagia and choking due to factors such as medication side effects and behavioural abnormalities. The aim of this study was to determine the frequency of dysphagia and the most effective interventions for this population. Studies published up to August 2010 were sought via a comprehensive electronic database search (CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, and Embase). Studies reporting dysphagia frequency or dysphagia intervention outcomes in adults with mental illness were included. Two reviewers independently assessed study eligibility and quality, and the results were synthesised descriptively. Ten studies were identified, each describing dysphagia frequency or death due to choking asphyxiation. No studies evaluating intervention effectiveness were identified. Study quality was limited by subjective assessment of outcomes. Six studies presented dysphagia frequencies ranging from 9 to 42% in varying subgroups. Four studies presented the frequency of choking asphyxiation death, including a large survey that concluded that adults with organic mental illness were 43 times more likely to die of this cause than the general population. Dysphagia is a common and significant cause of morbidity and mortality in adults with mental illness and our review found that there is a lack of studies evaluating the effectiveness of intervention techniques.
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