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Chokes and Strangulations

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1 Chokes and Strangulations
How Anatomical Structure of the Neck Physiology – Blood vs. Air Restriction Positions & Structures Why Control the Individual Control the Situation Finish quickly – Multiple Attackers !! When Upright / On the way to the ground / Ground Last Resort Only you will know – Legal implications When: - Was this ‘Minimum force necessary’ – CHECK WORDING of LAW – Reasonable Force

2 Definitions: Chokes technically refer to the constriction or blockage of the windpipe, which prevents breathing. Strangulation technically means compression of the arteries to prevent blood from reaching the brain. In most Martial Arts, these terms are used interchangeably.

3 Blood vs Air Restrictions
1. "Blood" chokes – Compression of arteries ( & veins ) in one or both side(s) of Neck. NOTE: No pain should be felt!! 2. "Air" chokes - chokes that attempt to stop the breathing. This choke in actual practice is generally effective due to the pain & panic involved, and not the actual cut-off of breathing. 3. "Combination" chokes - Those chokes which don't rely on either of the two above, but is rather a combination of the above two categories. ‘& Veins’ – If deoxygenated is prevented from returning to the lungs, blood pressure increases. leading to shock Experiments with human subjects and animals show the following effects from "choking": Unconsciousness is due to lack of oxygen and by the metabolites created in the brain as a result of: Acute cerebral anemia by pressure on: common carotid artery occipital artery jugular vein Shock, reflex action initiated on the receptor organ in the carotid sinus. The appearance of flushing of the face because of the disturbances in pressure in the carotid arteries and jugular veins. Decrease blood flow of the face shown by ultrasonic and laser-Doppler blood flow monitoring devices. The mean value is 89.4% with the lowest point in 6 seconds; after release return normal in 13.7 seconds. Decrease oxygen saturation in blood in the helix of the ear by using an ear oximeter. Down from 95 to 86% and reach a minimum of 82% in 2-4 seconds. After regaining consciousness return to 90 to 92%. Sixty percent oxygen saturation in the brain causes unconsciousness. Tachycardia hypertension, and mydriasis (dilated pupils) are caused by stimulation of the sympathetic nervous system (vagus nerve). The systemic pressure rises mm of Hg. After release the blood pressure returns to normal in 3-4 minutes. In some cases bradycardia and hypotension occur while other cases show tachycardia and hypertension depending on the hypersensitivity of the carotid sinus and where the pressure was applied. Cardiac volume decreases but the volume recovers in 10 seconds after awakening. The peripheral blood vessels are also involved: dilatation of muscle vessels and constriction of skin vessels. In shock, accompanied by unconsciousness, bradycardia and hypotension are observed with dilation of muscle vessels. Choking acts as a stressor on the circulatory and hypophysio-adrenocortical system: Decreased blood volume and increased plasma proteins as a result of increased permeability of blood vessels. This is similar to unconscious state following electric shock. No change in the hematocrit value or albumin/globulin. A temporary increase in eosinophiles, then after awakening, there is a decrease in number after 4 hours. The 17-ketosteroids in the urine: 2 hours after recovery, the amount is very much increased then gradually decreased (lasts 6-8 hours). The electroencephalogram (EEG): convulsions that appear in the unconscious stage are very similar to those of petit mal of epilepsy. No deleterious effects remained after the use of the choke hold. It is considerable less dangerous than a knockout in boxing.

4 HOW? Quickly !! If the carotid artery hold is properly applied, unconsciousness occurs in approximately 10 seconds (8-14 seconds). After release, the subject regains consciousness spontaneously in seconds. Neck pressure of 250 mm of Hg is required to occlude carotid arteries. The amount of pressure to collapse the airway is six times greater. Shock, reflex action initiated on the receptor organ in the carotid sinus, can decrease this time to < 2 seconds

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6 HOW? There are four carotid arteries, with a pair located on each side of the neck. This includes the right- and left-internal carotid arteries, and the right- and left-external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain.

7 Fig 1: Anterior triangle of the neck (front view)
The most effective method of shimewaza uses the principle of "maximum efficiency with minimal effort" by applying pressure directly on the carotid triangle without applying the pressure diffusely around the neck. The anterior cervical triangle of the neck (Fig. 1) contains the superior carotid triangle, within which there are the common carotid artery and branches, the carotid bodies, internal jugular vein, vagus nerve and branches, superior laryngeal nerve and the sympathetic trunk. Fig 1: Anterior triangle of the neck (front view)

8 Fig 2: The forearm applies pressure to the left superior carotid triangle. A top view of the head is shown with the back of the head furthest from the forearm. PHYSIOLOGY OF CHOKING The amount of pressure directed to the superior carotid triangle of the neck (Fig.2) and needed to render an adult unconscious is no more than 300 mm Hg. A proper performed choke, stated in general terms, requires no great amount of strength.

9 HOW? Dynamic Judo by Kazuzo Kudo
"The way you get a strangle on your opponent's neck depends on the type of technique you use: 1. In some you get your hold only on his windpipe. 2. In others you apply pressure to both the windpipe and to the carotid artery. 3. In still others you apply pressure to the carotid artery and the jugular vein."(Pg. 78) Comments: This clearly indicates the 2 major forms of chokes, 'air' and 'blood', and also discusses the combination of the two types. "In none of the strangles should you cause your opponent pain, but a strangle hold is not a real strangle unless your opponent suddenly finds himself being asphyxiated." Comments: As a *general* rule, this is certainly accurate. Chokes that deprive the brain of oxygenated blood ("Blood" chokes), certainly should be for the most part completely painless. Chokes that cut off the air supply however, cannot be. Kudo specified a category of chokes that puts pressure on the windpipe... and there is simply no way to apply pressure to the windpipe that is painless. "The name of this technique, literally naked strangle, indicates that you make no use of your opponent's training suit, but strangle him by joining your own two hands together and applying pressure to his throat."(Pg. 91)

10 Nami Juji-Jime Gyaku Juji-Jime (Thumb Inside) Ryote Jime (Thumbs pressed In) Kataha Jime Okuri Eri Jime

11 1998: guidelines reviewed

12 Maximum effect, Minimum effort
Compression of the carotid arteries is desirable because it requires the least force, is the quickest acting of the choking techniques, is the most universally effective against all opponents, and it is most in keeping with the efficiency principle of all arts, "maximum effect with minimum effort." Medical tests have established that the amount of pressure needed to occlude the arteries is six times less than the pressure needed to collapse the airway. Directly stopping the blood supply to the brain also results in loss of consciousness about six times faster than indirectly reducing oxygen in the brain through restricting breathing or the flow of air to the lungs.

13 A&P Anatomically, the anterior cervical triangle of the neck contains the superior carotid triangle. The pressure can be applied to either side. The anterior cervical triangle is a triangle bordered by the sternocleidomastoid muscle (large neck strap muscle) laterally, the mandible jaw bone above, and medially by the cervical midline, a line drawn from the tip of the jaw to the sternal notch. Within the anterior cervical triangle, there are three smaller triangles: submandibular (submaxillary or digastric) superior carotid inferior carotid (muscular). In the technique of choking, the most important triangle is the superior carotid which contains important structures. This triangle is bordered by the stylohyoid and the posterior belly of the digastric muscle above, the anterior border of the sternocleidomastoid muscle medially. Within the superior carotid triangle are the common carotid artery and branches, the carotid bodies, internal jugular vein, vagus nerve and branches, superior laryngeal nerve, and cervical sympathetic trunk. Overlying this superior carotid triangle is only skin, superficial fascia which usually are thin although there may be an appreciable amount of subcutaneous fat. Within the superficial fascia is an exceedingly thin (paper-thin) muscle, platysma muscle, which begins in the tela subcutaneous over the upper part of the thorax, passes over the clavicle (collar bone), and runs upward and somewhat medially in the neck and across the mandible to blend with superficially located facial muscles. The platysma muscle has no very important action, but will wrinkle transversely the skin of the neck and help to open the mouth. 'This muscle does not protect the underlying vital structures. Consequently, the amount of pressure directed to the superior carotid triangle needs to be no more than 300 mm Hg to cause unconsciousness in an adult. A child can, if the choke is properly performed, without great strength "choke out" an adult twice their size.

14 First Aid Basic First Aid: - ABC, Unconscious Casualty Thru to CPR
Unconsciousness occurs about 10 seconds after the application of an effective choke. After release, the athlete should regain consciousness in about 20 seconds. Should the athlete remain unresponsive after this period, seek medical assistance immediately. Unconsciousness in itself may be deemed a medical emergency if it is prolonged and the underlying cause is not recognized.

15 First Aid - Traditional
Traditional resuscitation techniques include: The direct massage of the carotid triangle on the neck to open up a collapsed artery or to manually stimulate the carotid sinus. Methods of inducing or simulating breathing through massage of the chest or diaphragm, expanding and contracting the lungs. Three such methods of Kodokan Judo are Sasoi Katsu, the inductive method, Eri Katsu, the lapel method, and So Katsu, the composite method. The Kodokan teaches Sasoi Katsu with the patient sitting before you. From behind, bend your right knee and place the kneecap against the patient's spine. Spread your fingers and place your hands on his or her lower chest, hooking your fingers under the lower ribs. Pull back as if opening the ribs to either side, put your weight on the shoulders to bend the body back, and press with your right knee. This will draw air into the lungs. When the ribs have opened as far as they will go, release them. Air will be exhaled from the lungs. Repeat the process slowly and regularly. For traditional Eri Katsu kneel to the right of the victim and support his or her upper body with your left arm around the shoulder. Put the palm of your right hand on the abdomen, just above the navel, and press up against the solar plexus or pit of the stomach. This will cause the diaphragm to rise, expelling air from the lungs. Reinforce the action by bending the upper body forward with your left arm. Gently release your pressure to allow air to enter the lungs. Repeat this procedure until respiration is restored. For So Katsu lay the victim on his or her back and kneel astride the hips. Place your hands, fingers spread apart and pointing toward his or her head, on the bottom of the rib cage. Lean forward and press against the ribs to make him or her exhale, then relax the pressure. Repeat this procedure, rocking forward and back, until the victim can breathe without assistance. Similarly this can be done with the victim on his stomach.

16 References: January 1996 edition of Judo Trends Magazine
© 1995/2005 by Neil Ohlenkamp, JudoInfo.com, Deaths Allegedly Caused by the Use of "Choke Holds" (Shime-Waza) - by E. K. Koiwai, M.D. Emergency Care for Choke Holds - John Boulay = pictures The copyright of some of the material and pictures is recognised and appreciated: I hope that the original authors realise that their material was used as it represented the best of this topic on the ‘net. However, I will remove your work if requested.


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