Traumatic asphyxia

Abstract

BackgroundTraumatic asphyxia is probably much more common than the surgical literature shows and should always be kept in mind as a possible complication of injuries of the chest and abdomen. AimsTraumatic asphyxia or Perte’s syndrome results from a severe crush injury causing sudden compression of the thorax. During a 3-year period, we treated five cases of traumatic asphyxia, which we report in this manuscript.MethodsThe patients were all male, ranging in age from 26 to 64. They suffered different types of crushing injuries: industrial accidents in two patients, run over by motor vehicles in two patients, and a farm accident in one patient. Most of the patients suffered some associated injuries, including fracture of the sternum in one patient, fracture of the right clavicle in one patient, and bilateral hemopneumothoraces in one patient. ResultsThe treatment included bilateral chest tube thoracostomy in one patient, and the others required supportive treatment. There was no mortality.ConclusionTreatment for traumatic asphyxia is supportive, and patient recovery is related to the generally associated injuries. Traumatic asphyxia should always be kept in mind as a possible complication of injuries of the chest and abdomen.

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.…”

“…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]. Other signs may accompany the classic clinical manifestations of this pathology, being the most common mental confusion, amnesia, psychomotor agitation and hyperpyrexia.…”

“…Other signs may accompany the classic clinical manifestations of this pathology, being the most common mental confusion, amnesia, psychomotor agitation and hyperpyrexia. 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 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 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]. We must not forget that this pathology is the result of a direct trauma on the thorax, therefore traumatic injuries as pulmonary contusion, hemothorax, pneumothorax, esophageal rupture, laceration of great vessels, myocardial contusion, flail chest, hepatic or splenic lacerations and injuries in pelvis must be rapidly ruled out.…”