Traumatic asphyxia: Difference between revisions
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*Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment) | *Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment) | ||
*[[Arrhythmia]] | *[[Arrhythmia]] | ||
*Impaired blood flow to the brain can cause | |||
** may result in [[Neuroexam|neurologic deficits]], [[AMS|altered mental status]], or [Seizures]] | |||
**[[ICH|Hemorrhagic]] [[Stroke (Main)|CVA]] is unlikely | |||
==Prehospital== | ==Prehospital== | ||
Revision as of 16:42, 7 December 2014
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]
Clinical Features
Many of the following features can be seen on exam depending on the extent of the force
- 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
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
Workup
- Chest Xray
- although often little diagnostic yield[3]
- 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
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
See Also
Sources
- ↑ 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
- ↑ 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