Carotid Choke Syncope

[AnthonyM83]

How would you manage a patient who has been "choked out" by police?

Would you recommend transport by ambulance? For those who have the option, would you send it BLS? Would you tell PD they could transport themselves if at all.

This is, of course, assuming everything checks out normal with patient (not on-drugs, no significant hx, no other injuries, pt calm now, AO3, etc).

Does it qualify as syncope?

It was trauma with loss of consciousness, technically. Does that change anything for you?

Realistically, kids choke themselves out all the time and usually don't have trouble unless they accidentally damage airway, but was trying to think how I would fit it into a protocol...

[fireflymedic]

Personally, I have issues releasing anyone who has had a syncopal episode be it due to PD choking them out, kids playing the choking game, or even an erotic type issue. Yes, I did bring that into play here because occasionally we do receive calls relating to that that have gone too far. If the patient is awake and alert now, yes they have the capability of refusing (depending on your area if in police custody, PD may be required to consent to treatment ) but I would still encourage them to be checked out. I think it is just the smart thing as damage may not be apparent now, but may make itself present later on. That's just my thoughts though. Stay safe out there !

[Doczilla]

The police "choke" (an incorrect term), otherwise known as a Lateral Vascular Neck Restraint, is often applied to interrupt blood flow to the brain and end a fight with a suspect. It's not a true "choke" since the airway is ideally not compromised during application (though it can be if the officer has to convert to a lethal technique based on suspect actions). When properly applied, bloodflow to the brain is interrupted and the patient briefly loses consciousness. The patient should return to a normal level of consciousness shortly thereafter, hopefully in handcuffs.

Check for signs of serious vascular injury to the neck (extremely rare). Listen for carotid bruits or stridor, check for bruising or swelling to the anterior neck, and assess respiratory effort (granted, the suspect will probably be winded from the physical confrontation). If none are present, you may safely discharge the patient into police custody.

'zilla

[VentMedic]

How often is LAPD doing this again? You would think that by now they would have elaborate protocols in place after the worldwide publicity this hold brought them.

Besides the thorough phyical assessment already mentioned, I would consider transporting the person if the length of unconsciousness was 20 seconds or more regardless of the physical findings.

Realistically, kids choke themselves out all the time and usually don't have trouble unless they accidentally damage airway, but was trying to think how I would fit it into a protocol...

Check out the pediatric subacutes and pedi nursing homes or the designated "peds wing" in your county LTC facility. You will find the results of kids "choking" themselves or each other. The lucky ones can get up and shake it off but there are some that don't.

Edited March 18, 2009 by VentMedic

[Just Plain Ruff]

Yes, I would transport. You cut off blood flow to the brain with the choke hold and there could be problems.

i'm sure that there have been countless times where the suspect get's up, rubs some dirt on it and walks it off but like a previous poster said, go look at the long term care wards of some childrens facilities.

[AnthonyM83]

How often is LAPD doing this again? You would think that by now they would have elaborate protocols in place after the worldwide publicity this hold brought them.

Not often, though I hear about it a few times a month (not bad for their size). From the situations described, I believe they're classifying LVNR as lethal force (or right below it) on their use of force continuum. It's reported to the public through their blog everytime it is used.