By: Megan M. Hamilton, MS, CCC-SLP
Tel: 952-212-0578
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Ms. Hamilton
Megan M. Hamilton MS CCC-SLP, the forensic Speech Language Pathologist (SLP) at Lios Manhe LLC, is experienced in analyzing a variety of medical conditions and their effect on airway protection and swallow function. SLPs do not determine cause of death but offer insight on whether the events documented are consistent with aspiration, airway blockage and choking to death.
A choking death secondary to obstruction of the airway by food material occurs over a period of time, typically between three and six minutes, and manifests signs of asphyxiation. Heart attack/Myocardial Infarction/Myocardial Ischemia/Cardiac Arrest is the depletion of oxygen to the heart muscle with death of heart tissue typically causes the stricken individual to pass out and collapse within seconds with death occurring in a short period of time. Myocardial Infarction does not manifest signs and symptoms of choking.
Cardiac arrest does mimics choking through food material being found in the trachea or larynx during autopsy or resuscitative efforts. Nausea and Vomiting are nonspecific gastrointestinal symptoms that occur during a heart attack with some regularity. Although the exact number of patients who suffer these symptoms is not known, one study demonstrated that about 69% of people who have a heart attack in the lower-back portion of the heart report nausea and vomiting, while only about 27% of those who have a heart attack in the front portion of the heart experience the same problems. Studies to date are not consistent in percentages or cardiac locations but are consistent in demonstrating nausea and vomiting during a heart attack.
The trachea and esophagus are anatomically adjacent with only the upper esophageal sphincter (UES) preventing material from exiting the esophagus and entering the trachea. During vomiting, the UES is open, thus the expulsion of material from the stomach through the esophagus and into the pharynx and ideally out the mouth. Material in the pharynx can enter the trachea or be held in the pyriform sinuses and later breathed into the airway or appear to block the trachea.
Increasing the likelihood of aspiration of stomach contents is the fact that more than half the patients in cardiac arrest gasp. This gasp is a survival reflex triggered by the brain and can increase the chances of survival for someone in cardiac arrest. It also serves to capture any materials in the oral cavity, pharynx or larynx and pull that material into the trachea and lungs. During this gasp, large chunks of material can enter the trachea and either occlude the airway or give the appearance of occluding the airway.
Documentation review for physical manifestations of choking as well as understanding the relative strengths and merits of underlying swallowing and respiratory functions can heavily influence the decision to settle or proceed. Contact hamilton@liosmanheLLC for forensic Speech Language Pathology expertise.Megan M. Hamilton, MS, CCC-SLP, earned her Master of Science degree from Marquette University and holds a lean six sigma green belt from Purdue University as well as a Certificate of Clinical Competence from the American Speech Language and Hearing Association (ASHA). Megan currently provides consultation to hospital speech language pathology and serves as a forensic medical SLP throughout the United States. Megan has held positions as direct care provider, site manager, regional vice president, and division manager of clinical education for national rehabilitation providers in long term care, sub acute, and pediatric care. She brings over 30 years of experience to her clients.
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8/17/2023· Speech-Language Pathology
Common Manifestation Of Death By Choking
By: Megan M. Hamilton, MS, CCC-SLP
It is not uncommon for documentation or discussion to use the term “choking” to describe instances in which food or liquid went “down the wrong pipe” or a significant cough occurred. Those instances are not, in fact, choking in the sense of foreign body airway obstruction that leads to death by asphyxiation.
3/20/2024· Speech-Language Pathology
By: Megan M. Hamilton, MS, CCC-SLP
Food material found in the airway or trachea in an autopsy gives the impression the patient choked to death and suggests liability on the providers’ part. That may be the case, some deaths simply are by choking and secondary to failure on the part of a caregiver to follow diet orders, feeding tactics, postural recommendations, compensatory strategies and/or other safe swallow recommendations.
1/15/2024· Speech-Language Pathology
Forensic Speech Language Pathologist And Dehydration In The Elderly
By: Megan M. Hamilton, MS, CCC-SLP
This article will address how a forensic speech language pathologist (SLP) can assist in determining if dehydration leading to hypernatremia or hyponatremia in the elderly can be considered a result of unmanaged dysphagia, substandard care, negligence on the part of medical staff or an unavoidable consequence of a medical condition.
