Traumatic asphyxia is a relatively rare syndrome among closed chest injuries, with an incidence rate of approximately 2-8% of all chest injuries.

bubble_chart Etiology

Common causes of injury include tunnel collapses, building collapses, and vehicle crush injuries. At the moment when the chest and upper abdomen are subjected to strong compression, the victim's glottis suddenly closes, preventing air from escaping the trachea and lungs. The combined effect of these two factors leads to a sudden increase in intrathoracic pressure, compressing the heart and major veins. Due to the lack of venous valves in the superior vena cava system, this sudden high pressure causes backflow of blood in the right heart, leading to venous overfilling and blood stasis. This can result in widespread capillary rupture and petechial hemorrhages, or even rupture and bleeding of small veins.

bubble_chart Clinical Manifestations

Traumatic asphyxia is more common in adolescents and children with good chest wall elasticity, and most cases are not accompanied by rib fractures. However, when the external force is excessive, it may be accompanied by sternal and rib fractures, as well as injuries to thoracic or abdominal organs, and injuries to the spine and limbs. Difficulty breathing or shock may also occur.

The manifestations include hemorrhagic petechiae or ecchymoses in the subcutaneous tissues of the head, neck, chest, and upper limbs, as well as in the oral mucosa and conjunctiva. In severe cases, the skin and conjunctiva appear purplish-red and edematous, leading some to call it "traumatic cyanosis" or "crush injury cyanosis syndrome." Hemorrhage in the deep tissues of the eye may cause exophthalmos, while retinal vascular rupture may lead to visual impairment or even blindness. Minor punctate hemorrhages and cerebral edema in the brain can cause hypoxia, resulting in transient disturbances of consciousness, dizziness, head fullness, restlessness, and, in rare cases, limb spasms, increased muscle tone, and hyperactive tendon reflexes. The pupils may dilate or constrict. If an intracranial hematoma occurs, it may lead to hemiplegia and unconsciousness.

For patients with simple traumatic asphyxia, only symptomatic treatment under close observation is required, including semi-recumbent rest, maintaining airway patency, oxygen inhalation, appropriate analgesia and sedation, and the use of antibiotics to prevent infection. Generally, intravenous fluid volume and infusion rate should be restricted. For petechiae or ecchymoses on the skin and mucous membranes, no special treatment is needed, as they will resolve on their own within 2–3 weeks. For cases with associated injuries, corresponding emergency and treatment measures should be taken, including shock prevention and management, handling of hemopneumothorax, and timely craniotomy or laparotomy. Traumatic asphyxia itself does not cause serious consequences; the prognosis depends on the severity of intrathoracic, intracranial, and other organ injuries.