Traumatic asphyxia: Difference between revisions

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==Background==
==Background==
*Normally in children from thoracic trauma
*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.
*in kids= benign
*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>
*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>


==Diagnosis==
==Prehospital==
have discolored upper torso from compression & incr pressure tmitted to valveless veins
*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==
[[File:PMC4458292 CRIEM2015-359814.001.png|thumb|Traumatic asphyxia patient with (a) bilateral subconjunctival hemorrhage; (b) facial cyanosis, petechial eruptions on the anterior surface of the thoracic cage and on left upper extremity.]]
[[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: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>
*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_exam|neurologic deficits]], [[AMS|altered mental status]], or [[Seizures]]
**[[ICH|Hemorrhagic]] [[Stroke (Main)|CVA]] is unlikely


==Differential Diagnosis==
==Differential Diagnosis==
{{Thoracic trauma DDX}}
{{Thoracic trauma DDX}}
==Evaluation==
[[File:PMC3441877 1752-1947-6-257-2.png|thumb|CT chest of a patient with traumatic asphyxia showing bilateral hemopneumothorax and multiple lung contusions, especially on the right.]]
*[[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>
**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==
==See Also==
[[Thoracic Trauma]]
*[[Thoracic Trauma]]
*[[Cardiac contusion]]


[[Category:Pulm]]
[[Category:Pulmonary]]
[[Category:Trauma]]
[[Category:Trauma]]
==References==
<references/>

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
  • Prepare for Advanced Airway if patient persistently hypoxic, unable to maintain airway, or has an anticipated poor clinical course

Clinical Features

Traumatic asphyxia patient with (a) bilateral subconjunctival hemorrhage; (b) facial cyanosis, petechial eruptions on the anterior surface of the thoracic cage and on left upper extremity.
Traumatic asphyxia with severe bilateral subconjunctival hemorrhages, chemosis, severe eyelid swelling, and mild exophthalmos.
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.
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.[3]

  • Upper-extremity cyanosis
  • Bilateral subconjunctival hemorrhage
  • Facial and neck edema
  • Engorged tongue

Signs and Symptoms

Differential Diagnosis

Thoracic Trauma

Evaluation

CT chest of a patient with traumatic asphyxia showing bilateral hemopneumothorax and multiple lung contusions, especially on the right.

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
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