1 00:00:00,240 --> 00:00:04,160 Speaker 1: This episode includes information about the death of individuals as 2 00:00:04,200 --> 00:00:07,160 Speaker 1: well as children. If this sort of thing upsets you, 3 00:00:07,680 --> 00:00:12,200 Speaker 1: this is not the episode for you. Welcome it may 4 00:00:12,240 --> 00:00:16,400 Speaker 1: have in the more with their host, doctor Kender Crowns 5 00:00:22,520 --> 00:00:26,239 Speaker 1: today's episode Grapes of Death. Today, I'm going to be 6 00:00:26,320 --> 00:00:29,720 Speaker 1: talking about a fairly common type of case. I see 7 00:00:29,720 --> 00:00:33,480 Speaker 1: these several times a year, and these are individuals dying 8 00:00:33,600 --> 00:00:37,199 Speaker 1: of choking. Choking is not just caused by food, but 9 00:00:37,240 --> 00:00:40,279 Speaker 1: it can also be caused by objects as well. It 10 00:00:40,360 --> 00:00:45,040 Speaker 1: causes greater than five five hundred fatalities every year, making 11 00:00:45,040 --> 00:00:47,760 Speaker 1: it the fourth leading cause of death in the United States. 12 00:00:48,280 --> 00:00:51,920 Speaker 1: In almost half of these cases occur at home. It 13 00:00:51,960 --> 00:00:55,400 Speaker 1: can affect every age group, but most commonly affects people 14 00:00:55,440 --> 00:00:58,360 Speaker 1: over the age of sixty five, also known as the elderly, 15 00:00:58,960 --> 00:01:02,320 Speaker 1: and children actually under the age of five. It can 16 00:01:02,360 --> 00:01:05,360 Speaker 1: also affect adults as well, and is often seen in 17 00:01:05,400 --> 00:01:09,240 Speaker 1: individuals who are intoxicated and in people with mental disorders. 18 00:01:10,120 --> 00:01:13,080 Speaker 1: Choking occurs when a foreign object lodges in the back 19 00:01:13,120 --> 00:01:16,520 Speaker 1: of your throat, blocking the larynx and trachia. The object 20 00:01:16,600 --> 00:01:20,120 Speaker 1: can also forcibly close the epiglottis, which is the cartilaginous 21 00:01:20,120 --> 00:01:23,280 Speaker 1: flap that closes over your airway when you swallow, so 22 00:01:23,360 --> 00:01:26,840 Speaker 1: you don't inhale food or fluids. If your airway is 23 00:01:26,880 --> 00:01:30,640 Speaker 1: completely blocked, you can't breathe, speak, or even cough, and 24 00:01:30,720 --> 00:01:32,600 Speaker 1: you can feel the object stuck in the back of 25 00:01:32,640 --> 00:01:35,280 Speaker 1: your throat. You'll keep trying to swallow and trying to 26 00:01:35,280 --> 00:01:38,479 Speaker 1: make it move, but eventually your brain realizes you aren't 27 00:01:38,480 --> 00:01:42,000 Speaker 1: getting air in and the clock is now ticking for consciousness. 28 00:01:42,400 --> 00:01:45,360 Speaker 1: Panic sets in. You grab at your throat with both hands, 29 00:01:45,760 --> 00:01:48,600 Speaker 1: singling those around you that something is wrong, trying to 30 00:01:48,600 --> 00:01:51,600 Speaker 1: get help. Your face, lips, and skin begin to turn 31 00:01:51,640 --> 00:01:54,960 Speaker 1: blue due to lack of oxygen, and in about seven 32 00:01:55,000 --> 00:01:58,520 Speaker 1: to ten seconds you go unconscious, and in about another 33 00:01:58,600 --> 00:02:02,120 Speaker 1: four to five minutes brain death occurs. If the object 34 00:02:02,200 --> 00:02:05,520 Speaker 1: can be cleared, breathing can be restored, and the main 35 00:02:05,560 --> 00:02:07,040 Speaker 1: way to do this is through the use of the 36 00:02:07,080 --> 00:02:10,120 Speaker 1: Heimlich maneuver, which is a maneuver that was developed in 37 00:02:10,200 --> 00:02:14,799 Speaker 1: nineteen seventy two by an American thoracic surgeon, doctor Henry Heimlich. 38 00:02:15,400 --> 00:02:18,400 Speaker 1: It's a life save and technique using abdominal thrust to 39 00:02:18,480 --> 00:02:21,960 Speaker 1: expel the obstruction, and it has saved millions of lives. 40 00:02:22,880 --> 00:02:26,239 Speaker 1: Seventy five percent of choking cases actually occur in the elderly. 41 00:02:26,800 --> 00:02:29,640 Speaker 1: The risk increases after the age of seventy one, making 42 00:02:29,680 --> 00:02:32,480 Speaker 1: the elderly more likely to choke than any other group 43 00:02:32,520 --> 00:02:36,840 Speaker 1: in the population. The main culprit is food, usually meat, 44 00:02:37,120 --> 00:02:41,600 Speaker 1: including the deadly hot dogs. Other things commonly choked on 45 00:02:41,639 --> 00:02:47,239 Speaker 1: are grapes, nuts, popcorn, hard candy, fruits, vegetables, and sticky food, 46 00:02:47,639 --> 00:02:51,440 Speaker 1: especially peanut butter. The elderly can even choke to death 47 00:02:51,520 --> 00:02:55,960 Speaker 1: on water. The main reasons for them choking is swallowing difficulties, 48 00:02:56,200 --> 00:02:59,919 Speaker 1: also known as dysphagia, less saliva and absence of tea. 49 00:03:01,000 --> 00:03:03,960 Speaker 1: Dysphasia effects up to one third of adults and is 50 00:03:04,040 --> 00:03:09,240 Speaker 1: caused by age related muscle weakness or underlying diseases like strokes, dementia, 51 00:03:09,360 --> 00:03:13,480 Speaker 1: or Parkinson's disease. Less saliva is a combination of aging 52 00:03:13,520 --> 00:03:17,440 Speaker 1: and medication side effects, and this can cause difficulty chewing 53 00:03:17,639 --> 00:03:20,160 Speaker 1: and swallowing. The lack of saliva can make the food 54 00:03:20,240 --> 00:03:22,680 Speaker 1: more dry and sticky, hard to manage in the mouth 55 00:03:22,720 --> 00:03:25,960 Speaker 1: and throat. Fewer teeth is also a very common one, 56 00:03:26,120 --> 00:03:29,400 Speaker 1: and less teeth means bigger bites, often swallowing things whole, 57 00:03:29,960 --> 00:03:32,480 Speaker 1: and this is the risk factor I see the most 58 00:03:32,760 --> 00:03:36,760 Speaker 1: in combination with tough overcooked steaks, resulting in large pieces 59 00:03:36,800 --> 00:03:39,960 Speaker 1: of meat, including the airways. One case I had was 60 00:03:40,000 --> 00:03:43,119 Speaker 1: an individual who had no teeth at all. He actually 61 00:03:43,200 --> 00:03:46,000 Speaker 1: died of a heart attack, not choking, but he had 62 00:03:46,040 --> 00:03:49,240 Speaker 1: a very interesting finding. The stomach felt like it had 63 00:03:49,280 --> 00:03:54,160 Speaker 1: hard lumps in it, and upon opening, contained unhewed artichoke 64 00:03:54,240 --> 00:03:58,120 Speaker 1: hearts about two point five inches wide. I was surprised 65 00:03:58,120 --> 00:04:00,320 Speaker 1: he didn't choke on these and he was able to 66 00:04:00,360 --> 00:04:03,760 Speaker 1: swallow them whole, but I guess anything is possible. A 67 00:04:03,880 --> 00:04:07,120 Speaker 1: syndrome seen commonly in the elderly and the middle age 68 00:04:07,160 --> 00:04:11,640 Speaker 1: associated with choking is a cafe coronary syndrome. This syndrome 69 00:04:11,680 --> 00:04:15,160 Speaker 1: occurs where an otherwise healthy individual collapses during a meal 70 00:04:15,440 --> 00:04:19,360 Speaker 1: in the absence of any signs of choking or asphyxia 71 00:04:19,560 --> 00:04:24,120 Speaker 1: or respiratory distress or neurological symptoms. The person just basically 72 00:04:24,160 --> 00:04:27,480 Speaker 1: stands up and collapses. People think it's a heart attack 73 00:04:27,520 --> 00:04:30,800 Speaker 1: and it results in the wrong emergency treatment being administered, 74 00:04:31,160 --> 00:04:34,280 Speaker 1: meaning the obstruction the airway is completely missed and the 75 00:04:34,279 --> 00:04:37,880 Speaker 1: person dies when they could have probably been saved. Typically, 76 00:04:37,920 --> 00:04:41,480 Speaker 1: the food involved in the cafe coronary syndrome is poorly 77 00:04:41,560 --> 00:04:45,240 Speaker 1: chewed steak that gets further wedged in the airway as 78 00:04:45,279 --> 00:04:50,000 Speaker 1: people try and restore breathing. Cafe coronary syndrome is also 79 00:04:50,160 --> 00:04:53,920 Speaker 1: often seen in the middle age por dentician taking big 80 00:04:53,960 --> 00:04:57,560 Speaker 1: bites of food while talking, and they are often intoxicated, 81 00:04:58,080 --> 00:05:01,599 Speaker 1: typically with alcohol. And this also brings us to another 82 00:05:01,640 --> 00:05:06,680 Speaker 1: installment of everybody's favorite true crime game show. Is it Methamphetamine, 83 00:05:06,839 --> 00:05:11,359 Speaker 1: Women or Alcohol? So let's get started. The case was 84 00:05:11,360 --> 00:05:14,000 Speaker 1: that of a twenty two year old male found unresponsive, 85 00:05:14,160 --> 00:05:17,520 Speaker 1: partially lying in his bed at his residence. His residence 86 00:05:17,600 --> 00:05:20,760 Speaker 1: was in disarray, Lamps were broken, things were thrown around, 87 00:05:20,920 --> 00:05:24,680 Speaker 1: stuff was torn up. His residence was trashed, but not 88 00:05:24,800 --> 00:05:27,119 Speaker 1: in a way that suggested he had been in a fight. 89 00:05:27,680 --> 00:05:31,640 Speaker 1: At autopsy, he was well developed and well nourished, appeared 90 00:05:31,680 --> 00:05:35,520 Speaker 1: the reported age. He had abrasions and lacerations about his head, 91 00:05:35,839 --> 00:05:39,120 Speaker 1: chest in upper and lower extremities, but again he had 92 00:05:39,160 --> 00:05:41,839 Speaker 1: been found in a secured residence, so there was no 93 00:05:42,000 --> 00:05:46,479 Speaker 1: thought of foul play. He exhibited small, particular hemorrhages about 94 00:05:46,480 --> 00:05:49,520 Speaker 1: his face, which are the little pinpoint hemorrhages that are 95 00:05:49,560 --> 00:05:53,320 Speaker 1: often seen with strangulation, hangings and things of that nature, 96 00:05:54,040 --> 00:05:56,760 Speaker 1: but they can also be associated with wretching and hard 97 00:05:56,800 --> 00:06:00,279 Speaker 1: gagging Internally, it was found that he had peace, a 98 00:06:00,320 --> 00:06:04,400 Speaker 1: credit card and other debris blocking his airway. These had 99 00:06:04,440 --> 00:06:07,479 Speaker 1: actually been pressed down on his epiglottis and closed his 100 00:06:07,560 --> 00:06:11,159 Speaker 1: trachee off. He had basically choked on a credit card. 101 00:06:11,800 --> 00:06:14,880 Speaker 1: He also had in his stomach multiple foreign bodies including 102 00:06:14,960 --> 00:06:18,760 Speaker 1: cell phone parts, wires, earphones, paper and other bits and 103 00:06:18,800 --> 00:06:23,080 Speaker 1: pieces of credit card, and in his intestines there was 104 00:06:23,120 --> 00:06:28,120 Speaker 1: an unfired bullet. He was basically a human goat. He 105 00:06:28,160 --> 00:06:31,520 Speaker 1: exhibited palmary congestion as well, so this credit card and 106 00:06:31,560 --> 00:06:35,800 Speaker 1: other debris had caused them to choke, wretch violently, resulting 107 00:06:35,800 --> 00:06:39,960 Speaker 1: in the particular hemorrhages and eventually dying from asphyxia. And 108 00:06:40,000 --> 00:06:42,880 Speaker 1: why did he do this? Were there women about? No? 109 00:06:43,720 --> 00:06:47,960 Speaker 1: Was he drinking? Was it meth What the toxicology showed 110 00:06:48,080 --> 00:06:50,880 Speaker 1: was he had methamphetamine on board and no alcohol and 111 00:06:50,920 --> 00:06:54,560 Speaker 1: no other drugs, So the answer is meth amphetamine. The 112 00:06:54,600 --> 00:06:58,479 Speaker 1: finding of methamphetamine made sense. Sometimes when a person is 113 00:06:58,520 --> 00:07:01,520 Speaker 1: on methamfetamine, they get itch, which would account for all 114 00:07:01,560 --> 00:07:05,080 Speaker 1: his abrasions, and it makes people do erratic things. I 115 00:07:05,120 --> 00:07:08,560 Speaker 1: always think, when it doesn't make sense, it's probably methen fetamine. 116 00:07:09,080 --> 00:07:12,360 Speaker 1: And eating your credit cards just didn't make sense. So 117 00:07:12,400 --> 00:07:15,000 Speaker 1: his cause of death was choking with a contributing factor 118 00:07:15,000 --> 00:07:18,840 Speaker 1: of methanfetamine. This case is a little unusual, not just 119 00:07:18,880 --> 00:07:22,040 Speaker 1: because of the credit card, but usually with the intoxication 120 00:07:22,200 --> 00:07:26,640 Speaker 1: choking cases, it's typically alcohol. Alcohol impairs a gag reflex, 121 00:07:26,800 --> 00:07:30,760 Speaker 1: relaxes muscles, and reduces the body's ability to react to choking. 122 00:07:31,600 --> 00:07:34,760 Speaker 1: Other factors in adult choking include laughing and talking with 123 00:07:34,800 --> 00:07:37,520 Speaker 1: food in your mouth and yes, your mom was right 124 00:07:37,840 --> 00:07:39,920 Speaker 1: when she advised you not to talk with food in 125 00:07:39,920 --> 00:07:44,080 Speaker 1: your mouth. Another factor in adult chokings is mental conditions. 126 00:07:44,560 --> 00:07:46,960 Speaker 1: A case of one of my colleagues was that of 127 00:07:47,000 --> 00:07:49,680 Speaker 1: a forty year old woman who was found unresponsive in 128 00:07:49,720 --> 00:07:53,120 Speaker 1: her secured residence. She was fully clothed laying in her 129 00:07:53,120 --> 00:07:55,800 Speaker 1: bedroom on the floor during a well being check. There 130 00:07:55,880 --> 00:07:58,320 Speaker 1: was no signs of foul play. The house was secured 131 00:07:59,000 --> 00:08:02,400 Speaker 1: and she was brought in for autopsy and autopsy she 132 00:08:02,480 --> 00:08:05,120 Speaker 1: was a well developed OBEs female and there was no 133 00:08:05,160 --> 00:08:09,520 Speaker 1: external evidence of injury. Internally, she had no findings except 134 00:08:09,600 --> 00:08:13,960 Speaker 1: when her throat was examined, they found four latex gloves 135 00:08:14,040 --> 00:08:17,480 Speaker 1: stuck in the back of her throat. These gloves blocked 136 00:08:17,480 --> 00:08:21,120 Speaker 1: her airway and caused her to die. But why rubber gloves. 137 00:08:21,760 --> 00:08:24,720 Speaker 1: The reason why, well, she had a condition called pika, 138 00:08:25,200 --> 00:08:29,160 Speaker 1: and let's discuss pika. Pika is a scientific term for 139 00:08:29,240 --> 00:08:33,080 Speaker 1: craving and subsequent consumption of non food items. It's not 140 00:08:33,120 --> 00:08:36,600 Speaker 1: an acronym or an abbreviation of a famous physician's last name. 141 00:08:37,200 --> 00:08:41,000 Speaker 1: Pica is actually the genus and species of the common magpie. 142 00:08:41,480 --> 00:08:44,280 Speaker 1: Magpies are frequently seen with all sorts of items in 143 00:08:44,320 --> 00:08:48,400 Speaker 1: their beaks, from chewing gum wrappers to wire hangers. Because 144 00:08:48,400 --> 00:08:51,800 Speaker 1: of their attraction to sparkly objects, they were thought to 145 00:08:51,840 --> 00:08:55,480 Speaker 1: be birds with an indiscriminate appetite, and as it turns out, 146 00:08:55,920 --> 00:08:59,400 Speaker 1: they don't swallow these items, they build their nests with them. 147 00:08:59,800 --> 00:09:03,160 Speaker 1: But the human condition of desiring non food items was 148 00:09:03,200 --> 00:09:07,240 Speaker 1: given the name pica in the sixth century because they 149 00:09:07,280 --> 00:09:10,160 Speaker 1: believe the birds were eating all of these odd items. 150 00:09:10,960 --> 00:09:14,040 Speaker 1: The exact cause of pika is unknown, but it is 151 00:09:14,120 --> 00:09:20,320 Speaker 1: often linked to nutritional deficiencies, pregnancies, developmental disabilities, mental health conditions, 152 00:09:20,720 --> 00:09:25,200 Speaker 1: and cultural practices. The list of substances consumed by individuals 153 00:09:25,200 --> 00:09:29,080 Speaker 1: with PIKA is very long, but earth or dirt is 154 00:09:29,120 --> 00:09:34,120 Speaker 1: the most commonly consumed substance, and out of all these substances, 155 00:09:34,280 --> 00:09:38,200 Speaker 1: with the exception of ice, they are usually dry, powdery, 156 00:09:38,320 --> 00:09:41,920 Speaker 1: and absorptive, and most of them are rather crunchy. The 157 00:09:41,960 --> 00:09:46,560 Speaker 1: American Psychiatric Association defines PIKA with four criteria. First, there 158 00:09:46,640 --> 00:09:50,160 Speaker 1: must be persistent eating of a non nutritive substance for 159 00:09:50,280 --> 00:09:54,000 Speaker 1: at least a month. Second, this behavior is inappropriate to 160 00:09:54,040 --> 00:09:58,080 Speaker 1: the person's developmental level. Third, the behavior is not a 161 00:09:58,120 --> 00:10:02,520 Speaker 1: culturally normative or socially so supported practice. And finally, if 162 00:10:02,559 --> 00:10:05,679 Speaker 1: the behavior occurs at the same time as another DSM 163 00:10:05,800 --> 00:10:10,120 Speaker 1: diagnosis or a medical disorder, it must be sufficient to 164 00:10:10,200 --> 00:10:13,960 Speaker 1: require additional attention. The clinical forms of PIKA share at 165 00:10:14,040 --> 00:10:17,160 Speaker 1: least four features, and these are the person with PIKA 166 00:10:17,240 --> 00:10:22,040 Speaker 1: appears or reports to be obsessed with eating certain substances. Second, 167 00:10:22,520 --> 00:10:25,840 Speaker 1: certain physical or sensory properties of the PIKA items are 168 00:10:25,920 --> 00:10:30,079 Speaker 1: highly important to the person. Third, in the general population, 169 00:10:30,200 --> 00:10:34,200 Speaker 1: in those with autism spectrum disorder, PIKA appears to be 170 00:10:34,360 --> 00:10:39,440 Speaker 1: very powerfully, positively reinforcing for a range of PIKA related behavior. 171 00:10:39,960 --> 00:10:43,240 Speaker 1: And finally, both groups of people engage in pika for 172 00:10:43,320 --> 00:10:47,560 Speaker 1: its short term benefits despite its long term harms. Some 173 00:10:47,600 --> 00:10:50,280 Speaker 1: segments of the population are more likely to engage in 174 00:10:50,320 --> 00:10:54,240 Speaker 1: PIKA than others. Pregnant women easily comprise the largest proportion 175 00:10:54,320 --> 00:10:59,280 Speaker 1: of consumers, while children form the second largest group. Children 176 00:10:59,400 --> 00:11:03,559 Speaker 1: most active seek out clay, paper, chalk, dirt, termite hills, 177 00:11:03,600 --> 00:11:07,880 Speaker 1: et cetera. For this reason, PIKA cannot possibly occur until 178 00:11:07,920 --> 00:11:10,920 Speaker 1: after the children are over two years of age. The 179 00:11:11,000 --> 00:11:14,200 Speaker 1: exact cause in any group is again unknown, but it 180 00:11:14,280 --> 00:11:17,560 Speaker 1: is believed to be triggered by a nutritional deficiency, mental 181 00:11:17,559 --> 00:11:21,320 Speaker 1: health conditions, and developmental factors. I have seen other examples 182 00:11:21,360 --> 00:11:24,280 Speaker 1: of pike o over the years, and some rather unusual 183 00:11:24,320 --> 00:11:26,960 Speaker 1: things have been eaten. But the most unusual one was 184 00:11:27,000 --> 00:11:30,000 Speaker 1: an individual who ate ballpoint pins, and on the day 185 00:11:30,080 --> 00:11:34,240 Speaker 1: he died, he had consumed over thirty ballpoint pins. They 186 00:11:34,280 --> 00:11:37,200 Speaker 1: filled his entire stomach and they were beginning to be 187 00:11:37,240 --> 00:11:41,240 Speaker 1: pushed into his intestines when one perforated his duodenum, which 188 00:11:41,280 --> 00:11:43,640 Speaker 1: is the beginning of the small intestine after the stomach, 189 00:11:44,120 --> 00:11:47,600 Speaker 1: and this resulted in fecal material bacteria, et cetera pouring 190 00:11:47,640 --> 00:11:51,559 Speaker 1: into his abdominal cavity and that resulted in paronitis, also 191 00:11:51,600 --> 00:11:55,200 Speaker 1: known as inflammation of the abdominal cavity. This eventually got 192 00:11:55,200 --> 00:11:59,400 Speaker 1: into his bloodstream, resulting in sepsis, which is bacteria getting 193 00:11:59,480 --> 00:12:03,480 Speaker 1: widespread throughout the body with an inflammatory response by the body, 194 00:12:03,840 --> 00:12:07,400 Speaker 1: and that results in septic shock which can cause tissue damage, 195 00:12:07,520 --> 00:12:10,480 Speaker 1: organ failure, and death, which is what happened in this case. 196 00:12:10,800 --> 00:12:14,080 Speaker 1: He didn't choke, but instead died from the perforation of 197 00:12:14,120 --> 00:12:18,080 Speaker 1: his bowel on the resultant paronitis and sepsis. I don't 198 00:12:18,080 --> 00:12:20,240 Speaker 1: think he meant to die from consuming the pins, and 199 00:12:20,280 --> 00:12:23,200 Speaker 1: he had probably done it before. As an aside, the 200 00:12:23,240 --> 00:12:26,600 Speaker 1: pins that were recovered actually still worked even though they 201 00:12:26,600 --> 00:12:33,560 Speaker 1: had been in the stomach for a period of time. Wow. So, 202 00:12:33,679 --> 00:12:36,320 Speaker 1: now that we've covered the elderly and adults, that brings 203 00:12:36,360 --> 00:12:38,880 Speaker 1: us to the other large group of choking victims, which 204 00:12:38,920 --> 00:12:42,560 Speaker 1: as children. Choking is the leading cause of death and children, 205 00:12:42,640 --> 00:12:45,600 Speaker 1: with one child dying every five days in the United States, 206 00:12:46,320 --> 00:12:48,960 Speaker 1: and seventy five percent of these occur in children under 207 00:12:48,960 --> 00:12:51,920 Speaker 1: the age of three. The most common case of pediatric 208 00:12:52,040 --> 00:12:55,720 Speaker 1: choking is food, with hard candy being the most common culprit. 209 00:12:56,480 --> 00:12:59,880 Speaker 1: Other common food items are grapes, hot dogs, and bones. 210 00:13:00,360 --> 00:13:04,160 Speaker 1: It suggested that all grapes be peeled in all hot dogs, 211 00:13:04,280 --> 00:13:07,280 Speaker 1: especially the tip of the hot dog, be cut into small, 212 00:13:07,320 --> 00:13:11,000 Speaker 1: bite sized pieces. The most common non food item that 213 00:13:11,080 --> 00:13:16,720 Speaker 1: causes choking are balloons, especially latex balloons, and coins. Coins 214 00:13:16,760 --> 00:13:21,400 Speaker 1: account for more choking incidents, but balloons cause more choking deaths, 215 00:13:21,840 --> 00:13:24,000 Speaker 1: and that is because of the way balloons can easily 216 00:13:24,040 --> 00:13:27,040 Speaker 1: stretch and mold to the child's airway, making it impossible 217 00:13:27,080 --> 00:13:30,320 Speaker 1: to breathe. They are also harder removed from the airway 218 00:13:30,440 --> 00:13:35,760 Speaker 1: due to their smooth, slippery texture, which thwarts typical rescue methods. 219 00:13:36,559 --> 00:13:40,079 Speaker 1: Foods and objects can easily block a child's airway because 220 00:13:40,080 --> 00:13:43,520 Speaker 1: their airway is significantly smaller, shorter, and more pliable than 221 00:13:43,520 --> 00:13:46,959 Speaker 1: an adult. A child's airway measures between six to eight 222 00:13:47,000 --> 00:13:50,680 Speaker 1: millimeters depending on the age, whereas an adult airway is 223 00:13:50,760 --> 00:13:54,000 Speaker 1: twenty to twenty six millimeters in males and fifteen to 224 00:13:54,040 --> 00:13:58,160 Speaker 1: twenty two millimeters in females. Other factors include the child's 225 00:13:58,200 --> 00:14:01,560 Speaker 1: airways funnel shaped, the tongue is proportionately bigger and the 226 00:14:01,600 --> 00:14:05,280 Speaker 1: epiglottis is floppy. One example I have of a child 227 00:14:05,400 --> 00:14:09,040 Speaker 1: choking on food is a five month old mail On 228 00:14:09,160 --> 00:14:11,520 Speaker 1: the day he died, he had been crawling and scooting 229 00:14:11,559 --> 00:14:14,280 Speaker 1: around on the floor like he usually did. He had 230 00:14:14,360 --> 00:14:16,760 Speaker 1: older siblings, and one of them earlier in the day, 231 00:14:16,840 --> 00:14:19,120 Speaker 1: had knocked over a number of items in the kitchen. 232 00:14:19,920 --> 00:14:22,760 Speaker 1: The mother and the child had diligently cleaned it all 233 00:14:22,840 --> 00:14:25,360 Speaker 1: up and thought they had gotten everything off the floor, 234 00:14:25,960 --> 00:14:29,880 Speaker 1: but they hadn't. Something had rolled under the stove and 235 00:14:29,960 --> 00:14:33,040 Speaker 1: the five month old found it. When he was found 236 00:14:33,080 --> 00:14:35,760 Speaker 1: by the mother, he was unresponsive on the floor in 237 00:14:35,800 --> 00:14:39,760 Speaker 1: the kitchen in the mid afternoon. She started CPR. The 238 00:14:39,840 --> 00:14:43,320 Speaker 1: other child called nine one one, but the time emergency 239 00:14:43,360 --> 00:14:47,040 Speaker 1: medical services arrived it was too late. The child had 240 00:14:47,080 --> 00:14:50,400 Speaker 1: passed away and was pronounced dead at the scene. He 241 00:14:50,520 --> 00:14:53,200 Speaker 1: was brought to the medical examiner's office for an autopsy, 242 00:14:53,920 --> 00:14:56,480 Speaker 1: and at his autopsy he was a normal five month 243 00:14:56,520 --> 00:15:00,680 Speaker 1: old male, no evidence of injury, no congenital anas, un normalities, 244 00:15:00,760 --> 00:15:04,800 Speaker 1: or birth defects. Internally, it was the same, no injuries, 245 00:15:04,920 --> 00:15:08,800 Speaker 1: no congenital abnormalities. But when I took out his throat structures, 246 00:15:09,280 --> 00:15:13,640 Speaker 1: he had a Maraschino cherry blocking his airway. He had 247 00:15:13,680 --> 00:15:16,520 Speaker 1: no teeth, so he had swallowed this cherry hole and 248 00:15:16,560 --> 00:15:18,640 Speaker 1: it had gotten stuck in the back of his throat 249 00:15:18,960 --> 00:15:22,680 Speaker 1: because his airway was so small, and the cherry completely 250 00:15:22,720 --> 00:15:25,720 Speaker 1: blocked it, and he was unable to breathe and probably 251 00:15:25,800 --> 00:15:29,440 Speaker 1: died within a few minutes. His cause of death choking, 252 00:15:29,920 --> 00:15:33,200 Speaker 1: manner of death accident. Food is the most common reason 253 00:15:33,240 --> 00:15:36,160 Speaker 1: for pediatric choking and is one of the things we 254 00:15:36,240 --> 00:15:39,320 Speaker 1: see the most at autopsy. I've seen other cases of 255 00:15:39,360 --> 00:15:42,120 Speaker 1: non food related items. I have had one that was 256 00:15:42,160 --> 00:15:45,840 Speaker 1: actually quite an unusual case of choking. The child didn't 257 00:15:45,880 --> 00:15:49,760 Speaker 1: die initially from the choking incident, but from a later complication, 258 00:15:50,880 --> 00:15:54,920 Speaker 1: and what he had swallowed was a cylindrical battery triple 259 00:15:54,960 --> 00:15:58,840 Speaker 1: A to be exact. In this case, he was a 260 00:15:58,960 --> 00:16:02,920 Speaker 1: four and a half year old male. He had developmental disabilities, 261 00:16:03,280 --> 00:16:06,280 Speaker 1: and his brother had actually been feeding him Cheetos when 262 00:16:06,320 --> 00:16:09,400 Speaker 1: he decided to switch and give him a battery, which 263 00:16:09,480 --> 00:16:13,000 Speaker 1: the child swallowed. He was noticed after swallowing the battery 264 00:16:13,040 --> 00:16:15,520 Speaker 1: to be choking on something. He was given a drink 265 00:16:15,520 --> 00:16:17,920 Speaker 1: of water and appeared to be no longer in distress. 266 00:16:18,600 --> 00:16:22,040 Speaker 1: The next day, the child had throat pain, trouble, swallowing, fever, 267 00:16:22,280 --> 00:16:25,160 Speaker 1: and was throwing up. He was taken to the hospital 268 00:16:25,320 --> 00:16:28,680 Speaker 1: and a CT was performed and it showed a battery 269 00:16:28,800 --> 00:16:32,680 Speaker 1: was stuck in his esophagus. They were surgically able to 270 00:16:32,680 --> 00:16:35,520 Speaker 1: remove the battery. But the thing about it is when 271 00:16:35,560 --> 00:16:39,120 Speaker 1: batteries get in your throat, especially button batteries, they can 272 00:16:39,200 --> 00:16:42,440 Speaker 1: generate an electrical current in the tissue fluids and that 273 00:16:42,480 --> 00:16:46,080 Speaker 1: produces hydroxide at the negative pole of the battery, leading 274 00:16:46,120 --> 00:16:50,080 Speaker 1: to corroso mucosal burns, and these burns can erode through 275 00:16:50,080 --> 00:16:54,280 Speaker 1: the esophagus into the surrounding tissues, and that's what happened 276 00:16:54,280 --> 00:16:57,920 Speaker 1: in this case. The child had mucosal injuries, but what 277 00:16:57,960 --> 00:17:01,880 Speaker 1: had happened was the injuries were deeper than just the esophagus. 278 00:17:02,000 --> 00:17:04,760 Speaker 1: They had burned through into the surrounding blood vessels near 279 00:17:04,800 --> 00:17:09,960 Speaker 1: the esophagus, and eventually these erosions burst. The child initially 280 00:17:10,000 --> 00:17:13,359 Speaker 1: started with nosebleeds and as they were trying to control them, 281 00:17:13,840 --> 00:17:17,960 Speaker 1: he began suddenly vomiting blood and a lot of it, 282 00:17:18,440 --> 00:17:21,320 Speaker 1: and it happened so quickly they couldn't stop it, and 283 00:17:21,400 --> 00:17:25,840 Speaker 1: he eventually bled out in a manner of minutes. At autopsy, 284 00:17:25,880 --> 00:17:29,480 Speaker 1: what I found is one ulcer in his esophagus had 285 00:17:29,480 --> 00:17:34,240 Speaker 1: gone completely through the esophagus and then completely through the aorda, 286 00:17:34,960 --> 00:17:39,760 Speaker 1: creating what is known as an aortic esophageal fistula, which 287 00:17:39,800 --> 00:17:43,399 Speaker 1: means there is a bridge between the aorta and the esophagus, 288 00:17:44,240 --> 00:17:48,240 Speaker 1: leading to blood getting into the esophagus. But he also 289 00:17:48,400 --> 00:17:52,879 Speaker 1: had another erosion from his esophagus into the pulmonary artery, 290 00:17:53,080 --> 00:17:57,320 Speaker 1: creating another fistula, which means the two biggest vessels of 291 00:17:57,320 --> 00:18:00,800 Speaker 1: his body, the pulmonary artery in the aorda had a 292 00:18:00,840 --> 00:18:04,160 Speaker 1: direct communication to his esophagus and there was no way 293 00:18:04,200 --> 00:18:07,920 Speaker 1: to stop them. With these two blood vessels being compromised, 294 00:18:08,400 --> 00:18:11,760 Speaker 1: the child bled out quickly and died. His cause of 295 00:18:11,760 --> 00:18:15,280 Speaker 1: death was esophageal fistula of his aortic and palmary artery 296 00:18:15,720 --> 00:18:19,360 Speaker 1: due to battery ingestion, and the manner of death was accident, 297 00:18:20,240 --> 00:18:23,280 Speaker 1: so it was not a choking per se, but still 298 00:18:23,480 --> 00:18:27,720 Speaker 1: something had been swallowed that resulted in his death. Inclosing, 299 00:18:28,000 --> 00:18:31,160 Speaker 1: the death of a child is always difficult and upsetting 300 00:18:31,200 --> 00:18:34,240 Speaker 1: to talk about and to hear about, but the most 301 00:18:34,240 --> 00:18:38,080 Speaker 1: common manner of death in children is actually accidents, and 302 00:18:38,280 --> 00:18:42,240 Speaker 1: accidents are almost always preventable, and we can do this 303 00:18:42,440 --> 00:18:46,600 Speaker 1: by talking about child death and create awareness. And sometimes 304 00:18:46,640 --> 00:18:49,840 Speaker 1: that awareness can save a life. So if you found 305 00:18:49,840 --> 00:18:53,360 Speaker 1: this episode helpful, share it, talk about it, and get 306 00:18:53,359 --> 00:18:56,800 Speaker 1: the information out there, because who knows, the life you 307 00:18:56,920 --> 00:18:59,880 Speaker 1: might save might be your own or someone you love. 308 00:19:00,840 --> 00:19:03,200 Speaker 1: And that brings us to the end of the episode. 309 00:19:03,320 --> 00:19:06,600 Speaker 1: I hope you learned something. Until the next time.