Traumatic Asphyxia Research Articles

Perthes syndrome associated with bilateral optic disc edema

Case report: Perthes syndrome, or traumatic asphyxia syndrome, results from a severe crush injury of the thorax. It manifests itself with facial and upper chest petechiae, subconjunctival hemorrhages, cervical cyanosis, and occasionally neurological symptoms. A patient who had been incarcerated under a block of marble presented with severe traumatic asphyxia syndrome complicated by pulmonary contusion, fractures of the right clavicle and the 8th and 9th ribs, minimal right hemothorax, liver contusion, and bilateral optic disc edema. Comments: To our knowledge, we present the first case of Perthes syndrome with bilateral optic disc edema.

Fatal agricultural injuries in preschool children: risks, injury patterns and strategies for prevention

Agricultural injuries are an important health concern for pediatric populations and particularly for children of pre school age. This study was conducted to estimate rates and determine patterns of fatal agricultural injury among young children exposed to agricultural hazards and to identify strategies to prevent such injuries. A national case series was assembled retrospectively for the years 1990-2001. We identified children aged 1-6 years who were fatally injured during the course of agricultural work or through contact with a hazard of an agricultural worksite. Using a standardized survey instrument, we collected data from provincial coroners' and medical examiners' case files. Fatal agricultural injury rates (calculated with denominator data from the Canada Census of Agriculture) were compared with national all-cause, unintentional fatal injury rates in the general population of Canadian children during the same period (calculated with denominator data from the Canada Census of Population). The annual rate of fatal agricultural injury was substantially higher than that of all-cause, unintentional fatal injury among Canadian children aged 1-6 years (14.9 v. 8.7 per 100,000 person-years, respectively). Differences in risk were attributed to elevated fatal agricultural injury rates among boys. Most injuries occurred in the agricultural worksite, largely (84/115 [73%]) the result of 3 mechanisms: being run over by agricultural machinery as a bystander (29%) or as an extra rider who fell from the machine (22%), or asphyxia due to drowning (23%). Major crush injuries (of the head, chest and abdomen) and asphyxia from drowning were the most frequent mechanisms of injury. Preschool-aged children exposed to agricultural worksites are at high risk of fatal injuries. Prevention strategies should focus on restricting children's access to these worksites. Physicians and allied health care professionals who care for rural families could take on a proactive role in communicating the nature and magnitude of these risks.

Perthes syndrome associated with bilateral optic disc edema

<h2>Abstract</h2> Case report: Perthes syndrome, or traumatic asphyxia syndrome, results from a severe crush injury of the thorax. It manifests itself with facial and upper chest petechiae, subconjunctival hemorrhages, cervical cyanosis, and occasionally neurological symptoms. A patient who had been incarcerated under a block of marble presented with severe traumatic asphyxia syndrome complicated by pulmonary contusion, fractures of the right clavicle and the 8th and 9th ribs, minimal right hemothorax, liver contusion, and bilateral optic disc edema. Comments: To our knowledge, we present the first case of Perthes syndrome with bilateral optic disc edema.

Brachial plexus lesions associated with traumatic asphyxia.

Abstract Among 19 patients admitted to hospital following a major disaster it was noted that 15 showed evidence of traumatic asphyxia and 7 had sustained brachial plexus injury. Three such cases are presented, the possible pathogenesis of the brachial plexus lesions is discussed, and the diagnostic difficulty presented by unconscious traumatically asphyxiated patients with monoparesis is highlighted.

Fatal traumatic asphyxia in a middle-aged man in association with entrapment associated hypoxyphilia

A case is reported of a 36-year-old man who died following occlusive entrapment within a device for the purpose of hypoxyphilic gratification. The device was constructed in his own home using instructions found on his home computer down-loaded from the Internet. The device comprised a tough plastic cocoon large enough to accommodate an adult human and incorporating a system of plastic piping connected to a household vacuum cleaner for the evacuation of air within the cocoon. The mechanism of death was thought to be traumatic asphyxia after examination of the deceased and re-construction of the apparatus with the body in situ. The implications of this unusual device for the purposes of hypoxyphilic gratification by occlusive entrapment and its inherent dangers are highlighted.

The brassiere ‘sign’ – A distinctive marker in crush asphyxia

The diagnosis of crush asphyxia typically relies on a history of chest or abdominal compression with the finding of skin petechiae and congestion. The following three cases of crush asphyxia demonstrate a distinctive pattern of petechiae and congestion associated with close-fitting clothing: Case 1, a 49-year-old woman who was crushed under a large hay bale; Case 2, a 35-year-old woman who was crushed between a wall and a car; Case 3, a 49-year-old woman who was crushed between a crane and the side of a truck. At autopsy in all three cases there were facial, conjunctival, neck and upper anterior chest petechiae. However, few or no petechiae, and reduced congestion, were observed in areas beneath the victims’ brassieres. Deaths in these cases were all due to crush asphyxia, with the pattern of petechiae on the chests of the victims influenced by close-fitting clothing that had compressed cutaneous vasculature. This brassiere ‘sign’ provided a readily observable and easily recordable sign of crush asphyxia due to chest compression, and illustrated that vascular engorgement is necessary for the development of petechiae in these circumstances.

The pathological features and circumstances of death of lethal crush/traumatic asphyxia in adults—A 25-year study

A 25-year retrospective study of cases of crush/traumatic asphyxia autopsied at Forensic Science SA, Adelaide, Australia from 1980 to 2004 was undertaken. A total of 79 cases of crush asphyxia was found consisting of 63 males (80%) and 16 females (20%). The age range of the males was 19–86 years (mean = 41.8 years) and of the females was 19–75 years (mean = 38.6 years). In 18 cases the exact circumstances of death were unclear, leaving 61 cases in which details of the fatal episode were available. Major categories included vehicle crashes ( N = 37), industrial accidents ( N = 9), farm accidents ( N = 6) and entrapment beneath vehicles ( N = 5). Forty of the 79 victims (51%) had only very minor bruises and abrasions; 28 (35%) had evidence of chest compression with rib and sternal fractures and large areas of soft tissue bruising of the chest; 7 cases (9%) had other significant injuries or findings that had contributed to death. All of these victims had signs of crush asphyxia in the form of intense purple congestion and swelling of the face and neck, and/or petechial hemorrhages of the skin of the face and/or conjunctivae. The pattern of pathological findings of crush asphyxia was not influenced by the presence or absence of concomitant serious or lethal injuries. In 4 cases (5%) where the circumstances of the lethal episode were those of crush asphyxia there were no characteristic pathological findings. This study has shown that a high percentage of crush asphyxias may be caused by vehicle accidents. It has also demonstrated that on occasion fatal crush asphyxia may have to be a diagnosis of exclusion, made only when there are characteristic death scene findings, and no evidence of lethal natural diseases or injuries at autopsy, with negative toxicological screening.

Isolated subconjunctival hemorrhages in nonaccidental trauma

To establish child abuse as part of the differential diagnosis of isolated bilateral subconjunctival hemorrhages in infants. To review three cases of nonaccident trauma initially presenting with isolated bilateral subconjunctival hemorrhages as the only significant clinical finding. Ophthalmic examination in cases 1 and 2 were entirely normal except for the large bilateral subconjunctival hemorrhages. Hematological parameters were normal in all three infants. Initial radiological findings were normal in case 1 but multiple healing rib fractures were identified when the chest X-ray was repeated 3 weeks later. Case 2 had skin and skeletal X-ray findings compatible with abuse at time of presentation to the ophthalmologist. Case 3 was admitted to hospital for multiple unexplained limb fractures but had been seen 2 weeks prior for poorly explained bilateral isolated subconjunctival hemorrhages and facial petechiae. Nonaccidental trauma should be considered in the differential diagnosis of bilateral isolated subconjunctival hemorrhages in infants especially if associated with facial petechiae. These isolated subconjunctival hemorrhages may be part of the traumatic asphyxia syndrome caused by severe, prolonged compression of the child's chest and upper abdomen. Appropriate assessment includes a complete ophthalmic and pediatric examination as well as hematological testing and imaging studies. If the coagulation profile and initial imaging studies are normal yet there remains a high suspicion of abuse, an immediate nuclear scan or a repeat skeletal survey or chest film 2 weeks later is indicated.

An unusual case of traumatic petechiae

We report a rare cause of traumatic petechiae without the full blown symptoms and signs of traumatic asphyxia. There were no complications encountered and there was spontaneous resolution.

Asphyxiation: a review

Asphyxia may be broadly defined as any condition that leads to tissue oxygen deprivation. This article reviews traumatic causes of asphyxia, including the syn drome known as traumatic asphyxia, where a crush injury to the thoracoabdominal area gives the striking clinical triad of cervicofacial cyanosis and oedema, subcon junctival haemorrhage and cutaneous petechial haemorrhages of the face, neck and upper chest. Other traumatic causes of asphyxia reviewed are strangulation due to hanging and autoerotic asphyxiation. However bleak the initial prognosis may appear, any patient who presents with a history of asphyxiation should initially be resuscitated according to the prioritized approach: airway with cervical spine control, oxygenation and ventilation, and circulation. The clinical appearance of the patient is not an indicator of outcome. The identification and treatment of associated compli cations and injuries is vital, since these are a major cause of morbidity and mortality if the patient survives the initial asphyxiation insult.

Traumatic Asphyxial Deaths Due to an Uncontrolled Crowd

Nine people died of traumatic asphyxia due to an uncontrolled crowd at a community basketball game in New York City in 1991. We reviewed the circumstances, postmortem findings, and the causes of death. The majority of people had petechiae of the conjunctivae and face consistent with chest compression. There were minimal superficial blunt injuries and no fractures or acute intoxications. These deaths are often incorrectly attributed to blunt force injuries, while the cause typically is asphyxia due to chest compression.

Traumatic asphyxia or Perthe's syndrome. Six cas reports

Perthe's syndrome or traumatic asphyxia is a clinical syndrome associating cervicofacial cyanosis, petechia and subconjonctival hemorrhage to neurological symptoms. This syndrome appears after severe and transient compressive blunt chest injury. A Valsalva maneuver is necessary before thoracic compression for the development of this syndrome. The treatment includes rapid chest decompression and cardiopulmonary resuscitation. The prognosis is good but a prolonged thoracic compression could lead to cerebral anoxia and neurological sequelae. We report six cases of Perthe's syndrome most of them resulting from thoracic compression after road traffic accidents. All of them made a good prognosis.

Inflicted Compressional Asphyxia of a Child

Compressional or traumatic asphyxia is a well recognized entity to most forensic pathologists. The vast majority of reported cases have been accidental. The case reported here describes the apparent inflicted compressional asphyxia of a small child. A review of mechanisms and related controversy regarding proposed mechanisms is discussed.

Hemorrhages in the root of the tongue in fire fatalities: the incidence and diagnostic value

Hemorrhages in the root of the tongue have been considered to be a finding associated with asphyxiation. The aim of the present study was to examine the incidence and diagnostic value of the lingual hemorrhages in fire fatalities with reference to the related pathological and toxicological findings, in comparison with asphyxiation and drowning cases. In fire fatalities ( n=90), small to marked hemorrhages were observed in 26 cases (28.9%). In the reference groups (asphyxiation and drowning), the hemorrhages were frequently observed in ligature strangulation ( n=10/15), manual strangulation ( n=5/7) and traumatic asphyxia ( n=4/5). In fire fatalities, the hemorrhages were closely associated with a lower blood carboxyhemoglobin (COHb) level, suggesting an influence of fatal burns: n=16/32 (50.0%), n=8/26 (30.8%) and n=2/32 (6.2%), respectively, in cases of COHb<30%, 30–60% and >60%. These findings suggested possible acute hemodynamic disturbance in the head including brain (cranial congestion) in the dying process due to fires. A careful differentiation from neck compression may be necessary in such cases.

Fatal unintentional traumatic asphyxia in childhood.

The present study was undertaken to examine specific features of unintentional traumatic asphyxial deaths in childhood. Coronial files and records at the Forensic Science Centre in Adelaide, South Australia, were examined over a 35-year period from 1966 to 2000 for all cases of traumatic asphyxial death occurring in children under the age of 17 years. Six cases of unintentional fatal traumatic asphyxia were identified. All of the victims were boys with an age range of 2-15 years (mean 6.8 years) and all were found dead at the scene. Fatal traumatic asphyxia resulted from entrapment beneath a chest of drawers, beneath a table tennis table, between a pile of wooden pallets and a metal fence, between a conveyor belt and its frame, and under a motor vehicle (in two cases). Fatal traumatic asphyxia in childhood is a rare event, with younger children commonly being trapped by furniture or by industrial equipment while playing, and older children being trapped under motor vehicles in similar circumstances to adult traumatic asphyxial deaths. Unsupervised play of young children around heavy and potentially unstable pieces of furniture may be dangerous, particularly if more than one child is present. Unsupervised play of young children in industrial yards should be avoided.

Tornado-Related Deaths and Injuries in Oklahoma due to the 3 May 1999 Tornadoes

During the evening hours of 3 May 1999, 58 tornadoes occurred in Oklahoma. One tornado reached F5 intensity and left a widespread path of death, injury, and destruction in and around the Oklahoma City metropolitan area. Other communities across the state were also affected. Data on persons who died or were injured were collected from medical examiner reports, hospital medical records, and follow-up questionnaires. In addition, community surveys were conducted in the damaged areas, and a random telephone survey of people in the Oklahoma City area was conducted. A total of 45 persons died, and 645 survivors were treated at a hospital for injuries/health conditions related to the tornadoes. Detailed analyses were conducted on the 40 deaths and 512 nonfatal injuries that resulted directly from the tornadoes. The average age of persons who died was significantly higher than that of injured survivors. Almost three-fourths (74%) of survivors were treated in an emergency department and released; 26% were hospitalized, with an average stay of 7 days. The most common kinds of injuries were soft-tissue injuries (cuts, bruises, and scrapes), fractures/dislocations, and brain injuries. The most common causes of injuries for survivors were being hit by flying/falling debris and being picked up or blown by the tornado. Probable causes of death included multiple injuries (50%), head injuries (23%), chest trauma (18%), and traumatic asphyxia (10%). The proportion of deaths among injured persons was higher in mobile homes, apartment buildings, and outdoors than in houses. The vast majority of persons received television warnings; few persons received warnings by weatherband radio. Survey data indicated that since the tornadoes there had been only a slight increase in the proportion of persons with a storm shelter on their home premises and in the proportion of persons who know the location of the nearest shelter. Effective preparedness plans should be developed in advance of situations with tornadic potential and implemented in a timely manner when warnings are issued. The accessibility and knowledge of the location of shelters also needs to be increased. Warning systems should be integrated and duplicative, and they should include traditional methods and new technology.

Successful Bystander Cardiopulmonary Resuscitation by Chest Compression without Ventilation; A Case of the Patient with Traumatic Asphyxia.

A 50-year-old construction worker had been pressed down beneath a forklift truck and sustained cardiopulmonary arrest. Physical findings were typical for traumatic asphyxia. The patient was resuscitated by a bystander using only external cardiac compression; rescue breathing was not performed. He had both coma and cardiopulmonary arrest persisted for 7 min until emergency medical technicians (EMT) arrived. However, he was resuscitated in cooperation with bystander, EMT, a nearest hospital and our hospital on resuscitation. Nearly full recovery ultimately resulted. Even incomplete resuscitation performed immediately by a bystander may offer a better chance of survival and permit a better functional outcome in traumatic asphyxia than proficient but delayed cardiopulmonary resuscitation.

Postmortem endoscopy of the ocular fundus: A valuable tool in forensic postmortem practice

Pathological changes of the ocular fundus in acute severe head or extracranial injury are difficult to document. In vivo examination usually has to be carried out under intensive care conditions. Postmortem ophthalmoscopy is usually impeded by rapid blurring of the cornea. Therefore, endoscopic fundal photography has been applied by using a pars plana approach during forensic postmortem procedures. This technique provides fundoscopic pictures of high quality as a valuable supplement for subsequent macro- and histopathological preparations and sections. Different patterns of fundoscopic findings seem to correspond to different types of injuries such as craniocerebral trauma, traumatic asphyxia and decompression sickness, and may allow some insight into the respective pathogenetic mechanism.

Traumatic Asphyxia Complicated by Unwitnessed Cardiac Arrest

We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.

Traumatic Asphyxia Complicated by Unwitnessed Cardiac Arrest

Traumatic Asphyxia Complicated by Unwitnessed Cardiac Arrest