An institutionalized man with severe mental disability and cerebral palsy, admitted from the ED with suspected aspiration pneumonia, died after a long struggle with respiratory difficulties. The cause of death was determined to be asphyxia resulting from a complete obstruction of the posterior pharynx and upper larynx by thickened oral and nasopharyngeal secretions. Although airway obstruction is common in people with motor or neurologic disorders and in those who are chronically debilitated or institutionalized, food and foreign matter are not the only culprits. This case serves to remind clinicians that a failure to provide good oral care and adequate hydration is not only poor practice but can result in death.
One case shows the tragedy that can occur when oral care is neglected.
Joseph A. Prahlow is a forensic pathologist at the South Bend Medical Foundation and a professor of pathology at Indiana University School of Medicine-South Bend at the University of Notre Dame. Tamara J. Prahlow is the director of Sonblest School in Galien, MI. Rex J. Rakow, now deceased, was a deputy coroner with the St. Joseph County Coroner's Office in South Bend, IN. Nathan D. Prahlow is the interim chairperson and an assistant professor of clinical physical medicine and rehabilitation in the Department of Physical Medicine and Rehabilitation at the Indiana University School of Medicine in Indianapolis. The authors dedicate this article to Mr. Rakow's memory. They have disclosed no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.
Contact author: Joseph A. Prahlow, firstname.lastname@example.org.