Traumatic asphyxia

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
• In children the chest wall is more pliable and there is often less morbidity unless there is also multiorgan trauma

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
  • 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
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

See Also

• Thoracic Trauma
• Cardiac contusion