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

Traumatic asphyxia in the young: report of two cases and literature review

Background

Traumatic asphyxia, also called masque ecchymotique, Ollivier’s syndrome, and Perthes syndrome, is a rare but serious form of chest trauma described for the first time by Ollivier in 1837. The purpose of this study is to report our experience with two cases of traumatic asphyxia and discuss their management in view of the relevant literature.

Results

During a 6-year period, the author treated 2 cases of traumatic (crush) asphyxia in a local teaching hospital. The two patients were males, aged 20 and 30 years and were crushed beneath their vehicles. The presenting symptoms and signs were irritability, dyspnea, cervicofacial cyanosis, petechiae, and sub-conjunctival hemorrhages. The second patient suffered multiple rib fractures, hemopneumothorax, pulmonary contusion, vertebral fracture, and paraplegia. Negative surgical exploration for suspected cardiac tamponade was performed in the first case, while the second was managed conservatively.

The first patient survived whereas the second succumbed because of the associated injuries.

Conclusions

Due to its widespread lesions, traumatic asphyxia should be looked upon as a systemic syndrome. Timely accurate diagnosis and supportive treatment save the majority of patients with traumatic asphyxia. In this rare syndrome, death may result from asphyxia secondary to thoracic compression or from the associated injuries.

Compression asphyxia and other clinicopathological findings from the Hillsborough Stadium disaster

Ninety-six people died following a crowd crush at the Hillsborough Football Stadium, Sheffield, UK in 1989. The cause of death in nearly all cases was compression asphyxia. The clinical and pathological features of deaths encountered in crowds are discussed with a particular focus on the Hillsborough disaster.

Experimental study on individual risk in crowds based on exerted force and human perceptions

Frequent and intense interactions between individuals inevitably occur in crowd disasters. Previous studies indicate that the primary risk evaluation parameters for individuals in crowds during these interactions are exerted force and its duration. In this study, a series of controlled laboratory experiments simulating static and fluctuant loads were conducted to obtain real-time exerted force data and the associated individual subjective feelings. An individual risk evaluation method is then established to assign a specific individual risk value to each data set of exerted force and its duration according to the individuals' feelings. This method divides the range of risk value into three zones: comfortable zone, uncomfortable zone and crisis zone. The transition from an uncomfortable zone to crisis zone is not a single numerical value but a range that considers individual differences. The method presented in this paper can assist in developing pedestrian simulation models as well as managing crowd events. Practitioner summary: Accident surveys indicate that casualties and injuries usually occur under a long-term static load or heavy dynamic load. We tested human body extrusion experiments in four conditions, measured the real-time load intensity and duration of the individual's action on the thoracic cavity during the mutual extrusion process, and an individual risk evaluation method has been established based on the force exerted on the body and its duration to prevent crowd disasters. Abbreviations: NIST: National Institute of Standards and Technology; IREM: individual risk evaluation method; CPR: cardiopulmonary resuscitation.

Subconjunctival haemorrhage in 147 dogs

OBJECTIVES

To identify differential diagnoses for subconjunctival haemorrhage in dogs.

MATERIALS AND METHODS

Retrospective case series.

RESULTS

Of 147 dogs with subconjunctival haemorrhage, 119 had a history of trauma. The most common types of injury were vehicular trauma (47/119) and dog attacks (32/119). Confirmed or suspected non-accidental injury was reported for 5/119. Of the 28 dogs without a history of trauma, 13 had a bleeding disorder and of these, immune-mediated thrombocytopenia was the most common diagnosis (9/13). Other causes included seizure disorders (4/28), vasculitis (3/28) and ocular or periocular disease (3/28).

CLINICAL SIGNIFICANCE

Subconjunctival haemorrhage in dogs can be secondary to a wide range of injuries and systemic diseases, bleeding diathesis or ocular disease.

Neuropathology and brain weight in traumatic-crush asphyxia

Traumatic (crush) asphyxia is a rare condition caused by severe compression of the chest and trunk leading to often extreme so-called asphyxial signs, including cyanosis in head and neck regions, multiple petechiae, and subconjunctival haemorrhage as well as neurological manifestations.

AIMS

To investigate the neuropathology and brain weight in traumatic asphyxia caused by different accidents such as industrial accidents and road traffic collision.

MATERIAL AND METHODS

Post mortem records of 20 cases of traumatic asphyxia (TA) resulting from different causes of which four brains are available for comprehensive neuropathological examination. The expected brain weights for given body height and associated 95% confidence range were calculated according to the following formula: baseline brain weight (BBW) + body height x rate (g/cm). The 95% confidence range was calculated by adding and subtracting the standard error (SE) x 1.96 (7-8).

RESULTS

There was a trend for higher brain weight in the TA cohort but it was not significant (1494 g vs 1404 g, p = 0.1). The upper limits of the brain weight of 95% confidence was 1680 g vs 1660 g, p = 0.9. The neuropathological examination of four available brains from the TA cohort showed severe congestion of blood vessels, perivascular haemorrhages and occasional βAPP deposits consistent with early axonal disruption.

CONCLUSION

Brain examination is informative as part of investigation of TA. Developing ischaemic changes and an increase in brain weight are the most likely indicators of a prolonged period of patient's survival.

A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

Traumatic asphyxia with diaphragmatic injury: a case report

Traumatic asphyxia, or Perthe's syndrome, is a rare clinical syndrome characterized by cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, neurological symptoms, and thoracic injury. It affects both adults and children after blunt chest traumas. The diagnosis of this condition is based mainly on the specific clinical signs, which should immediately bring to mind the severity of the trauma, the various probable types of pulmonary injuries, and the need for screening and careful assessment of other organs that might also be injured. In this report, we describe the case of a 39-year-old male who developed traumatic asphyxia after severe blunt chest trauma during his work at a construction site. The patient had multiple injuries to the chest, abdomen, head and neck, which were treated conservatively. An associated diaphragmatic injury was successfully treated by video-assisted thoracic surgery. This patient is one of five patients who were admitted to Saqr Hospital in the United Arab Emirates, diagnosed with traumatic asphyxia, and treated by mechanical ventilator, supportive measures, and fiberoptic bronchoscopy, for both diagnostic and therapeutic indications, in our unit in the period between July 2006 and June 2013. As traumatic asphyxia is a systemic injury, careful assessment of the patient and looking for other injuries is mandatory. Treatment usually involves supportive measures to the affected organs, but surgical intervention may sometimes prove to be an important part of the treatment. Bronchoscopy should be performed for diagnostic and therapeutic reasons because of the associated pulmonary and possible tracheobronchial injuries.