The Choking Game Is it a game

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The Choking GameIs it a game?

• Viking A. Hedberg, M.D.,M.P.H.
• Pediatrician
• Childrens Hospital at Dartmouth

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Why make such a big deal about this?
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Roulette

• 30-40 deaths/year in the country
• 87 were boys
• Average age was 13
• Most occurred when teen was alone
• Hard to measure minor injuries

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Community of Caring
Values are the reasons we give for what we do,
for how we live our lives -William Sullivan,
Carnegie Foundation

• Caring
• Respect
• Responsibility
• Trust
• Family

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Why am I here as a doctor?

• Achieve the healthiest (adolescent) population
  possible
• Help families raise children who become
  productive, responsible, healthy, well-adjusted
  adults
• Strive to optimize our patients quality of life
• Prevent the irreversibles
• Death/injuries
• AIDS
• School failure
• Drug abuse and dependence
• Unwanted pregnancy

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What is in your brain?

• Neurons (100 billion or 1011)
• Glial cells (Probably around 1012)
• Vascular network

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Neuronal networks are complex and changing

• Each neuron connects with multiple other neurons
• .15 quadrillion synapses 1.5X1023
• Lots of changes during childhood and adolescence
• Myelination
• Pruning

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Brains from KG to College
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Development in motion
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Learning involves changing the wiring

• Network modified over time depending on what your
  brain experiences-
• Skills foul shooting, playing piano, languages,
  writing, mathematics
• Emotional responses
• Nurture versus abuse
• Really like something-tastes, smells, sensations,
  addictions
• Injury-hypoxia or certain drugs

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What do neurons need to thrive and survive?

• The right milieu
• Glucose
• Oxygen

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Vasculature
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Cast of cerebral vasculature
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What happens in the choking game?

• Reduce blood flow through the vasculature
• Brain cells dont get enough oxygen
• Hypoxia causes brain cells to malfunction rush,
  euphoria, faint, seizure
• Injury and cell death
• Minor insult-changes to the neuronal network
• Global injury-you die

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Vasculature
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Why make such a big deal about this?
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Failure is not an option