A traumatic asphyxia in a child

Abstract

Purpose: Traumatic asphyxia in a child is rare and the pathophysiology is different from that occurring in an adult. We report a case of traumatic asphyxia in a child who recovered without specific treatment, even though chest and abdominal compression was severe.Clinical features: A three-year-old boy (14.2 kg) was run over by the rear wheel of a Jeep. He was under the tire for about three minutes and then was transferred to our hospital. When he arrived, he was lethargic with Glasgow Coma Scale of E3V4M6 (coma score of 13). He was cyanotic in his face and had a tire mark from the left shoulder to the right abdomen, petechia on the head, face, conjunctiva and chest, oral bleeding, and facial edema. Serum concentrations of liver enzymes were increased and microhematuria was detected. However, no injuries were seen in the brain, eye, chest, or abdomen. Cyanosis disappeared in a few hours. Facial and thoracic petechia disappeared in three days and that of the conjunctiva in five days. He was discharged from hospital on the 13th day without any disturbances. Conclusion:We present a three-year-old boy with traumatic asphyxia. He had no complications although he received severe thoraco-abdominal compression by a Jeep.Objectif: L'asphyxie traumatique, rare chez l'enfant, présente une physiopathologie différente de celle de l'adulte. Nous citons le cas d'un enfant qui a subi une asphyxie traumatique et qui a récupéré sans traitement particulier, même avec une compression thoracique et abdominale sévère.Éléments cliniques : Un garçon de 3 ans, (14,2 kg) a été écrasé sous une roue arrière d'un Jeep. Il s'est retrouvé sous le pneu pendant environ 3 min et a été conduit, par la suite, à notre hôpital. À son arrivée, il était léthargique et présentait une cote de E3V4M6 à l'échelle de Glasgow (score de coma de 13). Son visage était cyanosé et il avait une marque de pneu allant de l'épaule gauche à la partie droite de l'abdomen, des pétéchies à la tête, au visage, sur la conjonctive et la poitrine, un saignement buccal et un oedème facial. Les concentrations sériques d'enzymes hépatiques étaient augmentées et on a détecté une microhématurie. Cependant, aucune lésion n'a été observée au cerveau, aux yeux, au thorax ou à l'abdomen. La cyanose est disparue en quelques heures, les pétéchies faciales et thoraciques en trois jours et celles de la conjonctive en cinq jours. L'enfant a pu quitter l'hôpital au 13 e jour et ne présentait aucun trouble.Conclusion : Nous avons cité le cas d'un enfant de 3 ans qui a souffert d'asphyxie traumatique. Il n'a pas présen-té de complications même s'il a subi une sévère compression thoraco-abdominale.

Traumatic Asphyxia with Diaphragmatic Injury: A Case Report

“…Alternatively, increased airway pressure may compress or obliterate the inferior vena cava to protect the lower part of the body. 10 In our patient the trauma occurred at work, whereas most published cases followed road traffic accidents. 4 The characteristic physical appearance of our patient was the first thing to attract the attention towards the diagnosis of traumatic asphyxia; the importance of an accurate history, paying attention to the mechanism of trauma and a thorough systemic clinical examination are to be stressed.…”

Traumatic asphyxia: A rare syndrome in trauma children

“…The weight and the duration and of compression affect the outcome. Important weight can be tolerated for a short period, whereas a lower weight associated to a longer period can result in severe consequences [4].…”

“…The lower venous territory is protected by the presence of valves and by the obliteration or the compression of inferior vena cava after thoracic hyper pressure [4].…”

“…Thus, in some pediatric cases, even with severe chest and abdominal compression, thoracic lesions were not associated with rib fracture [10]. In children, the prognosis is generally favorable in the absence of severe associated lesions, with the exception of possible visual sequelae, and the mortality rate is usually low [4].…”

Child Deaths

“…The pathophysiology is different from adults (Large & Nielssen 2010). In the literature there some case reports concerning crush under car or jeep tires, or under some objects or garage door (Wyatt et al, 1998, Nishiyama & Hanaoka 2000. When thorax is stable, but there is no respiratory movement, traumatic asphyxia can occur.…”