choked

• adj.

• (声が)詰まった

関

choke

　

WordNet

1. stopped up; clogged up; "clogged pipes"; "clogged up freeways"; "streets choked with traffic" (同)clogged
2. the atmosphere in a mine following an explosion; high in carbon dioxide and incapable of supporting life (同)blackdamp
3. fail to perform adequately due to tension or agitation; "The team should have won hands down but choked, disappointing the coach and the audience"
4. constrict (someones) throat and keep from breathing (同)strangle
5. reduce the air supply; "choke a carburetor" (同)throttle
6. breathe with great difficulty, as when experiencing a strong emotion; "She choked with emotion when she spoke about her deceased husband"
7. a coil of low resistance and high inductance used in electrical circuits to pass direct current and attenuate alternating current (同)choke coil, choking coil
8. a valve that controls the flow of air into the carburetor of a gasoline engine
9. be too tight; rub or press; "This neckband is choking the cat" (同)gag, fret
10. wring the neck of; "The man choked his opponent" (同)scrag
11. check or slow down the action or effect of; "She choked her anger"

PrepTutorEJDIC

1. …'を'『息を止める』,'を'窒息させる / (…で)…'を'むせさせる,息苦しくする《+『名』+『with』(『by』)+『名』》 / (…で)…'を'いっぱいにする,ふさぐ,(…を)…‘に'ぎっしり詰める《+『名』+『up』(+『up』+『名』)+『with』+『名』》 / …'を'進行(動き)を止める / 『息が詰まる』,窒息する / (…で)むせぶ,息苦しくなる《+『with』+『名』》 / 〈U〉〈C〉窒息,息が詰まること / (パイプの中などの)閉塞(へいそく)部 / 〈C〉(電気器具の)チョークコイル / 〈C〉チョーク(ガソリンエンジンの空気調整装置)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/05 10:25:13」(JST)

wiki en

[Wiki en表示]

"Chocking" redirects here. For the mechanical tool, see Wheel chock.

For the act of compressing someone's neck, see Strangling. For other uses, see Choke.

Choking
Classification and external resources
A demonstration of abdominal thrusts on a person showing signs of choking
ICD-10	F41.0, R06.8, T17, W78-W80
ICD-9	784.9, 933.1
MeSH	D000402

Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal. Oxygen stored in the blood and lungs keep the victim alive for several minutes after breathing is stopped completely.

Choking can be caused by:

• Physical obstruction of the airway by a foreign body.
• Respiratory diseases that involve obstruction of the airway.
• Compression of the laryngopharynx, larynx or vertebrate trachea in strangulation.

Symptoms and signs

• The person cannot speak or cry out, or has great difficulty and limited ability to do so.
• Breathing, if possible, is labored, producing gasping or wheezing.
• The person has a violent and largely involuntary cough, gurgle, or vomiting noise, though more serious choking victims will have a limited (if any) ability to produce these symptoms since they require at least some air movement.
• The person desperately clutches his or her throat or mouth, or attempts to induce vomiting by putting their fingers down their throat.
• If breathing is not restored, the person's face turns blue (cyanosis) from lack of oxygen.
• The person does any or all of the above, and if breathing is not restored, then becomes unconscious.

Cause

The type of choking most commonly recognized as such by the public is the lodging of foreign objects (also known as foreign bodies, but consisting of any object which comes from outside the body itself, including food, toys or household objects) in the airway.

This type of choking is often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst the patient is eating. In one study, peanuts were the most common obstruction.

Treatment

A device used to self administer the Heimlich

Choking can be treated with a number of different procedures, with both basic techniques available for first aiders and more advanced techniques available for health professionals. In the United States, members of the public commonly assume that abdominal thrusts, also known as the Heimlich Maneuver, are the correct procedure for choking, due to widespread promotion of this technique in the past, including recommendations from the American Heart Association and the American Red Cross. People elsewhere also often assume this, due in part to widespread use of this technique in movies.^{[citation needed]}

Most modern protocols, including those of the American Heart Association and the American Red Cross, recommend several stages, designed to apply increasingly more pressure. The Red Cross changed their recommendation in 2006, ending their promotion of abdominal thrusts as the primary treatment for choking.

The key stages in most modern protocols include:

Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by an irritating substance rather than an obstructing one, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for a short time.

Back slaps

The majority of protocols now advocate the use of hard blows with the heel of the hand on the upper back of the victim. The number to be used varies by training organization, but is usually between five and twenty.

The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway.

Almost all protocols give back slaps as a technique to be used before potentially damaging interventions such as abdominal thrusts. Henry Heimlich, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe. The 1982 Yale study by Day, DuBois, and Crelin that "persuaded the American Heart Association to stop recommending back blows for dealing with choking...was partially funded by Heimlich's own foundation." According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."

Abdominal thrusts

Abdominal thrusts, also known by the proprietary name the Heimlich maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary", published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure. Heimlich has objected to the name "abdominal thrusts" on the grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the wrong site.

Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.

Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.

In some areas, such as Australia, authorities believe that there is not enough scientific evidence to support the use of abdominal thrusts and their use is not recommended in first aid.

Self treatment with abdominal thrusts

A person may also perform abdominal thrusts on themselves by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuer's hands would normally do so. As with other forms of the procedure, it is possible that internal injuries may result.

Modified chest thrusts

A modified version of the technique is sometimes taught for use with pregnant and/or obese patients. The rescuer places their hand in the center of the chest to compress, rather than in the abdomen.

Finger sweeping

The American Medical Association advocates sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions, once the choking victim becomes unconscious.

Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth.^{[citation needed]} However, many modern protocols recommend against the use of the finger sweep since, if the patient is conscious, they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique.

Direct vision removal

The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start breathing on their own. Severe cases where there is an inability to remove the object may require cricothyrotomy.

CPR

In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving both chest compressions and artificial respiration. These actions are often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the lungs.

Notable cases

• The President of the United States, George W. Bush, survived choking on a pretzel on January 13, 2002, an event that received major media coverage.
• Jimmie Foxx, a famous Major League Baseball player, died by choking on a bone.
• Tennessee Williams, the playwright, died after choking on a bottle cap.
• An urban legend states that obese singer Mama Cass choked to death on a ham sandwich. This was borne out of a quickly discarded speculation by the coroner, who noted a partly eaten ham sandwich and figured she may have choked to death. In fact, she died of a heart condition, often wrongly referred to in the media as heart failure.
• Queen Elizabeth The Queen Mother was admitted to hospital for an operation in May 1993 after choking on a fish bone.

Other uses of abdominal thrusts

Dr. Heimlich also advocates the use of the technique as a treatment for drowning and asthma attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Criticism of these uses has been the subject of numerous print and television reports which resulted from an internet and media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.

See also

• Pulmonary aspiration

References

External links

• Choking at the Open Directory Project

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 小児における気道異物 airway foreign bodies in children
• 2. 小児および思春期における”窒息ゲーム”およびその他の首絞め行動 the choking game and other strangulation activities in children and adolescents
• 3. 成人における気道内異物 airway foreign bodies in adults
• 4. 幼児および小児における嚥下障害による誤嚥 aspiration due to swallowing dysfunction in infants and children
• 5. Swallowing disorders and aspiration in palliative care: Assessment and strategies for management

English Journal

• All choked up about the pseudotumor cerebri syndrome.

• Galetta SL, Balcer LJ.SourceFrom the Department of Neurology, Division of Neuro-ophthalmology, NYU School of Medicine, New York, NY.
• Neurology.Neurology.2013 Aug 14. [Epub ahead of print]
• The diagnosis of pseudotumor cerebri, or idiopathic intracranial hypertension (IIH), is most confidently established in the typical patient with evidence of papilledema, imaging that does not suggest a structural lesion, and a CSF examination that shows both normal composition and elevated intracran
• PMID 23946302

• Biogeochemical responses to nutrient inputs in a Cuban coastal lagoon: runoff, anthropogenic, and groundwater sources.

• González-De Zayas R, Merino-Ibarra M, Soto-Jiménez MF, Castillo-Sandoval FS.SourcePosgrado en Ciencias del Mar y Limnología, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacán, Mexico, DF, 04510, Mexico.
• Environmental monitoring and assessment.Environ Monit Assess.2013 Jul 16. [Epub ahead of print]
• Laguna Larga, a coastal lagoon in central Cuba, has been heavily altered by tourism infrastructure construction and sewage disposal. We hypothesize that this has decreased the circulation and caused eutrophication of the lagoon. To assess this, 12 bimonthly samplings were carried out in 2007-2008. T
• PMID 23856810

• Possibility for the development of cosmetics with PLGA nanospheres.

• Ito F, Takahashi T, Kanamura K, Kawakami H.SourceDepartment of Applied Chemistry, Graduate School of Urban Environmental Sciences, Tokyo, Metropolitan University, Hachioji, Tokyo, Japan. fuminoito@spice.ocn.ne.jp
• Drug development and industrial pharmacy.Drug Dev Ind Pharm.2013 May;39(5):752-61. doi: 10.3109/03639045.2012.696653. Epub 2012 Jun 22.
• The optimized preparation of Poly-(lactide-co-glycolic acid) (PLGA) nanospheres containing ubiquinone (UQ) for cosmetic products was pursued. By investigating various conditions for the preparation of UQ/PLGA nanospheres such as the molecular weight of PLGA, PLGA concentration, and UQ concentration,
• PMID 22725249

Japanese Journal

• 桜島火山における寄生火口の噴火(<特集>桜島火山)

• 横山 泉
• 火山 58(1), 91-102, 2013-03-29
• 桜島火山には多くの寄生火口が地質及び地形の面から認められている.また,その噴火史において寄生火口の噴火がしばしば記録されている.寄生火口の分布パターンを調べるのに,色んな方法が提案されてきたが,ここでは,火山中心から半径方向の密度分布(km^2当たり)を調べた.一般論として,火山の下に点力源を仮定して,地表面で直応力の分布と水平差応力の分布を考え,岩石の強度を考慮すると,寄生火口の生ずる地点の見当 …
• NAID 110009597094

• Morphologic and functional changes in retinal vessels associated with branch retinal vein occlusion.

• Muraoka Yuki,Tsujikawa Akitaka,Murakami Tomoaki,Ogino Ken,Kumagai Kyoko,Miyamoto Kazuaki,Uji Akihito,Yoshimura Nagahisa
• Ophthalmology 120(1), 91-99, 2013-01-00
• … In all eyes with venous overcrossing, the retinal vein appeared to be compressed and choked between the internal limiting membrane and the arterial wall at the A/V crossing. …
• NAID 120005241454

• 鳥取層群産魚類化石のタフォノミー : その2:堆積相と魚類化石層の形成プロセス

• 浅野 弦一,矢野 孝雄,平尾 和幸 [他],田中 優一
• 地球科學 66(5), 177-191, 2012-09-25
• 鳥取市国府町宮下の西黒沢海進期堆積物からは,浅海性魚類化石が多産する.魚類化石のタフォノミー解明の一環として,この論文では中-下部中新統鳥取層群の堆積相を解析し,魚類化石層の形成プロセスを明らかにする.主な結論は,次の4点にまとめられる.1)鳥取層群の堆積相解析によって,各層準の堆積環境は次のように復元された:蛇行河川〜扇状地(円通寺礫岩砂岩泥岩層),湖成デルタ(生山砂岩泥岩層),蛇行河川-氾濫原 …
• NAID 110009517987

Related Links

• Choked | Define Choked at Dictionary.com

verb (used with object) 1. to stop the breath of by squeezing or obstructing the windpipe; strangle; stifle. 2. to stop by or as if by strangling or stifling: The sudden wind choked his words. 3. to stop by filling; obstruct; clog: Grease ...

• CHOKED | Facebook

CHOKED. 90 likes · 0 talking about this. ... Choked gonna give yaz a teaser of a new track tonight called "SCORCHED". no bassist yet so its only drums, guitar and 1 vocal but its still sounds like a BEAST!!!

• Urban Dictionary: choked

mad or upset ... 1. choked mad or upset I was so choked my car got stolen, so i found the person who did it and pushed him into a wall, he was pretty choked. mark as favorite buy choked mugs & shirts

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 76」「うっ血乳頭」
関連記事	「choke」

「100Cases 76」

　　[★]

☆case76　頭痛

■glossary

傾眠 drowsiness 正常、病的の区別なく眠り込む場合に用いられる

意識不鮮明　confusion 周囲に対する認識や理解は低下し、思考の清明さや、記憶の正確さが失われる

錯乱　confusion　夢幻様状態より見当識障害と思考の滅裂が見られる状態(PSY.40)

MA = Master of Arts 文学修士

　The Master of Arts (BrE: MA, UsE: M.A.) is awarded in Arts, Humanities, Theology and Social Sciences (Wikipedia)

graduate student 大学院生

rousable adj. 覚醒できる、目を覚ますことができる

rouse vt. ～の目を覚まさせる、呼び起こす。喚起する、鼓舞する、奮起させる。(感情を)起こさせる、かき立てる

lateralize vt. (生理)(大脳が)(左右半球に心的機能差がある、左右差がある。(器官・機能・活動などが)大脳の(左右いずれかの)片側優位下にある。(医学)(障害などが)大脳の片半球にあると診断される

乳頭浮腫 papilledema 原因を問わず視神経乳頭が腫脹している状態

うっ血乳頭 choked disc 脳圧亢進による乳頭浮腫

■症例

24歳、男性　精神学の修士過程を専攻している大学院生

主訴：激しい頭痛

現病歴：頭部全体に痛みがある。2回嘔吐。傾眠と錯乱が認められるようになった。明るい光を嫌う()he finds bright lights uncomfortable。

既往歴：病気の既往はない。アレルギーはない。タバコ1日10本。アルコール24 unit/week(缶ビール(350ml)13.7本/週)。薬は服用してない。

家族歴：彼女と同居。3歳と4歳の子供がいる。

・診察 examination

　見た感じ紅潮しており、調子が悪そう。体温：39.2℃。項部硬直あり(he has stiffness on passice flexion of his neck)。皮疹なし。副鼻腔に圧痛なし。鼓膜所見は正常。脈拍：120/分。血圧：98/74 mmHg。心血管系、胸部、腹部に異常所見なし(normal)。意識レベル低下。命令に応じて覚醒する(JCS10？)。局所神経症状認めない。眼底所見正常

・検査 investigation

　血液検査

　　白血球：上昇。血清Na：低下。血清尿素：上昇。血清クレアチニン：上昇。血液培養：検査中

　画像検査

　　胸部X線：異常所見なし。頭部CT：正常

　心電図：洞性頻脈

　腰椎穿刺

　　髄液所見：混濁。白血球：増多。蛋白：増多。糖：低下(普通の人の血糖100mg/dLと考える。→　1g/L　→　1/180　mol/L　→　5.56 mmol/L。グラム染色：結果待ち

■Q

　診断、鑑別診断、管理

■A

　細菌性髄膜炎、髄膜炎・クモ膜下出血、経験的抗菌薬投与・

■解説

(第1パラグラフ)細菌性髄膜炎

・(症状)突然発症。激しい頭痛、嘔吐、錯乱、羞明、項部硬直

・低血圧、白血球増多、腎機能低下　→　ウイルス性よりむしろ細菌性の感染を示唆する。　←　重症敗血症～敗血症ショックかな？(私見)

・(髄膜炎菌の種類)

＜テーブル挿入　髄膜炎＞

・(疫学)HIM. 2621 (多分、全患者中(←私見))

　Streptococcus pneumoniae ～50%

　Neisseria meningitidis ～25%、

　group B streptococci ～15%

　Listeria monocytogenes ～10%

　Haemophilus influenzae type B <10%

・Neisseria meningitidisは全身性の脈管の皮疹(点状出血、紫斑)が特徴的(generalized vasculitic rash)

(第2パラグラフ)鑑別診断

・激しい頭痛

　・the most severe headaches are experienced in meningitis, subarachnoid hemorrhage and classic migraine.

　　・meningitis：単回の発作(single episode)。症状は時間単位で出現。

　　・subarachnoid hemorrhage：単回の発作(single episode)。突然発症(突発完成？)。硝子体出血を認めることがある。

　　・classic migraine：繰り返す(数回/年～1回/週。平均月2回。発作は4-72時間継続)

・髄膜刺激：急性に発熱をきたした多くの病態でみられる(acute febrile conditions)。特に子供。　←　そうなの？

・頚部硬直：頚部や脊椎の局所感染症でも起こる。　←　パーキンソン病などによる筋トーヌスの異常亢進も除外しよう

・他の髄膜炎：脳脊髄液所見で鑑別する

(第3パラグラフ)経験的治療

・(細菌性)髄膜炎が疑われたら、確定診断する前に適切な抗菌薬を投与(empirical treatment)。　→　数時間の経過で死亡することがある。

・ペニシリンアレルギーがなければ、ceftriaxoneかceftaximeの静脈内投与が一般的な治療法

(第4パラグラフ)腰椎穿刺

・乳頭浮腫がない、あるいは占拠性病変を示唆する片側性の神経徴候(lateralized neurological signs)がある患者では(CTの結果を待たずに)腰椎穿刺をすぐにやるべき(CASES)　←　どういう事？

・局在性の神経徴候(localized neurological sign)がある場合はまずCTを撮るべき(CASES)。　→　the dangers of coning　←　鉤ヘルニアの事？

(第5パラグラフ)細菌性髄膜炎の管理

・診断：CSF検査(グラム染色、髄液培養(確定診断、感受性試験)

・管理

　・意識が低下しているのでそれなりの看護(must be nursed)。アヘン剤による鎮痛。生理食塩水による低ナトリウム血症の補正。低血圧を補正するためにinotrope(a drug with positive inotropic effects, e.g. dobutamine, digitalis, milrinone )も必要かもしれない。(100CASES)

　・感受性のある抗菌薬の投与(大量静注、髄液移行性の高いもの)、髄液所見の正常化・CRP 陰転後、1週間抗菌薬を投与して治療を終了。対症療法として脳圧亢進には高張脳圧降下薬(マンニトールなど)を投与。(IMD.1042)

(第6パラグラフ)家族構成を考えた治療

・(意訳)誰が3-4歳の世話をしていたのか分からないけど、子供も検査すべき。髄膜炎菌か原因菌が不明だったら、リファンピシンによる予防的治療と髄膜炎球菌に対する予防接種をすべき。　←　日本ではどうなんでしょうか。

□350ml アルコール5%

350x0.05/10=1.75 unit

■莢膜を有し、髄膜炎を起こす細菌　→　莢膜を有することで血液中で補体などを介した貪食を免れ、血行性にクモ膜下腔まで到達しうる。

・Streptococcus pneumoniae

・Haemophilus influenzae type b

・Neisseria meningitidis

■敗血症

・定義

　感染症による全身性炎症反応症候群(SIRS)をセプシス(sepsis, 広義の敗血症？)とする

　感染症の病原体は、一般細菌(グラム陽性菌・陰性菌)、真菌、寄生虫、ウイルスなど

　皮膚や粘膜の傷とか、種々の臓器にある感染巣から、細菌がリンパ流から血中に入り、全身に播種されて、新たに転移性の感染巣をつくり、重篤な全身症状を引き起こす。

・全身性炎症反応症候群の診断基準

　下記項目のうち2項目以上が当てはまる

　　1. 体温>38℃ or 体温<36℃

　　2. 心拍数>90bpm

　　3. 呼吸数>20回/min or PaCO2<32mmHg

　　4. (白血球数>12,000/ul or 白血球数<4,000/ul) or ( 幼若好中球>10% )　←　ここでいう幼若好中球とは桿状好中球のことである。

・敗血症の周辺疾患概念

　1. 全身性炎症反応症候群 systemic inflammatory response syndrome SIRS

　　発熱や白血球増加などの全身の炎症の徴候によって特徴づけられる病態(SIRSの診断基準に合致する病態)

　2. 敗血症 sepsis

　　SIRSが感染の結果である場合

　3. 重症敗血症 severe sepsis

　　主要臓器障害を伴う敗血症

　4. 敗血症性ショック septic shock

　　輸液投与に不応性の低血圧を伴う重症敗血症

　5. 多臓器機能障害症候群 multiorgan dysfunction syndrome MODS

　　2つ以上の主要臓器の機能異常

　6. 多臓器不全 multiorgan failure MOF

　　2つ以上の主要臓器の不全状態

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

PSY = 標準精神医学 第3版

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「うっ血乳頭」

　　[★]

choked

英

choked disc

関

乳頭浮腫 papilledema　←同義語ではないので注意

定義

• 1. 脳圧亢進による乳頭浮腫
• 2. 脳圧亢進による両側視神経乳頭の腫脹。

参考

• 1. 眼底所見

http://www.mutsukawa-ganka.gr.jp/m-7/disk/disk.html

http://www.med.teikyo-u.ac.jp/~ortho/med/pic/P%20edema1.jpg

http://www4.ocn.ne.jp/~nurophth/o_disc_swelling.htm

• 2. 視神経・眼窩疾患

http://shutoku.fc2web.com/digital_textbook/ophthalmology/extraocular_disease2.html

国試

• 098F009：「視神経乳頭の発赤と腫脹」と表現される

「choke」

　　[★]

• vt.

• 窒息させる。(煙・涙などが)(人を)むせさせる
• 詰まらせる、ふさぐ(up)
• (エンジン)のチョークを引く
• (植物を)烏、(火を)消す
• [fig](感情・涙などを)抑える、(成長・発展などを)妨げる

• vi.
• n.

関

(adj.)choked