Traumatic asphyxia

Background

Traumatic asphyxia occurs when sudden and blunt chest trauma forces retrograde flow of blood through the superior vena cava and into the neck and head.
Normally a result of blunt chest trauma from an MVA ^[1]
In children the chest wall is more pliable and there is often less morbidity unless there is also multiorgan trauma^[2]

Maintain adequate oxygenation > 92%
Maintain blood pressure with small fluid boluses if necessary (250cc boluses)
Assess for tension pneumothorax if patient hypoxic or hypotensive
- Perform Needle thoracostomy if indicated
Prepare for Advanced Airway if patient persistently hypoxic, unable to maintain airway, or has an anticipated poor clinical course

Many of the following features can be seen on exam depending on the extent of the force.^[3]

Chest wall bruising or significan tmechanism consistent with thoracic trauma (i.e. seatbelt sign, steering wheel deformity, airb deployment)
Arrhythmia
Impaired blood flow to the brain can cause
- may result in neurologic deficits, altered mental status, or [Seizures]]
- Hemorrhagic CVA is unlikely

Chest X-ray
- although often little diagnostic yield^[4]
- used to assess for gross Pneumothorax, Rib fracture, or mediastinal widening concerning for Aortic Dissection or Pulmonary Contusion
CT with IV contrast for better assessment of lung and vasculature

↑ Centers for Disease Control and Prevention. Accidents or unintentional injuries. http://www.cdc.gov/nchs/fastats/accidental-injury.htm
↑ Gutierrez IM, Ben-Ishay O, Mooney DP. Pediatric thoracic and abdominal trauma. Minerva Chir. Jun 2013;68(3):263-74
↑ Hubble MW, et al. Chest Trauma. In Hubble MW, Hubble JP, eds, Principles of Advanced Trauma Care. Albany, NY: Delmar/Thompson Learning, 2002.
↑ Cook AD, Klein JS, Rogers FB, et al. Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration. J Trauma. May 2001;50(5):843-7