Can you give me one example of this happening and resulting in a death. Every death from a domestic head injury Ive heard of involves death later in hospital
Suppose you have a situation when a child does not have adult supervision, they fall and become unconscious. In some cases the child (or adult) has either a compromised airway or an airway without patency. Blood oxygen saturation levels drop scarily quickly in children. Very quickly cyanosis. is evident. Simple head tilt chin lift manoeuvres will often resolve the situation (depending on the exact cause - airway obstruction or apnoea). If there's no adult supervision to perform basic life support and the child remains hypoxic then death would occur in around five minutes.
You're correct that most brain injuries that cause apnoea are witnessed in hospital because it takes time for the trauma to cause apnoea (depending on the nature of the injury). But if a victims airway is compromised or totally obstructed then unless they receive immediate life support then they will arrest and die very quickly (particularly children). Someone posted the example of the young lass in Asda who asphyxiated on a coat zip toggle.
Falls are the most common cause of domestic trauma. I see about three a week where the patient needs intubating in A&E because of lack of airway patency due to head trauma (and it's not a big city hospital).
Here's a medical website on the most common cause of upper airway obstruction:
https://blog.sscor.com/what-are-the-most-common-causes-of-upper-airway-obstruction
Airway obstructions are common and may even be underreported. The prevalence and type of airway obstruction varies with age. Children younger than 4, for example, are more vulnerable to choking-related upper airway obstructions, and adults commonly experience airway obstruction caused by complications from smoking. First responders will inevitably encounter a wide variety of airway obstructions and must be prepared to promptly respond to each with appropriate medical care. Here are the most common causes of upper airway obstruction.
Tongue-Related Airway Obstruction
A relaxed tongue is the most common cause of upper airway obstruction in patients who are unconscious or who have suffered spinal cord or other neurological injuries. The tongue may relax into the airway, causing an obstruction. In some cases, other injuries complicate this phenomenon. For example, a patient who is unconscious following a blow to the head may also have suffered upper airway trauma, causing both the tongue and the trauma to block the airway.
Foreign Body/Choking
The most common cause of airway obstruction in children is a foreign body lodged in the airway. Choking can fully or completely obstruct the airway. Small toys, round foods such as berries and grapes, rocks, pebbles, and other enticing objects are common culprits. Eighty-eight percent of airway obstruction deaths occur in children younger than 4, highlighting the need for vigilance about children’s access to small objects and breakable toys.
Trauma
Traumatic injuries can directly obstruct the airway, such as when a gunshot or knife wound collapses portions of the airway. Trauma can also cause continuous bleeding or vomiting that obstructs the airway, making airway management difficult and increasing the risk of aspiration pneumonia. In the latter scenario, continuous suction via the SALAD technique can clear the airway and lower mortality risk.
Traumatic brain and spinal cord injuries may also lead to upper airway obstruction. If a patient cannot clear their own airway, they may require suctioning. In some cases, brain and spinal cord injuries inhibit the brain’s ability to control breathing, coughing, and other important respiratory functions.
