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].
Entire Body System
- Inflammation
Recovery from an appendectomy depends on the severity of the inflammation. If inflammation is mild, recovery can take a few days to a week. [medicinenet.com]
Systemic inflammation is found in infants with NE, and we therefore were interested in cytokines associated with hypoxia, including vascular endothelial growth factor (VEGF) and erythropoietin (Epo). [ncbi.nlm.nih.gov]
Appendicitis is an inflammation of a part of the intestine called the appendix, a narrow, finger-shaped sac near where the small and large intestines come together. [parents.com]
The suffix "-itis" means inflammation, so appendicitis is inflammation of the appendix. Appendicitis occurs when mucus, stool, or a combination of the two blocks the opening of the appendix that leads to the cecum. [onhealth.com]
- Anemia
Women at risk for asphyxia neonatorum pregnancies should receive focused prenatal care from an obstetrician skilled at preventing and detecting problems such as anemia that may contribute to asphyxia neonatorum. [yourdictionary.com]
[…] muscles ( muscle relaxants, poliomyelitis ) damage to the respiratory center ( morphine intoxication) disruption of gas exchange (diseases of the lung parenchyma ) 3.2 Internal suffocation obstruction of oxygen transport ( carbon monoxide intoxication, anemia [flexikon.doccheck.com]
Anemia —A condition in which there is an abnormally low number of red blood cells in the bloodstream. It may be due to loss of blood, an increase in red blood cell destruction, or a decrease in red blood cell production. [healthofchildren.com]
Hypertension can cause a decrement in blood flow resulting in asphyxia while anemia causes intrapartum hypoxia [ 8 ],[ 20 ]. [ijponline.biomedcentral.com]
Also, blood disorders such as anemia in the infant may prevent the blood from carrying enough oxygen. What happens during birth asphyxia? Two types of chemical changes may happen when oxygen levels in the newborn are decreased. [dolmanlaw.com]
- Sudden Infant Death Syndrome
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 cause of death was asphyxia and blunt force injuries.’ [lexico.com]
‘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]
- Epilepsy
Symptomatic parieto-occipital epilepsy caused by mild perinatal hypoxic-ischemic encephalopathy is sometimes pharmaco-resistant and accompanied by mild cognitive and visuospatial impairments. [ncbi.nlm.nih.gov]
One study reported an association of epilepsy with postterm birth. 30 Conversely, we found that postterm birth did not lead to increased risk for epilepsy or sensorineural defects, whereas early-term birth did. [pediatrics.aappublications.org]
Birth asphyxia often causes hypoxic-ischemic encephalopathy (HIE), a form of neonatal brain damage that can lead to cerebral palsy (CP), epilepsy, and other disabilities. [abclawcenters.com]
Associated neurologic morbidities include learning disabilities, ADD, cerebral palsy, epilepsy, visual impairment and significant cognitive and developmental disorders. [pedclerk.bsd.uchicago.edu]
- Hyperthermia
OBJECTIVE: The purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by 1 H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome. [ncbi.nlm.nih.gov]
While current guidelines call for preventing hyperthermia and initiating TH in NBs with moderate to severe HIE, they do not specify the measures that should be initiated during resuscitation. 16,17 In any case, given the usual decline in body temperature [analesdepediatria.org]
Respiratoric
- Pneumonia
We describe a death in a hospital wardrobe of a 40-year-old male suffering from HIV infection and lobar pneumonia. [ncbi.nlm.nih.gov]
Antibiotics: to guard against pneumonia which is liable to develop after prolonged resuscitation. Links Fetal distress : Guidelines, reviews Newborn respiratory tract diseases : Guidelines, reviews [gfmer.ch]
[…] abnormalities Water breaking more than 12 hours before delivery Meconium (infant bowel contents) in the fluid surrounding the baby before birth Hemorrhage occurring prior to childbirth Infection in the mother that may cause breathing problems, such as pneumonia [health.cvs.com]
- Respiratory Distress
Abstract A new born baby boy presented with birth asphyxia and respiratory distress. He went into cardiac arrest twice but was resuscitated. [ncbi.nlm.nih.gov]
Adult respiratory distress syndrome in full-term newborns.Faix RG, Viscardi RM, DiPietro MA, Nicks JJPediatrics. 1989;83(6):971. 13. Birth asphyxia alters neonatal intestinal motility in term neonates .Berseth CL, McCoy HH. [pedclerk.bsd.uchicago.edu]
Respiratory distress, low blood pressure, or other signs of low blood flow to the kidneys or intestines. Problems with a baby's circulatory, digestive and respiratory systems may also suggest that a baby has birth asphyxia. [ucsfbenioffchildrens.org]
Links Fetal distress : Guidelines, reviews Newborn respiratory tract diseases : Guidelines, reviews [gfmer.ch]
- 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]
- 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]
In 1900, Perthes [7], observed mental dullness, hyperpyrexia, hemoptysis, tachypnea, and contusion pneumonia and since then, petechial hemorrhages of the mucus membranes, epistaxis, hematemesis, rectal bleeding, hematoma of the esophagus, albuminuria, [heighpubs.org]
- Respiratory Insufficiency
insufficiency immediately after birth with hypotonicity. [ncbi.nlm.nih.gov]
Gastrointestinal
- 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]
After an appendectomy, call your doctor right away if you have: Persistent vomiting Continued pain in your abdomen Dizziness/feelings of faintness Blood in your vomit, urine, or stool Fever Diarrhea [webmd.com]
[…] contentid=746&language=English">vomiting</a></li><li> <a href="/Article?contentid=30&language=English">fever</a></li></ul><p>If the appendix has burst, your child will feel continuous, severe pain throughout the whole abdomen. [aboutkidshealth.ca]
- 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]
Asphyxia can be result from choking, drowning, electric shock, injury. [yourdictionary.com]
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]
- Nausea
Language Options Appendicitis A Appendicitis Appendicitis English Gastrointestinal Preschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years) Appendix Digestive system Conditions and diseases Caregivers Adult (19+) Fever;Nausea [aboutkidshealth.ca]
Fewer than 50% of people with appendicitis have the traditionally described symptoms in which pain begins in the upper abdomen or around the navel, then nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain shifts to [merckmanuals.com]
Digestive upset Appendicitis can cause nausea and vomiting. You may lose your appetite and feel like you can’t eat. You may also become constipated or develop severe diarrhea. [healthline.com]
Later symptoms include: Chills and shaking Hard stools Diarrhea Fever Nausea and vomiting Your health care provider may suspect appendicitis based on the symptoms you describe. Your provider will do a physical exam. [medlineplus.gov]
- Gagging
[…] suffocation hypoxia: suffocation without CO 2 retention, no fear of suffocation, sometimes associated with euphoria. 3 Causes 3.1 External suffocation low oxygen atmosphere (head in a plastic bag, high altitude) obstruction of airways (because of being gagged [flexikon.doccheck.com]
Three of the deaths involved adults who were gagged; 2 deaths involved infants with foreign material pushed into the mouth. [ncbi.nlm.nih.gov]
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]
Cardiovascular
- Cyanosis
The lungs were enlarged bilaterally and had a purplish hue to its colour (cyanosis) with patched of sub-pleural haemorrhages and intra parenchymal haemorrhages. [heighpubs.org]
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]
The symptoms of asphyxia neonatorum are bluish or gray skin color (cyanosis), slow heartbeat (bradycardia), stiff or limp limbs (hypotonia), and a poor response to stimulation. [yourdictionary.com]
External findings: bloated face and cyanosis petechiae on the skin of the face, conjunctiva and oral mucosa. possibly a bitten-off tongue, ejaculation or passage of feces and urine Internal findings: extravasation due to petechiae under the serous membranes [flexikon.doccheck.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]
- 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]
Myocardial function eventually becomes depressed and hypotension results in end organ damage to a variety of systems. [pedclerk.bsd.uchicago.edu]
Anaesthetic agents causing hypotension. Severe anaemia. Eclamptic fit. Placental causes: Placental compression as in: Tonically contracted uterus. Prolonged labour after rupture of membranes. [gfmer.ch]
- Tachycardia
MESSAGE: Early identification and management of ventricular tachycardia in neonate with perinatal asphyxia can be life-saving. [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. [gfmer.ch]
Ears
- Hearing Impairment
However, if the asphyxial episode is severe, an infant may die, or survive with life-long neurologic disabilities, including cerebral palsy, mental retardation, vision and hearing impairments, and learning disabilities. [pediatrics.emory.edu]
impairments Visual impairments Feeding problems, nutritional concerns, and oral health issues Pain symptoms Respiratory conditions Skin issues Orthopedic issues Mental health conditions The long-term effects of birth asphyxia depend on the part of the [abclawcenters.com]
The rates of visual and hearing impairments did not differ significantly between the two groups, and head circumference and growth were similar in the two groups (Table S10 in the Supplementary Appendix ). Table 4. Table 4. [nejm.org]
Eyes
- Conjunctival Petechiae
[…] fabric, metal chain) 4 pounds of pressure required to occlude jugular veins (preventing venous drainage of head) and 5 - 11 pounds to occlude carotid arteries Loss of consciousness occurs in 10 - 15 seconds; death within 3 - 5 minutes May see facial and conjunctival [pathologyoutlines.com]
Face, Head & Neck
- Facial Edema
Patients can also display jugular venous distention and facial edema. [2] Associated injuries include pulmonary contusion, myocardial contusion, hemo / pneumothorax, and broken ribs. [3] [4] Causes [ edit ] Traumatic asphyxia occurs when a powerful compressive [en.wikipedia.org]
Urogenital
- Renal Insufficiency
Renal insufficiency and acute renal failure. In: Avery's Diseases of the Newborn, 7th ed, Taeusch, HW, Ballard, RA (Eds), WB Saunders, Philadelphia 1998, p. 1158. 10. [pedclerk.bsd.uchicago.edu]
Neurologic
- Encephalopathy
KEYWORDS: Cerebral palsy; Cognitive outcome; Hypoxic ischemic encephalopathy; Neonatal encephalopathy; Newborn [ncbi.nlm.nih.gov]
- 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]
Electrographic seizures occurred in 11 of the 49 infants. [pediatrics.aappublications.org]
For example, seizures may not occur immediately after birth and a clinical neurologic syndrome may evolve over 2-3 postnatal days. [uichildrens.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]
- Irritability
Recurrent airway irritation may have contributed to uvular hypertrophy, due to inflammatory and reactive changes. [ncbi.nlm.nih.gov]
Appendicitis can easily be confused with something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation bladder or urine infections Crohn's disease a pelvic infection In women, symptoms similar to those of appendicitis can [nhs.uk]
[…] different for each person and can seem like the following conditions that also cause pain in the abdomen: abdominal adhesions constipation inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, long-lasting disorders that cause irritation [niddk.nih.gov]
As the appendix becomes more swollen and inflamed, it will irritate the lining of the abdominal wall, known as the peritoneum. This causes localized, sharp pain in the right lower part of the abdomen. [healthline.com]
[…] occurring prior to childbirth Infection in the mother that may cause breathing problems, such as pneumonia Prolonged first and second stages of labor Pre- or post-term labor Delivery with forceps or a vacuum device Mild asphyxia may cause: Poor muscle tone Irritability [health.cvs.com]
- Confusion
Appendicitis can easily be confused with something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation bladder or urine infections Crohn's disease a pelvic infection In women, symptoms similar to those of appendicitis can [nhs.uk]
Of all your body’s many functions, modern medicine is still confused about one thing: the appendix. It’s possible your appendix fights off some infections, but doctors aren’t quite sure. Cleveland Clinic is a non-profit academic medical center. [health.clevelandclinic.org]
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]
Since there is no known function of the appendix and to prevent diagnostic confusion in the future, the surgeon removes it to prevent potential appendicitis in the future. Appendectomy: Step 2 of 8. [onhealth.com]
Confusion regarding the existence of a national policy and the specifics of its content will limit the translation of policy into programmes. [health-policy-systems.biomedcentral.com]
- 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]
Salient features of sarnat stages of post-hypoxic encephalopathy Stage I Stage II Stage III Level of consciousness hyperalert lethargic or obtunded stuporous Neuromuscular control Muscle Tone Posture normal mild distal flexion mild hypotonia strong distal [uichildrens.org]
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]
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].
Serum
- 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]
During these events, the oxygen content of fetal blood may decrease (hypoxemia), and the carbon dioxide or carbonic acid content of the fetal blood may increase (hypercapnia). [medscape.com]
[…] after 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]
Asphyxia is defined biochemically as a condition of impaired respiratory gaseous exchange that leads to hypoxaemia, hypercapnia and metabolic acidosis. [scielo.org.za]
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.
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
- 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.
- Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361:1349.
- Graham MA, Hanzlick R. Asphyxia. In:. Forensic Pathology in Criminal Cases. 2nd ed. Carlsbad, Calif: Lexis Law Publishing; 1997.
- 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
- Rossen R, Kabat H, Anderson JP. Acute arrest of cerebral circulation in man. Arch Neurol Psychiatr. 1943;50:510-31.
- 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.
- Rajakumar PS, Vishnu Bhat B, Sridhar MG, et al. Electrocardiographic and echocardiographic changes in perinatal asphyxia. Indian J Pediatr 2009; 76:261.
- 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.
- DiMaio VJ, DiMaio D. Forensic Pathology. 2nd ed. Boca Raton, Fla: CRC Press; 2001:234.
- Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353:1574.