Traumatic asphyxia: Difference between revisions
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[[File:PMC2992570 kjo-24-380-g001.png|thumb|Traumatic asphyxia with severe bilateral subconjunctival hemorrhages, chemosis, severe eyelid swelling, and mild exophthalmos.]] | [[File:PMC2992570 kjo-24-380-g001.png|thumb|Traumatic asphyxia with severe bilateral subconjunctival hemorrhages, chemosis, severe eyelid swelling, and mild exophthalmos.]] | ||
[[File:PMC3047851 12245 2010 204 Fig1 HTML.png|thumb|A patient with traumatic asphyxia. The head, neck, and upper chest are strikingly cyanotic and edematous, with multiple petechiae; he also had bilateral subconjunctival hemorrhages and bilateral hemopneumothorax.]] | [[File:PMC3047851 12245 2010 204 Fig1 HTML.png|thumb|A patient with traumatic asphyxia. The head, neck, and upper chest are strikingly cyanotic and edematous, with multiple petechiae; he also had bilateral subconjunctival hemorrhages and bilateral hemopneumothorax.]] | ||
[[File:PMC2840592 12245 2009 115 Fig1 HTML.png|thumb|A patient with traumatic asphyxia: diffuse petechiae and purpura throughout face and eyelids and submucosal hemorrhages on the lower lip.]] | |||
Many of the following features can be seen on exam depending on the extent of the force.<ref> Hubble MW, et al. Chest Trauma. In Hubble MW, Hubble JP, eds, Principles of Advanced Trauma Care. Albany, NY: Delmar/Thompson Learning, 2002.</ref> | Many of the following features can be seen on exam depending on the extent of the force.<ref> Hubble MW, et al. Chest Trauma. In Hubble MW, Hubble JP, eds, Principles of Advanced Trauma Care. Albany, NY: Delmar/Thompson Learning, 2002.</ref> | ||
*Upper-extremity cyanosis | *Upper-extremity cyanosis | ||
Latest revision as of 22:22, 20 April 2022
Background
- Traumatic asphyxia occurs when sudden and blunt chest trauma forces retrograde flow of blood through the superior vena cava and into the neck and head.
- Normally a result of blunt chest trauma from an MVA [1]
- In children the chest wall is more pliable and there is often less morbidity unless there is also multiorgan trauma[2]
Prehospital
- Maintain adequate oxygenation > 92%
- Maintain blood pressure with small fluid boluses if necessary (250cc boluses)
- Assess for tension pneumothorax if patient hypoxic or hypotensive
- Perform Needle thoracostomy if indicated
- Prepare for Advanced Airway if patient persistently hypoxic, unable to maintain airway, or has an anticipated poor clinical course
Clinical Features
Many of the following features can be seen on exam depending on the extent of the force.[3]
- Upper-extremity cyanosis
- Bilateral subconjunctival hemorrhage
- Facial and neck edema
- Engorged tongue
Signs and Symptoms
- Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment)
- Arrhythmia
- Impaired blood flow to the brain can cause
- may result in neurologic deficits, altered mental status, or Seizures
- Hemorrhagic CVA is unlikely
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Chest X-ray
- although often little diagnostic yield[4]
- used to assess for gross Pneumothorax, Rib fracture, or mediastinal widening concerning for Aortic Dissection or Pulmonary Contusion
- CT with IV contrast for better assessment of lung and vasculature
Management
See Also
References
- ↑ Centers for Disease Control and Prevention. Accidents or unintentional injuries. http://www.cdc.gov/nchs/fastats/accidental-injury.htm
- ↑ Gutierrez IM, Ben-Ishay O, Mooney DP. Pediatric thoracic and abdominal trauma. Minerva Chir. Jun 2013;68(3):263-74
- ↑ Hubble MW, et al. Chest Trauma. In Hubble MW, Hubble JP, eds, Principles of Advanced Trauma Care. Albany, NY: Delmar/Thompson Learning, 2002.
- ↑ Cook AD, Klein JS, Rogers FB, et al. Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration. J Trauma. May 2001;50(5):843-7