Asphyxia (Asphyxias)

    Image943-knee mount[1]

    It is a condition of the body where there is extreme decrease in oxygen concentration and increase in the concentration of the carbon dioxide resulting in death. Asphyxia might get induced by electric shock, injury, choking, toxic gas inhalation and drowning [1].

    This disorder is triggered by the following process: Radiation.


    Symptoms of asphyxia include noisy breathing and gradual cessation of breathing, hypertension, face cyanosis, rapid pulse, convulsions, swollen veins on the neck and head, paralysis and slow loss of consciousness. Apart from these symptoms, there might be certain complications that can become severe leading to irreversible coma, brain death and death. Symptoms of asphyxia for a newborn baby might include low heart rate, pale skin color, weak reflexes, weak breathing, acidosis, meconium stained amniotic fluid and seizures [6].

    Entire body system
    Congestive Heart Failure
    Sudden Infant Death Syndrome
    • ‘Substantial increases were noted for deaths due to asphyxia, sudden infant death syndrome, infection, and external causes.’[]
    • A child is said to die of SIDS (sudden infant death syndrome) if he/she: is less than 1 year of age, died while sleeping and that death remains unexplained after a thorough investigation, including a complete autopsy and review of the circumstances of[]
    • One example is overlay, in which an adult accidentally rolls over onto an infant during co-sleeping, an accident that often goes unnoticed and is mistakenly thought to be sudden infant death syndrome.[]
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  • Face, Head & Neck
    Facial Edema
    • Cyanosis due to excessively deoxygenated hemoglobin in the venous blood (see the image above) Facial edema due to increased venous pressure causing tissue fluid transudation (see the image below) Facial and upper neck edema.[]
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  • neurologic
    • Severe symptoms of HIE include stuporous affect, flaccidness, absent primitive reflexes and seizures.[]
    • Grade 3: severe encephalopathy with a stuporous, flaccid infant, and absent reflexes. infant may have seizures and has abnormal EEG with decreased background activity and/or voltage suppression.[]
    • Severe HIE• Stupor or coma is typical.• may not respond to any physical stimulus.• Breathing may be irregular, and the infant often requires ventilatory support.• Generalized hypotonia and depressed deep tendon reflexes are common.• Neonatal reflexes[]
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  • respiratoric
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  • gastrointestinal
    • Symptoms of asphyxia vary but may include light-headedness, nausea, and gasping, followed by unconsciousness and death.[]
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  • musculoskeletal
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  • cardiovascular
    • Symptoms: Some of the symptoms of asphyxia include noisy breathing, cyanosis of face, swollen neck veins, brain death, pale skin color and weak reflexes.[]
    • But there are indications of asphyxia with some cyanosis around the face.[]
    • Cyanosis Post mortem fluidity of blood Cardiac dilatation Asphyxia is classified into different types Mechanical asphyxia.[]
    • This results in severe respiratory distress and cyanosis.[]
    • CLINICAL FEATURES Apnoea, bradycardia Altered respiratory pattern - grunting, gasping Cyanosis Pallor-shock Hypotonia Unresponsiveness 13.[]
    • Diagnosis Signs of Foetal Distress Foetal heart rate changes: in the form of; Tachycardia: 160 beats / min. due to sympathetic stimulation caused by mild hypoxia.[]
    • There is evidence of sympathetic over-stimulation with tachycardia, dilated pupils and jitteriness. normal EEG.[]
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  • Eyes
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  • Workup

    Diagnosis of asphyxia is done primarily using primary tests rating the individuals from 0 to 10. This number range is called Apgar score, which gives rating for heart rate, skin color, muscle tone, breathing effort and reflexes. Low Apgar score of 0 to 3 lasting for a period of greater than 5 minutes is a sign of birth asphyxia.

    Diagnosis will be complete with the application of techniques, like computerized tomography scan, magnetic resonance imaging and head ultrasound. The quality and intensity of brain activity is determined by the electroencephalogram. Some more tests are also conducted considering premature baby’s sensory responses. Tests for hearing and sight are helpful to conclude whether the damage has occurred to the brain cells or not [7, 8].


    Other Pathologies
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  • Laboratory

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  • Treatment

    Some of the treatments done for asphyxia include first aid to eliminate the foreign body, expired air resuscitation, cardio-pulmonary resuscitation and emergency resuscitation. Treatment strategies for asphyxia include improving oxygen delivery in the body, generally with the help of mechanical ventilation. Blood circulation is monitored regularly and is improved by giving extra fluids or drugs or blood to support blood pressure and heart function. If the blood pressure is very high the brain might bleed heavily [9].

    As asphyxia affects other parts of the body along with the brain, asphyxia affected baby will be monitored with specific attention towards kidneys, heart and liver. Asphyxia is commonly observed in the newborn babies just after their birth [10].


    Prognosis of asphyxia is indicated by the risk of neurodevelopmental disability apart from intrapartum complications in birth asphyxia. About 8 to 17 percent of cerebral palsy is observed along with adverse perinatal events of asphyxia in the newborns with birth asphyxia. Hypotonia, seizures, metabolic acidosis at birth and Apgar score<=3 leads to cerebral hypoxia.


    • Preferential flow to heart, brain and adrenals aerobic anaerobic metabolism glucose pyruvic acid lactic acid Acidosis Acidosis failure of autoregulation impaired perfusion increasing acidosis Death unless resuscitated 11.[]
    • Hypotonia, seizures, metabolic acidosis at birth and Apgar score<=3 leads to cerebral hypoxia.[]
    • Synonyms Birth asphyxia; Hypoxic ischemia (HI); Hypoxic ischemic encephalopathy; HIE; Neonatal asphyxia; Prenatal cerebral injury; Hypoxia; Acidosis; Ischemia Definition and Characteristics American Academy of Pediatrics (AAP) and American College of[]
    • Hypoxia and acidosis can depress myocardial function, leading to hypotension and ischemia.[]
    • Foetal acidosis: scalp blood pH 7.2.[]
    Acute Respiratory Distress Syndrome
    • Other causes of oxygen deficiency include but are not limited to: Acute respiratory distress syndrome Carbon monoxide inhalation, such as that from a car exhaust and the smoke's emission from a lighted cigarette: carbon monoxide has a higher affinity[]
    • Lung: Complications include pulmonary edema and acute respiratory distress syndrome (ARDS).[]
    Cardiac Arrest
    • One method of reestablishing normal respiration is cardiopulmonary resuscitation (CPR), a particularly effective way of dealing with victims of cardiac arrest and near-drowning.[]
    Cardiac Arrhythmia
    • Cardiac arrhythmia (irregular FHR): due to severe hypoxia.[]
    • The term is now obsolete, having been replace in mid-twentieth century by the more specific terms anoxia , hypoxia , hypoxemia and hypercapnia . 1895 .[]
    • Asphyxiant gas Erotic asphyxiation Hypercapnia Respiratory acidosis Sir James Kay-Shuttleworth (1834).[]
    • Moreover, it is followed by hypoxemia, acidosis and hypercapnia, mandatory criteria for a clinically relevant model of perinatal asphyxia ( Seidl et al., 2000 ).[]
    • Hypoxia and acidosis can depress myocardial function, leading to hypotension and ischemia.[]
    • Neonatal asphyxia can result from the presence of analgesics or anesthetics in the mother’s bloodstream, strangulation by the umbilical cord , maternal hypotension, or a number of other causes.[]
    •  Interruption of umbilical cord blood flow, eg: cord compression during labour Failure of exchange across the placenta, eg: abruption Inadequate perfusion of maternal side of placenta, eg: maternal hypotension Compromised fetus who cannot tolerate[]
    • Anaesthetic agents causing hypotension.[]
    • The terms hypoxia and anoxia are often used synonymously.[]
    • Hypoxia and acidosis can depress myocardial function, leading to hypotension and ischemia.[]
    • HIE describes CNS damage that results from hypoxia.[]
    • The metabolic response to hypoxia remains unclear, as does its role in alleviating or attenuating the injury sustained.[]
    • Hypotonia, seizures, metabolic acidosis at birth and Apgar score<=3 leads to cerebral hypoxia.[]
    Pulmonary Edema
    Respiratory Acidosis
    • Asphyxiant gas Erotic asphyxiation Hypercapnia Respiratory acidosis Sir James Kay-Shuttleworth (1834).[]
    Respiratory Failure
    • Inhaled Nitric Oxide Inhaled nitric oxide is an alternative method used to treat infant asphyxia through the treatment of any respiratory failure and other breathing complications such as pulmonary hypertension.[]
    • . - respiratory failure in newborn, a condition caused by inadequate intake of oxygen before, during, or just after birth.[]
    • Asphyxia can be result from choking, drowning, electric shock, injury.[]
    • Management of shock1.Hypovolumic shock needs replacement with fluids, plasma, or blood.2.Cardiogenic shock warrants use of pressors like dopamine and / or dobutamine.[]
    • Asphyxia can be induced by choking, drowning, electric shock, injury, or the inhalation of toxic gases.[]
    • Officers yell for him to raise his hands, warning that they would shock him with a Taser, until they realize he isn’t responsive.[]
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  • Etiology

    Chemical asphyxia involves inhalation of the substance that interferes with the ability of the body to make use of oxygen. For instance, carbon monoxide blocks the binding of hemoglobin to the oxygen in red blood cells. Simple asphyxia results when the oxygen is displaced by another gas. Drowning is the state of asphyxia, where the lungs are filled with any liquid or water. Drowning is classified into various types like secondary drowning, near-drowning and immersion syndrome. Suffocation is one of the causes of asphyxia, which can be further divided into entrapment, choking, strangulation, and smothering. Entrapment involves being closed inside an air-tight container. Mechanical asphyxia includes positional asphyxia, riot-crush deaths and traumatic asphyxia [3].


    In the United States, the 10th major cause of neonatal deaths occurred due to intrauterine hypoxia and birth asphyxia. Many authorities suggest that perinatal asphyxia occurs in 3 to 5 newborns out of 1000 live births.

    Sex distribution
    Age distribution


    Traumatic asphyxia is an uncommon syndrome resulting from severe compression of thoracic region by any heavy object increasing the thoracic and superior vena cava blood pressure causing reverse flow of blood from the heart to the veins of the head and neck [4].

    As the veins of head and neck do not have any valves, the capillaries are also extensively rushed with blood, sometimes breaking them. In his research findings, Dr. Joseph Volpe from the Harvard University at Boston, USA, said that many processes can lead to brain damage in birth asphyxia. According to him, several types of cell damage can occur from asphyxia that includes selective neuronal necrosis in brain stem, cerebral cortex and basal ganglia, parasagittal cerebral injury and strokes with focal lesions. During asphyxia, blood pressure drops and is accompanied by a drop in the flow of blood to the brain. The above changes lead to a condition called Ischemia, resulting in brain damage. Ischemia in turn leads to neuronal and oligodendoglial damage. Oligodendogiial damage results in decreased energy production and a decrease in ATP causing glutamate release. Glutamate reacts with the glutamate receptors leading to changes in the membrane function and calcium accumulation. Further, mitochondrial function is disturbed and the free radicals are also released causing cell death [5].


    Cardiotocograph is a tool that aids in detecting fetal well-being and asphyxia at the time of labor. Abnormality in cardiotocograph is termed as pathological CTG trace or acidic pH. Recognizing a fetus with pathological CTG trace during labor might possibly refer to birth asphyxia or hypoxia. Interpreting CTG trace correctly and taking proper care in time can prevent asphyxia.


    Some of the situations that can cause asphyxia include obstruction of airways due to laryngospasm, asthma, blocks due to the presence of foreign material, being in environments like under waters where oxygen supply is not available directly, and in environments where there is excessive smoke which does not allow breathing. Oxygen deficiency can be caused by many other conditions. Birth asphyxia or perinatal asphyxia is ahypoxia condition in the newborn observed during birth. When the chest or abdomen is compressed posteriorly and interferes in breathing, it is called as compressive asphyxia or traumatic asphyxia [2].

    Patient Information

    • Definition: the extreme deficiency of oxygen supply to the body and the elevation of carbon dioxide concentration in the body is called asphyxia.
    • Cause: Asphyxia results due to drowning, strangulation, suffocation, choking, entrapment, smothering, or other similar causes. Chemical asphyxia is caused due to the ingestion of a chemical, while mechanical asphyxia results by applying intensive pressure on the mouth and nostril.
    • Symptoms: Some of the symptoms of asphyxia include noisy breathing, cyanosis of face, swollen neck veins, brain death, pale skin color and weak reflexes. Severity of the disease leads to the complications like irreversible coma and brain death
    • Diagnosis: Diagnosis of asphyxia is performed with Apgar score, computerized tomography scan and magnetic resonance imaging scan. The quality of the brain activity is measured by electroencephalogram.
    • Treatment: Treatment for asphyxia includes implementing initially first aid techniques like cardio-pulmonary resuscitation. Oxygen delivery to the body is done by mechanical ventilation. Blood circulation and heart function is monitored by administering drugs or extra fluids. 



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    3. Graham MA, Hanzlick R. Asphyxia. In:. Forensic Pathology in Criminal Cases. 2nd ed. Carlsbad, Calif: Lexis Law Publishing; 1997.
    4. Sauvageau A. Agonal sequences in four filmed hangings: analysis of respiratory and movement responses to asphyxia by hanging. J Forensic Sci. Jan 2009;54(1):192-4
    5. Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Arch Neurol Psychiatr. 1943;50:510-31.
    6. Vilke GM, Michalewicz B, Kohlkorst F, Neuman T, Chan TC. Does weight force during physical restraint cause respiratory compromise? [abstract 27]. Acad Emerg Med. 2005;12(5 suppl 1):16.
    7. Rajakumar PS, Vishnu Bhat B, Sridhar MG, et al. Electrocardiographic and echocardiographic changes in perinatal asphyxia. Indian J Pediatr 2009; 76:261.
    8. Costa S, Zecca E, De Rosa G, et al. Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia? Acta Paediatr 2007; 96:181.
    9. DiMaio VJ, DiMaio D. Forensic Pathology. 2nd ed. Boca Raton, Fla: CRC Press; 2001:234.
    10. Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353:1574.

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