Traumatic asphyxia: Difference between revisions
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*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> | ||
*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> | *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> | ||
==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== | ==Clinical Features== | ||
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*Engorged tongue | *Engorged tongue | ||
==Signs and Symptoms== | ===Signs and Symptoms=== | ||
*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]] | ||
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**[[ICH|Hemorrhagic]] [[Stroke (Main)|CVA]] is unlikely | **[[ICH|Hemorrhagic]] [[Stroke (Main)|CVA]] is unlikely | ||
== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | |||
==Diagnosis== | |||
== | |||
*Chest Xray | *Chest Xray | ||
**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 | ||
== | |||
==Management== | |||
==See Also== | ==See Also== | ||
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[[Category:Trauma]] | [[Category:Trauma]] | ||
== | ==References== | ||
<references/> | <references/> | ||
Revision as of 22:20, 3 December 2015
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
Diagnosis
- Chest Xray
- 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