During a riot-control operation, a detainee held in a lateral vascular neck restraint suddenly becomes limp and unresponsive about 15 seconds after the hold is applied. The immediate mechanism of unconsciousness is:

• A Complete obstruction of the laryngeal airway
• B Reflex apnoea from pressure on the carotid body chemoreceptors
• C Bilateral compression of the carotid arteries with abrupt reduction of cerebral blood flow ✓
• D Compression of the vertebral arteries against the cervical transverse processes

Explanation

The carotid sleeper hold or mugging compresses both carotid arteries against the cervical spine while sparing the airway, dropping cerebral perfusion and producing loss of consciousness in roughly 10 to 15 seconds. Airway obstruction would take several minutes to cause unconsciousness, which is what distinguishes a vascular restraint from a true chokehold. If the hold is maintained beyond a few minutes, irreversible brain damage or death follows, and the technique has caused well-documented custody deaths.

Reference: Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.