Traumatic asphyxia refers to widespread congestion and hemorrhagic damage to the skin, mucous membranes, and peripheral capillaries of the upper body caused by blunt trauma to the chest. When the chest and upper abdomen are subjected to violent compression, with the glottis tightly closed, intrathoracic pressure rises dramatically. As a result, blood from the right atrium retrogrades through the superior vena cava system, which lacks venous valves. This leads to overfilling, dilation, and rupture of the peripheral veins and capillaries in the upper body, causing congestion and hemorrhage.
Clinical Manifestations
Patients may present with pinpoint purplish-blue petechiae on the skin of the face, neck, and upper chest, with these findings being most pronounced on the face and orbital areas. Petechiae or even hemorrhages may be observed on the mucous membranes of the mouth, nasal cavity, and bulbar conjunctiva. Retinal or optic nerve hemorrhages may result in temporary or permanent visual impairment. Tympanic membrane rupture may cause bleeding from the external auditory canal, tinnitus, or hearing loss. Following injury, many patients may experience transient disturbances of consciousness, restlessness, dizziness, delirium, or even clonic seizures of the limbs. Pupils may become dilated or extremely constricted. These manifestations are believed to be associated with minor petechial hemorrhages and cerebral edema. If cranial venous rupture occurs, patients may become comatose or suffer fatal outcomes.
Management
The prognosis for traumatic asphyxia depends on the magnitude and duration of the applied pressure as well as the presence of associated injuries. Patients are managed with symptomatic treatment while undergoing close monitoring. Petechiae and ecchymoses on the skin and mucous membranes typically resolve spontaneously within two to three weeks. In rare cases, cardiac arrest or respiratory arrest may occur after the pressure has been relieved; therefore, preparations for immediate resuscitation are essential. For patients with associated injuries, appropriate and proactive management is provided in accordance with the specific injury.