| Traumatic asphyxia | |
|---|---|
| Specialty | Emergency medicine  |
Traumatic asphyxia, orPerte's syndrome,[1] is a medical emergency caused by an intense compression of thethoracic cavity, causingvenous back-flow from the right side of the heart into the veins of the neck and the brain.[2]
Traumatic asphyxia is characterized bycyanosis in the upper extremities, neck, and head as well aspetechiae in theconjunctiva. Patients can also displayjugular venous distention and facialedema.[3] Associated injuries includepulmonary contusion,myocardial contusion,hemo/pneumothorax, andbroken ribs.[4][5]
Traumatic asphyxia occurs when a powerful compressive force is applied to the thoracic cavity. This is most often seen inmotor vehicle accidents, as well as industrial and farming accidents. However, it can be present anytime a significant pressure is applied to the thorax.
The sudden impact on the thorax causes an increase inintrathoracic pressure.[4] In order for traumatic asphyxia to occur, aValsalva maneuver is required when the traumatic force is applied.[6] Exhalation against the closed glottis along with the traumatic event causes air that cannot escape from the thoracic cavity. Instead, the air causes increased venous back-pressure, which is transferred back to the heart through theright atrium, to thesuperior vena cava and to the head and neck veins and capillaries.[4]
Patients are seen with a cyanotic discoloration of the shoulder skin and neck and face, jugular distention, bulging of the eyeballs, and swelling of the tongue and lips. The latter two are resultants of edema, caused by excessive blood accumulating in the veins of the head and neck and venous stasis.
For individuals who survive the initial crush injury, survival rates are high for traumatic asphyxia.[4][6][7]