Fatal outcome of a sand aspiration

Abstract

Although extensive deep aspiration of sand, gravel, or dirt is a very rare incident, its consequences may be severe ranging from the necessity of immediate intensive care to death. Cases reported so far were due to external causes such as cave-ins, near drowning, or being buried under sand masses. We report a case of a 2 1/2-year-old boy who ingested sand while playing in a sandbox with his older brother. Despite early resuscitation and endotracheal intubation efforts, he died subsequently showing clinical signs of asphyxia due to airway obstruction. Autopsy revealed sand masses obstructing the trachea and lobar bronchi of both lungs as well as brain edema, while no signs of blunt trauma, forced sand ingestion, or preexisting medical conditions were found. This case demonstrates that fatal self-administered sand aspiration may occur in early childhood. The pathophysiology of the lethal outcome with regard to the physical properties of sand and implications for the clinical assessment of emergency situations are discussed.

Unique drowning in an atypical medium: paraffin wax in the setting of a motor vehicle crash—case report and literature survey

“…Indeed, both Hewer [58] and Bonilla-Santiago [59] detailed cases of drowning in heavy surf where, as a result of a thick suspension of sand mixed with sea water, there was obstruction of the mouth, pharynx, and the majority of the tracheobronchial tree, which were densely packed with sand. A number of cases involving sand as the sole medium have been reported, as referenced by Kettner [60]. Although Lothe [61] authored perhaps the first fatal case involving only sand in 1964, despite its title (''Drowning'' in sand), this report is not wholly representative of the expected findings, as the author acknowledges the cause of death ''…was not direct obstruction of the air passages by inhalation of sand…as there was not enough sand in the mouth, trachea or bronchi to have caused obstruction.''…”

The soiled paediatric airway ‐ a case report and literature review of massive soil aspiration

“…soil, sand) should consist of vigorous attempts to clear the larger airways before commencing ventilation [3,4]. Fine dry soil can behave in a semi-fluid manner (like sand), so breathing and coughing can also cause migration of small particles distally [1]. Fine dry soil can behave in a semi-fluid manner (like sand), so breathing and coughing can also cause migration of small particles distally [1].…”

“…on construction sites or tunnel cave-ins) and, occasionally, due to intentional burial [1]. However, massive aspiration of soil is rare, even in the adult population, with most case reports of massive particulate aspiration involving sand.…”

“…Massive soil aspiration in adults tends to be associated with muddy water drowning, motor vehicle accidents, accidental burials (e.g. on construction sites or tunnel cave-ins) and, occasionally, due to intentional burial [1]. In the paediatric population, sand and soil aspiration most often occurs following accidental ingestion [1].…”

Classification of Asphyxia: The Need for Standardization

“…Yet, one team called it smothering while the other considered it as choking. Probably in response to this bewilderment with definitions, some authors do not employ the words smothering or choking and use instead less specific appellations, such as ''aspiration of foreign bodies'' or ''asphyxia by obstruction of the airways'' (29)(30)(31)(32)(33)(34)(35).…”