Explain how a carotid choke works.

**DCS** · Posted On: 5/25/2011 5:57am

Ventricular fibrillation precipitated by carotid sinus pressure: Case report and review of the literature

Carotid sinus pressure (CSP) is used often for both therapeutic and diagnostic purposes. Despite its low incidence of attendant complications CSP can cause fatal arrhythmias. A case report of VT and VF resulting from CSP is presented and the literature is reviewed. The mechanism is unknown, but it is suggested that increased vagal tone and possible vagal-mediated catecholamine release may stimulate ventricular ectopic foci with the subsequent production of tachyarrhythmias. Knowledge of the potential complications of CSP and the ability to treat them is necessary to safeguard patient safety.
http://www.sciencedirect.com/science...02870372901846

Fatal ventricular fibrillation during carotid sinus stimulation

The third case of ventricular fibrillation (the first with autopsy) occurring during carotid sinus stimulation is reported. Although this patient received only moderate amounts of digoxin, had no obvious electrolyte derangement, and received carotid sinus stimulation for only a few seconds, a fatal outcome occurred. The heart was normal at necropsy. Although carotid sinus stimulation is an invaluable and usually a safe tool in the treatment and diagnosis of cardiac arrhythmias, it is suggested that caution be used in applying this maneuver to the critically ill patient who has received even modest amounts of cardiac glycosides.
http://www.ajconline.org/article/000...043-9/abstract

**danno** · Posted On: 5/25/2011 6:03am

it doesn't sound consistent with what happens when you're getting strangled.

**DCS** · Posted On: 5/25/2011 6:10am

Well, you asked:

can you knock someone out within a few seconds by pressing on those nerves and nothing else?

So, basically, you can.

And if the someone is aged or has a medical condition, you could even cause death.

Pressing on those nerves and nothing else is a strangle/choke? No.

**danno** · Posted On: 5/25/2011 6:37am

so you're not saying it plays a role in techniques like the RNC?

**DCS** · Posted On: 5/25/2011 6:50am

I think messing with carotid sinus baroreceptors plays a lesser role in RNC compared to ryote, tsukkomi or cross collar chokes.

**danno** · Posted On: 5/25/2011 6:55am

ok, well i tend to think that they all work for the same reason. i'm terribly skeptical about this nerve stuff. even if you're pressing on the nerve somewhat and it has some kind of effect, i don't believe that is the reason people go to sleep when you choke them.

**DCS** · Posted On: 5/25/2011 7:31am

Originally Posted by danno

ok, well i tend to think that they all work for the same reason. i'm terribly skeptical about this nerve stuff. even if you're pressing on the nerve somewhat and it has some kind of effect, i don't believe that is the reason people go to sleep when you choke them.

Carotid sinus is not exactly a nerve.

**danno** · Posted On: 5/25/2011 8:11am

i asked about pressing on the vagus nerve to knock someone out. you posted stuff about carotid sinus pressure and said that yes, you can knock someone out by pressing on nerves. now you say that you weren't actually talking about nerves.

i'm not an anatomist and my girlfriend is asleep. help me out here.

**Snake Plissken** · Posted On: 5/25/2011 8:24am

Originally Posted by danno

can you knock someone out within a few seconds by pressing on those nerves and nothing else?

based on their anatomical proximity to the vascular system, it is usually going to be impossible to stimulate one without the other

Arteries (which take blood away from the heart) are generally deeper within the body, while the veins which return it to the heart are shallower. Being shallower, the veins can be more easily restricted by external pressure, unlike the deeper arteries.

I touched on this earlier. Above the waist, veins lay upon arteries. Below the waist, arteries lay upon veins.

However, the major tributaries, such as the jugular/carotid pairs, are anatomically extremely close and bound with fascia.

**danno** · Posted On: 5/25/2011 8:30am

ok.

Carotid sinus massage

Massage of the carotid sinus, carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. Like the valsalva maneuver, it is a therapy for SVT.[2] It is less effective than pharmaceutical management of SVT with verapamil or adenosine[3] though is still the preferred first-line of treatment in a hemodynamically stable patient[4]

Carotid sinus reflex death

Carotid sinus reflex death is a disputed mechanism of death in which manual stimulation of the carotid sinus allegedly causes strong glossopharyngeal nerve (Vagus nerve is for aortic arch baroreceptors) impulses leading to terminal cardiac arrest. Carotid sinus reflex death has been pointed out as a possible cause of death in cases of strangulation, hanging and Erotic asphyxiation,[5] but such deductions remain controversial. Studies have however suggested that the carotid sinus reflex can be a contributing factor in other mechanisms of death by reducing blood pressure and heart rate, especially in the elderly or in people suffering from carotid sinus hypersensitivity. A carotid massage can also possibly dislodge a thrombus, or some plaque. This could lead to any number of life threatening effects, including stroke.[6]

http://en.wikipedia.org/wiki/Carotid_sinus