7-01: Traumatic Asphyxia

Introduction

Seat Belt Injury. Abrasions from a 3-point restraint causing rib fractures and a pneumothorax. (Photo contributor: Brad Russell, MD.)

Clinical Summary

The clinical findings of traumatic asphyxia are due to a sudden increase in intrathoracic pressure against a closed glottis. The elevated pressure is transmitted to the veins, venules, and capillaries of the head, neck, extremities, and upper torso, resulting in capillary rupture. Strangulation and hanging are common mechanisms. Survivors demonstrate plethora, ecchymoses, petechiae, and subconjunctival and retinal hemorrhages. Severe injuries may produce central nervous system injury with blindness, seizures, posturing, and paraplegia.

Management and Disposition

Treatment is supportive, with attention to other concurrent injuries. Long-term morbidity is related to the associated injuries.

Pearls

1. Facial petechiae are known as Tardieu spots.

2. One should be alert for associated rib and vertebral fractures.

3. Perthes syndrome is traumatic asphyxia following thoracic crush injury.