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Traumatic asphyxia

1960; Elsevier BV; Volume: 29; Issue: 3 Linguagem: Inglês

10.1016/0002-9343(60)90046-2

1555-7162

Herbert L. Fred, Frank W. Chandler,

Child Abuse and Related Trauma

1.1. A unique case of traumatic asphyxia is described and a review of the subject is presented. 2.2. Traumatic asphyxia is a relatively rare but distinct and unforgettable syndrome characterized by striking bluish red to bluish black discoloration of the head, neck, and upper part of the thorax with massive subconjunctival hemorrhage. In the majority of cases it results from severe compression or squeezing injuries to the thorax and/or upper part of the abdomen. 3.3. The rise in intrathoracic pressure brought about by a crushing injury causes the blood from the right side of the heart and great thoracic veins to be ejected cephalad. This in turn produces sudden overdistention and paralysis of the cutaneous capillaries and venules in that portion of the body supplied by veins with incompetent valves. Occasionally, minute hemorrhages may also appear in the affected areas, but the discoloration is due primarily to venous stasis and usually clears completely within two weeks without undergoing chromatic changes. 4.4. Associated injuries and complications are common, especially those affecting the eyes. In addition to the subconjunctival hemorrhage which usually persists for about a month, there may be exophthalmos, swollen lids, pupillary changes, ocular palsies, hemorrhages and exudates in the retina, papilledema, and all sorts of transient or permanent disturbances in vision. 5.5. Varying degrees of hemorrhage may be present in the mouth, nose and ears, and tinnitus or temporary deafness may develop. 6.6. Many different pulmonary complications have been encountered, whereas cardiac abnormalities have been recognized rarely. The patient reported on herein is the first to manifest pericardial effusion. It is suggested that a search be made for injury to the heart in every victim of traumatic asphyxia. 7.7. Unconsciousness, signs of cortical irritation, and injury to the spinal cord or peripheral nerves may be observed, and fractures of various bones, especially the ribs, are very common. Skull fractures, however, are quite rare. 8.8. Traumatic asphyxia has not been reproduced satisfactorily in animals, presumably because of the difference in structure and function of the animal and human thoraces. 9.9. Examination at necropsy has served only to confirm the abnormalities noted clinically. It is interesting, however, that the brain has usually shown no change except cerebral congestion. In a few living subjects, biopsies of the skin from the affected areas have demonstrated distention of the capillaries and venules, with or without a very small amount of blood in the surrounding tissues. 10.10. The diagnosis is made from the all important history and characteristic appearance of the patient. 11.11. The treatment is supportive and should be directed toward the associated injuries and complications. 12.12. Traumatic asphyxia is usually not as serious as the patient's initial appearance would suggest. Approximately 90 per cent of those who survive for more than an hour will recover.