Traumatic asphyxia (compression of the chest, syndrome of the superior vena cava) occurs due to a sharp and relatively long compression of the thorax or upper abdomen. One of the main types of traumatic injuries in mass injuries is crowd crushing, earthquake, mine collapses, etc. Due to the violation of venous outflow from the upper half of the body, the pressure in the system of the superior vena cava increases dramatically with the formation of multiple small hemorrhages (petechiae) in the skin, mucous membranes Shells and internal organs, especially in the brain. Often periorbital edema develops, as well as subconjunctival hemorrhages and retina of the eye. Persistent blue staining of the upper half of the trunk and face can be noted. This type of injury can be combined with a bruise of the lung, heart, liver damage. Fracture of the ribs, as a rule, does not happen. Traumatic asphyxia of mild degree is usually self-terminated and during the course of several weeks its signs disappear.
Symptoms. Traumatic asphyxia is characterized by pinpoint hemorrhages in the skin, mucous membranes and conjunctiva. Verification of the diagnosis usually presents no difficulties, since it is for traumatic asphyxia that the appearance of the head and neck is incomparable with the lower part of the trunk: the upper sections look full, while the lower ones look pale.
The clinical picture, depending on the duration and force of compression, is different. In mild cases, the victims are excited, the face is puffy, slightly cyanotic, the petechiae are noticeable on the conjunctiva, breathing is quickened. With an average degree of severity of chest compression, the victim is not oriented in space, is hindered or agitated, tachypnea, hemoptysis or respiratory failure are noted. The face is edematic, cyanotic, multiple petechiae on the face, neck, conjunctiva of the eyes, pronounced dyspnea, impaired vision. In severe cases, patients without consciousness, there is a sharp cyanosis of the entire body, sometimes the face, neck, upper half of the trunk. Multiple petechiae on the face, conjunctiva of the eyes and on the skin of the upper body (symptom "decollete"), face, neck, hands. Breathing is superficial, frequent, in the absence of treatment it is replaced by a rare agonistic up to a complete stop.
The diagnosis in typical cases is simple and is based on anamnesis, the characteristic appearance of patients, the presence of petechiae on conjunctiva and skin. When examined, there is evidence of cyanosis, a sign of increasing hypoxemia due to respiratory failure. If the cyanotic color is only the face, neck and upper half of the chest (symptom "decollete"), one should suspect traumatic asphyxia, which occurs when the chest is squeezed. Differentiate follows from the closed craniocerebral trauma, asphyxia due to the regrutation and aspiration of vomit, the ingress of foreign bodies into the respiratory tract.
Urgent care. Thoracic trauma requires, above all, special attention to the condition (patency) of the respiratory tract and to the mechanics of breathing. The main and decisive aspect of resuscitation is effective ventilation. In light cases - peace, ice on the head; With excitation, sedatives (seduxen or Relanium, 1% solution of diphenhydramine) are administered; In cases of moderate severity - elevated position, inhalation of oxygen, cardiovascular drugs. In severe cases in the absence of consciousness - artificial respiration using a mask from the AMBU apparatus, the use of air ducts (S-tube, laryngeal mask), emergency intubation of the trachea (kombityub). Intravenously injected 20 ml 40% glucose solution, lasix 40-80 mg to prevent pulmonary edema and reduce cerebral edema.
Hospitalization in severe cases in the intensive care unit, with traumatic asphyxia of moderate severity - in the traumatological or thoracic department of the multi-profile hospital. Transportation in a prone position with a raised head. In mild cases after a diagnostic observation for an hour in the hospital reception room, the patient may be referred for outpatient treatment in the absence of respiratory failure and neurologic symptoms.