Objectives
You will be able to identify signs and
symptoms in a child who is “playing the
choking game.”
2. You will be able to describe the
pathophysiology of brain cell death with
the use of this practice.
3. You will understand how to teach youth
how to respond to those encouraging this
practice.
4. Understand current statistics on this
practice and how deadly it has become in
the teen population.
1.
Choking game defined:
Known as “the choking game”, this
practice occurs mainly in the young
adolescent and teen ages, and has
brought forth untimely death in too many
children.
 It refers to intentionally cutting off the
oxygen supply to the brain with the goal
of producing a temporary syncope and
euphoria.

Reasons Kids do this?
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During school, to get out of class
Peer pressure; challenge of a dare; a rite of
passage into a social group; amusement
over erratic behavior.
Curiosity in an altered state of
consciousness
A belief it induces euphoria
Intensifying an existing high while under the
influence of ecstasy or LSD.
The prospect of intoxication, at NO COST.
Demographics:
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The majority of participants are male (87%
in 2008 data). Yes, girls die, too.
North Carolina had a rate of 25% female in
2008, higher than the average of 13%.
Age ranges from 6-19 years, with the most
fatalities in the 11-16 year range.
In 2008, 45 states had reported cases.
This has no geographic boundary; it
happens in rural and metropolitan areas,
alike.
Demographics:
In 2008, Texas and California had the
highest number of cases.
 96% of deaths occurred while the youth
was ALONE.
 93% of the parents had never heard of
this practice until their child died from it.
 The actual rates of death from this
practice is probably much higher than is
reported; many are deemed a suicide by
hanging;

Demographics:
From 1995-2007, deaths attributed to the
choking game numbered 82 (U.S.) in youth
aged 6-19 years.
 From 2007-2011, deaths due to choking
game in USA=135.
 The number of deaths attributed to suicide
by hanging/suffocation in youth age 6-19
years numbered 5,101 from 1999-2005.

Source: Choking game deaths, news media reports,
suicide by hanging/suffocation, National Vital Statistics
System.
Additional Age Info:
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2011: 9,11,12, 13 & 17 year olds have died
2010: ranges from 8-21, with ages 12, 13,
& 14 tied as largest group range
2009: ages 6-23; age 13 largest group
2008: ages 7-20, 22,28, 30, & 37. Age 12,
again, had the highest number cases.
2007: ages 7-23, 25, 41, & 51. Age 12
had the largest group.
Countries Affected: 2006-2011

USA, Canada, India, France, Ireland,
Korea, Malaysia, Peru, South Africa,
Australia, Egypt, England, Germany,
New Zealand, Jamaica, Russia,
Scotland, Greece, Italy, and Mexico.
New Data: Known stats
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2011: 8 deaths in USA and 1 recovery,
1 death in England,
2010: 42 cases worldwide, 25 were USA;
10 USA cases recovered.
2009: 75 cases worldwide, 47 were USA;
18 USA cases recovered.
2008: 126 cases worldwide: 84 were
USA; only 5 of those recovered
2007: 147 worldwide cases. 77 were from
USA; 12 recovered
2 Mechanisms of Injury

A ligature around the neck or pressure
on the internal carotid artery, known as
STRANGULATION, causes two
significant responses:
1. Pressure on the carotids also induces
pressure on the baroreceptors, which
cause vasodilation in the brain leading
to insufficient brain perfusion, thus
unconsciousness occurs.
2 Mechanisms of Injury:
2. A message via the vagus nerve to the
SA node decreases the rate and volume
of cardiac output, typically by up to 1/3.
This may escalate into asystole. With no
heartbeat, no oxygen, death may result.
2 Mechanisms of Injury:

SELF-INDUCED HYPOCAPNIA

This requires hyperventilation until
symptoms of hypocapnia occur, such as
tingling, light-headedness dizziness.
Then, holding the breath or having the
chest compressed by an accomplice.
These actions may augment the effects
of hypoxia by causing more vagal
stimulation.
2 Mechanisms of Injury:

Hyperventilation leads to excessive
elimination of CO2. No additional O2 is
breathed in. The blood becomes
abnormally alkaline. Alkalosis interferes
with normal oxygen use by the brain.
Symptoms include neuromuscular
irritability, muscle spasms, numbness &
tingling of the extremities and circumoral
areas, dizziness, & giddiness, often
interpreted as euphoria.
2 Mechanisms of Injury:
Alkalosis generally induces vasodilation in
the body, but in the brain, it causes
vasoconstriction. This vasoconstriction is
worsened by a sudden increase in blood
pressure caused by holding the breath.
The alkalosis-induced euphoria can lead
rapidly to hypoxia-induced
unconsciousness.
 The brain has a very low tolerance for
hypoxia if vasoconstriction is not reversed.
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2 Mechanisms of Injury:
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Normally, if the brain is hypoxic, the ANS
in the body diverts blood to the brain.
Because the brain is vasoconstricted,
this mechanism is not available. Vasoconstriction is reversed when CO2
builds up in the blood. If this buildup
does not happen quick enough, or
vasodilation does not occur, irreversible
brain damage or death is a reality.
Results of the Practice:

With strangulation and self-induced
hypocapnia blackouts, the victim my
experience dreaming, hallucinations,
short-term memory loss, seizure-like
activity. Full recovery usually occurs
within seconds, but these activities may
cause permanent brain injuries or death,
particularly when “played” alone or with
a ligature.
Common names in UK, USA, and
Australia:

Fainting game, Riding a Rocket, Airplaning, America
Dream Game, Black Out, Breath Play, Bum Rushing,
California Choke, California Dreaming, California
High, California Knockout, Choking out, Cloud Nine,
Dying game, Dream game, Elevator, Flatline Game,
Flatliner, Funky Chicken, Harvey Wallbanger,
Hyperventilation Game, Indian Headrush, Knockout
game, Pass-out game, natural high, sleeper hold,
Space Cowboy, Space Monkey, Suffocation game,
Suffocation Roulette, Teen choking game, Rising
Sun, High Riser, Tingling Game, Trip to Heaven,
Rocket Ride, Speed Dreaming, Wall-Hit, and Purple
Dragon.
Other information:
Unlike autoerotic asphyxia, this practice
is NOT COMMON IN ADULTS, but has
been done by adults.
 It can be ADDICTIVE.
 Sources for information include:
http://chokinggame.net,
www.gaspinfo.com.

Signs to look for:

Discussion of the game and it’s terms;
bloodshot eyes; marks on the neck;
severe headaches; disorientation after
spending time alone; ropes, scarves,
and belts tied to bedroom furniture or
doorknobs, or found on floor;
unexplained presence of items like dog
leashes, choke collars, bungee cords,
etc.
Bibliography
Fainting Game. http://en.wikipedia.org/.
11/01/2010.
 GASP: Choking Game Community
Support. www.gaspinfo.com. Accessed
11/01/2010, 4/8/2011..
 Gardner, Amanda. ‘Choking Game’ Turned
Deadly. 2/14/2008. The Washington Post.
 Statistics. http://chokinggame.net.
Accessed 10/2/2010 & 4/8/2011.
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