Monday, November 4, 2013

Series Post: Ask Dr. Dina - Choking, Strangling, and Other Fun

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance!

Today we're going to talk about breathing. Or rather, the lack thereof.

Now, there's a difference between asphyxiation and choking. Most people use the terms interchangeably, and they're wrong, and I'll tell you why.

Choking is the obstruction of air flow, whether that's by something lodged in the trachea (airway, aka "the throat," though technically the throat is made up of two orifices - the larynx ["voicebox"] that leads to the lungs for breathing [the lower part is called the "trachea"] and pharynx which leads to the esophagus and stomach) or constriction of it by trauma. The trachea is in front of the esophagus, and you can feel it just above the hollow of your throat. It feels kind of bumpy with some ridges. See those in the picture below?

used with permission wikipedia creative commons
Throat Anatomy (used with permission via Wikipedia Commons)

This is why you'll see health care professionals making a cut on the throat in medical dramas to get a tube in to help someone breathe, because the airway is compromised in some fashion and they need a tracheotomy.

Choking is when air can't get through the trachea (aka "windpipe") because something is preventing it (like someone's hands around a throat, a piece of food, water down the airway, etc.) from reaching the lungs.

Asphyxiation is the lack of oxygen. This can be from gases like carbon monoxide, smoke, chemical agents, sleep apnea, a drug overdose, exposure to toxins, smothering (like a pillow over the face), low atmospheric pressure like high altitudes or a vacuum like space, disease, crushing of the chest not allowing expansion of the lungs…lots and lots of things can cause asphyxiation. You've all heard of auto-erotic asphyxiation? Yeah. This means intentionally decreasing the supply of oxygen (usually via constricting the airway by a choking or hanging method) in order to experience a heightened sense of euphoria during orgasm. (NOTE: DO NOT TRY THIS AT HOME. THIS IS HOW PEOPLE DIE, BECAUSE THERE IS VERY LITTLE VOLUNTARY CONTROL OVER THE BODY DURING ORGASM AND IF YOU ARE CHOKING OR HANGING YOURSELF YOU CAN AND PROBABLY WILL PASS OUT COMPLETELY AND DIE. THEN SOMEONE FINDS YOUR NAKED, BLOATED CORPSE AND KNOWS WHAT YOU DID THERE AND WE'RE NOT GOING TO TALK ABOUT THAT RIGHT NOW, EITHER, SO MOVE ALONG.)

Now you know the difference between the two, what's the point?

The point is, use the proper term. When your character "has the life choked out of them," explain by what. What's doing it? Are they choking on something (is something in the airway?) or are they being strangled? Or do you mean they're suffocating/asphyxiating in a smoke-filled room because their house is on fire?

Choking is violent. There's usually coughing and flailing and struggling and clawing at the throat and so on, and if you're lucky enough to have someone around who knows the Heimlich maneuver, you might make it out of the situation alive. If you're alone, find a chair or something. You've only got a few seconds, though, because the average person can only go about seven to fourteen before passing out from lack of oxygen. Hint: This is a very, very narrow margin and passes interminably slowly when you're fighting for your life, so if you (or your character) are choking, work fast. Did you ever play the fainting game when you were sleeping over at someone's house? Good. Don't. It's dangerous and some people never wake up.

Strangulation is pretty much the same thing. Strangulation is a physical thing that compromises the air flow, only it's usually outside the body. There's all sorts of differentiation when it comes to strangulation, but they all pretty much have to do with trauma to the throat area. Chokeholds are common in a lot of martial arts/blood sports/combat scenarios, because you're trying to incapacitate your opponent by cutting off their airflow. They can't breathe, they pass out, threat neutralized. They're called chokeholds for this very reason – you're choking them. Remember, the window for this is very small – seven to fourteen seconds – so if your character can do it right, it's a good way to have them deal with a hostile rather than having them attempt to knock the baddie out with a frying pan.

Strangulation also applies to garroting and hanging.

Smothering is when your character walks into a room filled with smoke or other gas and passes out because they can't breathe. Other than having a pillow pushed over someone's face, smothering usually isn't violent. It's quick and quiet - and in the case of some gases, invisible and painless -, which is why the gas chamber was once considered a humane form of capital punishment.

Again, if you're writing these things, know the terms to use.

Technically they're interchangeable and no one will really call you on it, unless you get a nitpicky medical professional like myself who really hates it when a character being strangled is written as "smothered in blood." No, smothering is totally different than strangulation. "Smothered" is asphyxiation, not choking. You could say "drowning in his own blood," because that's saying that blood is obstructing the trachea/entering the lungs (we'll get to what drowning is and does in another post – just go with it here) and causing the character to choke/be strangled by the liquid. Then you'd be medically accurate, which is what you want, right?


That's what I thought.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

1 comment:

  1. Hurray for the accuracy of medical terminology! And other medical things.


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