Traumatic asphyxia due to blunt chest trauma: a case report and literature review

Abstract

IntroductionCrush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in the literature, reporting usually poor outcomes.Case presentationWe present the case of a 44-year-old Caucasian man who developed traumatic asphyxia with severe thoracic injury and mild brain edema after being crushed under heavy auto vehicle mechanical parts. He remained unconscious for an unknown time. The treatment included oropharyngeal intubation and mechanical ventilation, bilateral chest tube thoracostomies, treatment of brain edema and other supportive measures. Our patient’s outcome was good. Traumatic asphyxia is generally under-reported and most authors apply supportive measures, while the final outcome seems to be dependent on the length of time of the chest compression and on the associated injuries.ConclusionTreatment for traumatic asphyxia is mainly supportive with special attention to the re-establishment of adequate oxygenation and perfusion; treatment of the concomitant injuries might also affect the final outcome.

Perthes´ Syndrome: Traumatic Asphyxia

“…At ocular level there may be exophthalmos, double vision, loss of visual acuity, and blurry vision, these alterations are explained by retinal hemorrhages [12]. Additionally, epistaxis due to capillary break and hearing loss due to edema in Eustachian tubes or even hemo-tympanum may be seen [11][12][13]. The natural history of all these injuries is characterized by a progressive resolution, including the neurological symptoms previously mentioned which, in general, revert in 24 hours without sequels.…”

“…The extension of the signs and possible sequels, depends on the duration and severity of the thoracic compression at which the patient was exposed [11]. Among the typical physical examination findings of traumatic asphyxia it is worth mentioning the following: intense vascular congestion in the superior aspect of the thorax, with petechial hemorrhages in face, neck and conjunctiva, this set of clinical manifestations is known also as mask of Morestin [1,7,12].…”

“…The approach of these patients must be integral, initiating for assuring the airway, the patient must place supine with the head tilt to 30 degrees, in order to diminish intracranial pressure [8][9][10][11][12]. Oxygen therapy and fluids must begin at once and must consider the need to place mechanical ventilation according to patient requirements and extension of lung injuries [12][13].…”

“…The prognosis of these patients generally is favorable, however the morbidity and mortality depends on several factors including the age of the patient, duration of compression, severity of pulmonary injuries and existence of associated injuries specifically those that involve the cardiovascular system or central nervous system [5,8,11].…”

Traumatic asphyxia: A rare syndrome in trauma children

“…It is a rare syndrome, first described in 1937 by Oliver d'Angers as the ecchymotic mask. Others names are also used to describe this syndrome: Traumatic cyanosis, compressive cyanosis, traumatic apnea, Oliver's syndrome, and Perthes syndrome [1,2].…”