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Asphyxia

Asphyxias

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].


Presentation

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].

Sudden Infant Death Syndrome
  • Abstract Although unexpected infant death in a cot has traditionally been attributed to sudden infant death syndrome, careful evaluation of death scenes and sleeping environments has increasingly identified deaths due to accidental asphyxia from so-called[ncbi.nlm.nih.gov]
  • It is pertinent for the pathologist to thoroughly examine the structures of the pharynx, and the uvula in particular, in any case of pediatric death suspected to result from asphyxia or sudden infant death syndrome (SIDS).[ncbi.nlm.nih.gov]
  • ‘Substantial increases were noted for deaths due to asphyxia, sudden infant death syndrome, infection, and external causes.’ ‘The remaining cases included asphyxia, aspiration, sepsis, and unknown cause.’[oxforddictionaries.com]
  • ‘Substantial increases were noted for deaths due to asphyxia, sudden infant death syndrome, infection, and external causes.’[en.oxforddictionaries.com]
  • 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[babyyourbaby.org]
Dyspnea
  • During a mean follow-up period of 13.2 months, 13 patients had died and 30 patients remained alive without dyspnea.[ncbi.nlm.nih.gov]
  • Rarely, especially if the mass is located at the base of the tongue, airway obstruction and dyspnea can ensue. This unusual presentation has been mainly seen in very young children and has caused death in about half of these cases.[ncbi.nlm.nih.gov]
  • On arrival, she had severe dyspnea and neck swelling; thereafter, a 26-mm-thick retropharyngeal swelling was visualized on lateral cervical plain X-ray study, extending from C1 anterior vertebrae to mediastinum.[ncbi.nlm.nih.gov]
Tachypnea
  • Symptoms include cyanosis, nasal flaring, tachypnea and crackles on exam. Treatment includes oxygen supplementation, ventilation and addressing cardiac dysfunction (11).[pedclerk.bsd.uchicago.edu]
Choking
  • When a death is due to choking, one must consider what conditions contributed to or predisposed the person to choking (eg. alcohol, drugs and physical and mental impairments).[ncbi.nlm.nih.gov]
  • KEYWORDS: adverse effects; clotiapine; fatal case; fish choking; forensic science; mechanical asphyxia[ncbi.nlm.nih.gov]
  • This is particularly true for choking deaths.[ncbi.nlm.nih.gov]
  • From Wikidata Jump to navigation Jump to search condition of severely deficient supply of oxygen to the body suffocation asphyxiation choking to death on one's own vomit edit English asphyxia condition of severely deficient supply of oxygen to the body[wikidata.org]
Vomiting
  • From Wikidata Jump to navigation Jump to search condition of severely deficient supply of oxygen to the body suffocation asphyxiation choking to death on one's own vomit edit English asphyxia condition of severely deficient supply of oxygen to the body[wikidata.org]
  • Placing the victim on his or her side, with the head resting on the arm, will prevent vomit aspiration and facilitate breathing if necessary. Monitor the victim closely to make sure the airway is open and the victim is breathing.[judoinfo.com]
Gagging
  • Hanging(Suspension) Ligature Strangulation Manual Strangulation Smothering Gagging Choking Drowning Asphyxia Images Scroll[forensicpathologyonline.com]
  • […] signs of struggle (contusions/abrasions on face and mouth) in adult victims Choking: blockage of internal airways Accidental : large food bolus in airway, usually intoxicated adults, elderly with neurodegenerative disorders, young children Homicidal : gag[pathologyoutlines.com]
  • Symptoms include abdominal distention, delayed gastric emptying as well as gagging. Treatment involves delaying feeds for 5-7 days until intestinal neuronal and motor control recovers (13).[pedclerk.bsd.uchicago.edu]
Nausea
  • Symptoms of asphyxia vary but may include light-headedness, nausea, and gasping, followed by unconsciousness and death.[encyclopedia.com]
Hypotension
  • Troponin-T concentration was significantly higher in babies with hypotensive shock and hepatic injury, but not acute kidney injury.[ncbi.nlm.nih.gov]
  • 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.[britannica.com]
  • 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.[britannica.com]
  • Myocardial function eventually becomes depressed and hypotension results in end organ damage to a variety of systems.[pedclerk.bsd.uchicago.edu]
  •  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[slideshare.net]
Cyanosis
  • 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.[symptoma.com]
  • […] fibrinolysin will cause: (i) increased fluidity of blood (ii) neck veins and right heart distended with blood (iii) increased hypostatic blood - The blood will contain increased levels of reduced haemoglobin and this accounts for bluish discoloration (cyanosis[med.pdn.ac.lk]
  • Cyanosis Post mortem fluidity of blood Cardiac dilatation Asphyxia is classified into different types Mechanical asphyxia. Chemical Asphyxia. Environmental asphyxia. Pathological asphyxia. Miscellaneous. Mechanical Interference with Respiration.[forensicpathologyonline.com]
  • Symptoms include cyanosis, nasal flaring, tachypnea and crackles on exam. Treatment includes oxygen supplementation, ventilation and addressing cardiac dysfunction (11).[pedclerk.bsd.uchicago.edu]
  • Cyanosis —A bluish tinge to the skin that can occur when the blood oxygen level drops too low.[healthofchildren.com]
Tachycardia
  • MESSAGE: Early identification and management of ventricular tachycardia in neonate with perinatal asphyxia can be life-saving.[ncbi.nlm.nih.gov]
  • The first neonate was born with severe asphyxia and left ventricular myocardial infarction with ventricular tachycardia. In this patient, systemic flow was maintained by right-to-left shunting through the patent ductus arteriosus.[ncbi.nlm.nih.gov]
  • 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. Bradycardia: 100 beats / min due to vagal stimulation caused by moderate hypoxia.[gfmer.ch]
  • There is evidence of sympathetic over-stimulation with tachycardia, dilated pupils and jitteriness. normal EEG. Grade 2: moderate encephalopathy with the infant displaying lethargy, hypotonia and proximal weakness.[quizlet.com]
Conjunctival Petechiae
  • petechiae at autopsy Fractures of hyoid bone, tracheal cartilage, cervical vertebrae are rare; hemorrhage in neck muscles also rare Hyoid fractures are more common in older victims, because hyoid bone is cartilaginous and incompletely ossified in children[pathologyoutlines.com]
Seizure
  • The seizures comprised complex partial seizures with visual symptomatology in 5 cases, complex partial seizures without visual symptomatology in 4 cases, and focal motor seizures with secondary generalization in the remaining case.[ncbi.nlm.nih.gov]
  • The absence of crying and archaic reflexes persisted and there was an onset of generalized tonic or clonic seizure. First level metabolic and inflammatory markers were within the normal range.[ncbi.nlm.nih.gov]
  • Electrographic seizures occurred in 11 of the 49 infants.[pediatrics.aappublications.org]
  • The same study also tended todispel one of the previously commonlyheld assumptions relating to the timingof seizures; namely that an early onsetof seizures after birth was an indicationof an earlier asphyxial event.[cmglaw.com]
  • We observed a highly significant difference between the two periods in the proportion of infants with neonatal seizures and age at discharge after birth.[ncbi.nlm.nih.gov]
Stupor
  • MORE RELATED WORDS FOR ASPHYXIA stupor noun daze, unconsciousness Roget's 21st Century Thesaurus, Third Edition Copyright 2013 by the Philip Lief Group.[thesaurus.com]
  • Severe symptoms of HIE include stuporous affect, flaccidness, absent primitive reflexes and seizures. These infants have a 75% risk of dying in the neonatal period and those that survive will have significant neurologic morbidities (7).[pedclerk.bsd.uchicago.edu]
  • 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[slideshare.net]
  • 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.[quizlet.com]
Confusion
  • It should not be confused with do-osae, which is a colloquial term for the guard position. International Judo Federation. IJF Referee Rules Archived 2012-04-15 at the Wayback Machine. www.ijf.org. URL last accessed March 6, 2006 Lewis, Bill.[en.wikipedia.org]
  • Consultations are available to help you sort through confusing or difficult medical issues. We work with many children and families from around the Northwest and beyond.[seattlechildrens.org]
  • Arrangements that result in unbalanced use of egress or ingress routes, dead ends, or similar confusing and irregular pathway choices, are not acceptable.[web.archive.org]
Agitation
  • Application of the hold to an individual who is agitated and struggling may increase the struggling, with increased release of catecholamines. The catecholamines working with the carotid sinus stimulation may produce a cardiac arrest.[datenschlag.org]

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].

Hypercapnia
  • Methods: Twenty-four newborn pigs in two intervention groups were exposed to 8% oxygen and hypercapnia, until base excess fell to -20 mmol/l or the mean arterial blood pressure declined to n 12) or saline (vehicle-treated group, n 12).[ncbi.nlm.nih.gov]
  • […] asphyxia. [15] Research by Ola Didrik Saugstad and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen. [16] [17] See also [ edit ] Asphyxiant gas Erotic asphyxiation Hypercapnia[en.wikipedia.org]
  • When a type 2 excludes note appears under a code it is acceptable to use both the code ( R09.0 ) and the excluded code together. hypercapnia ( ICD-10-CM Diagnosis Code R06.89 Other abnormalities of breathing 2016 2017 2018 2019 Billable/Specific Code[icd10data.com]
Brain Edema
  • Theassumption was that seizures frombirth asphyxia resulted from the buildup of brain edema, which generallytakes a minimum of 6 to 8 hours tofully develop.[cmglaw.com]

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

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.

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].

Epidemiology

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

Pathophysiology

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].

Prevention

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.

Summary

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. 

References

Article

  1. Pathak H, Borkar J, Dixit P, Shrigiriwar M. Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases. Forensic Sci Int. Sep 10 2012;221(1-3):e21-4.
  2. Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361:1349.
  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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Last updated: 2017-08-09 18:13