Difference between revisions of "Traumatic asphyxia"

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==Background==
 
==Background==
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*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 <ref>Centers for Disease Control and Prevention. Accidents or unintentional injuries. http://www.cdc.gov/nchs/fastats/accidental-injury.htm</ref>
 
*Normally a result of blunt chest trauma from an MVA <ref>Centers for Disease Control and Prevention. Accidents or unintentional injuries. http://www.cdc.gov/nchs/fastats/accidental-injury.htm</ref>
 
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*In children the chest wall is more pliable and there is often less morbidity unless there is also multiorgan trauma<ref>Gutierrez IM, Ben-Ishay O, Mooney DP. Pediatric thoracic and abdominal trauma. Minerva Chir. Jun 2013;68(3):263-74</ref>
==Signs and Symptoms==
 
*Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment)
 
*[[Arrhythmia]]
 
  
 
==Prehospital==
 
==Prehospital==
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**Perform [[Needle thoracostomy]] if indicated
 
**Perform [[Needle thoracostomy]] if indicated
 
*Prepare for [[Advanced Airway]] if patient persistently hypoxic, unable to maintain airway, or has an anticipated poor clinical course
 
*Prepare for [[Advanced Airway]] if patient persistently hypoxic, unable to maintain airway, or has an anticipated poor clinical course
==Workup==
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*Chest Xray
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==Clinical Features==
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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>
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*Upper-extremity cyanosis
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*Bilateral subconjunctival hemorrhage
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*Facial and neck edema
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*Engorged tongue
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===Signs and Symptoms===
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*Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment)
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*[[Arrhythmia]]
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*Impaired blood flow to the brain can cause
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**may result in [[Neurologic_exam|neurologic deficits]], [[AMS|altered mental status]], or [Seizures]]
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**[[ICH|Hemorrhagic]] [[Stroke (Main)|CVA]] is unlikely
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==Differential Diagnosis==
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{{Thoracic trauma DDX}}
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==Evaluation==
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*[[Chest X-ray]]
 
**although often little diagnostic yield<ref>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</ref>
 
**although often little diagnostic yield<ref>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</ref>
 
**used to assess for gross [[Pneumothorax]], [[Rib fracture]], or mediastinal widening concerning for [[Aortic Dissection]] or [[Pulmonary Contusion]]
 
**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
 
*CT with IV contrast for better assessment of lung and vasculature
==Differential Diagnosis==
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{{Thoracic trauma DDX}}
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==Management==
  
 
==See Also==
 
==See Also==
[[Thoracic Trauma]]
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*[[Thoracic Trauma]]
[[Cardiac Contusion]]
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*[[Cardiac contusion]]
  
[[Category:Pulm]]
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[[Category:Pulmonary]]
 
[[Category:Trauma]]
 
[[Category:Trauma]]
  
==Sources==
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==References==
 
<references/>
 
<references/>

Revision as of 21:34, 26 July 2016

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
  • 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

Differential Diagnosis

Thoracic Trauma

Evaluation

Management

See Also

References

  1. Centers for Disease Control and Prevention. Accidents or unintentional injuries. http://www.cdc.gov/nchs/fastats/accidental-injury.htm
  2. Gutierrez IM, Ben-Ishay O, Mooney DP. Pediatric thoracic and abdominal trauma. Minerva Chir. Jun 2013;68(3):263-74
  3. Hubble MW, et al. Chest Trauma. In Hubble MW, Hubble JP, eds, Principles of Advanced Trauma Care. Albany, NY: Delmar/Thompson Learning, 2002.
  4. 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