Asphyxia is the condition of suffocation which is followed by critical falling of level of oxygen (hypoxia) and excess of carbon dioxide (giperkapniya) in blood and fabrics. At asphyxia sharply or the phenomena of respiratory insufficiency accrue: cyanosis of skin, , participation in breath of auxiliary muscles; in a terminal stage the coma, spasms, respiratory standstill and warm activity develops. The condition of asphyxia is diagnosed on the basis of assessment of complaints and fizikalny data, a pulsoksimetriya. In this case rendering emergency aid which includes restoration of passability of airways, oxygen inhalations, tracheotomy, IVL, medicamentous therapy is required.
Asphyxia (asphyxia; Greek - and - denial + sphyxis - pulse; literally - "lack of pulse") – the zhizneugrozhayushchy state connected with gas exchange violation, development of hypoxemic and giperkapnichesky syndromes and leading to disorder of breath and blood circulation. Dysfunction of the respiratory center, a mechanical obstacle for intake of air in lungs, damage of respiratory muscles can be the cornerstone of asphyxia. All types and forms of asphyxia, irrespective of the reasons, demand carrying out urgent (and sometimes and resuscitation) actions as already in a few minutes after development of sharp oxygen starvation, there can come death. In medicine the problem of asphyxia is urgent for a neonatology, pulmonology, traumatology, toxicology, resuscitation and other disciplines.
All reasons leading to an asfiksichesky state can be divided on pulmonary and extra pulmonary. The first of them are most often connected with an external sdavleniye of airways or their vnutriprosvetny impassability (obturatsiy). The compression of pneumatic ways is from the outside observed at a suffocation (hanging, an udavleniye by a loop or hands), a trachea sdavleniye, neck injuries, etc. Obstructive disorders of breath most often are caused by a language zapadeniye, obstruction of a trachea and bronchial tubes foreign matters, vnutriprosvetny tumors, hit in airways of food, emetic masses, waters during the drowning, blood at pulmonary bleeding. The sharp stenosis of airways can develop at a trakheobronkhita, an asthmatic attack, allergic hypostasis or a burn of a throat, hypostasis of vocal chords. Also refer the gas exchange violations caused by an acute pneumonia, massive ekssudativny pleurisy, total pheumothorax or gemotoraksy, atelektazy or hypostasis of lungs, TELA to number of the pulmonary reasons of asphyxia.
Among extra pulmonary factors of asphyxia the states leading to defeat of the respiratory center are in the lead: intoxications, craniocereberal injuries, strokes, overdose medicinal and drugs (for example, morphine, barbiturates). Paralysis of respiratory muscles as the asphyxia reason, can develop against the background of infectious diseases (botulism, poliomyelitis, tetanus), poisoning with kurarepodobny medicines, a vertebral and spinal trauma, a myasthenia and so forth. Violations of transportation of oxygen in fabric arises at massive bleedings, disorders of blood circulation, poisoning with carbon monoxide, metgemoglobinoobrazovatel.
The sdavleniye or injury of a thorax complicating respiratory excursions is the cornerstone of traumatic asphyxia. The asphyxia caused by the insufficient content of oxygen in the inhaled air can develop at long stay in badly ventilated mines and wells, at a high-rise disease, at violation of supply of oxygen in the limited closed systems (for example, at divers). Fetoplatsentarny insufficiency, intra cranial patrimonial injuries, aspiration of amniotic waters most often lead to asphyxia of newborns.
The mechanism of development of asphyxia at all types of suffocation has the common pathogenetic features. As a consequence of oxygen insufficiency serves accumulation in blood of products of incomplete oxidation with development of metabolic acidosis. In cages heavy violations of biochemical processes develop: sharply the amount of ATP decreases, course of oxidation-reduction processes changes, decreases etc. cellular components also death of a cage is a consequence of proteolytic processes. Before everything irreversible changes develop in cells of a brain, and at damage of the respiratory and sosudodvigatelny centers quickly there comes death. In a cardiac muscle at asphyxia there are hypostasis, dystrophy and a necrosis of muscle fibers. From lungs alveolar emphysema and hypostasis is noted. In serous covers (a pericardium, a pleura) melkopyatnisty hemorrhages are found.
Depending on the speed of development of suffocation (malfunction of breath and haemo dynamics) distinguish sharp and subsharp asphyxia. On the mechanism of emergence it is accepted to distinguish the following types of asphyxia:
- mechanical – restriction or the termination of access of air to airways is caused them by a sdavleniye, an obturation or narrowing;
- toxic – suffocation develops as a result of oppression of the respiratory center, paralysis of respiratory muscles, violation of transport of oxygen blood as a result of hit in an organism of chemical compounds;
- traumatic - suffocation is a consequence of the closed injuries of a thorax.
Other option of classification suggests to allocate asphyxia from a sdavleniye (compression and strangulyatsionny – a suffocation), asphyxia from closing (aspiration, obturatsionny, drowning) and asphyxia in the limited closed space. A special type of suffocation is the asphyxia of newborns considered within pediatrics.
In the clinical course of asphyxia allocate four phases. The first phase is characterized by compensatory increase in activity of the respiratory center in the conditions of a lack of oxygen. During this period the patient has a fright, concern, excitement; dizziness, cyanosis of integuments, inspiratory short wind with the forced breath; tachycardia, increase HELL. At the asphyxia caused by a sdavleniye or violation of passability of airways, the patient strongly coughs, speaks hoarsely, makes attempts of release from the squeezing factor; the person becomes bloated, crimson-blue.
In the second phase against the background of exhaustion of compensatory reactions short wind gains expiratory character (the exhalation amplifies and extended), cyanotic coloring of skin accrues, the frequency of respiratory movements and warm reductions urezhatsya, HELL decreases. In the third, preterminalny phase, there is a short-term termination of activity of the respiratory center: there are episodes , there is a falling of arterial pressure, reflexes die away, loss of consciousness and a lump develops. In the last, fourth phase of asphyxia agonalny breath is observed, spasms are noted, pulse and HELL are not defined; involuntary urination, defecation and an ejaculation are possible.
At gradually developing asphyxia (within several hours or days) the victim sits, having inclined a trunk and having extended a neck forward; widely opened mouth greedy catches air, it is often put out outside tongue. Skin is usually pale, it is expressed lips and nails; on a face the fear of death is displayed. At a decompensation asphyxia gets the phasic current described above.
Asphyxia is complicated by fibrillation of ventricles, hypostasis of lungs and a brain, traumatic shock, an anury. Pregnant women can have a spontaneous abortion. As a cause of death of the patient usually serves paralysis of the respiratory center. At sharp development death comes in 3-7 minutes. In the remote period at the patients who endured asphyxia aspiration pneumonia, paresis of vocal chords, different types of amnesia, change of the emotional status (irritability, indifference), violations of intelligence can be observed up to weak-mindedness.
In sharp cases and at the known reason diagnosis of asphyxia comes easy. If the patient in consciousness, he can show complaints to dizziness, short wind, darkening in eyes. Objective data depend on an asphyxia phase. Pulsoksimetriya allows to determine the size of pulse and extent of saturation of hemoglobin by oxygen. Identification and elimination of the pulmonary reasons of asphyxia requires consultation of the pulmonologist, sometimes – the endoscopist. In other cases traumatologists, neurologists, infectiologists, toxicologists, psychiatrists, narcologists, etc. can be involved in diagnostics. The diagnostic stage has to be most compressed on time as carrying out profound inspection (a X-ray analysis, a diagnostic bronkhoskopiya, etc.) because of weight a condition of the patient often is actually impossible.
As the Patomorfologichesky signs demonstrating that death came from asphyxia serve cyanosis of the person, hemorrhage in conjunctivas, cadaveric spots of bluish-lilac color with multiple ekhimoza, liquid state of blood, stagnation of blood in the right departments of heart at an empty left half, krovenapolneny internals, etc. At a suffocation on a neck the strangulyatsionny furrow from the squeezing loop is visible, fractures of cervical vertebras are defined.
First aid at asphyxia
The complex of urgent actions is defined by the reason and a phase of asphyxia. At mechanical suffocation, first of all, it is required to restore passability of pneumatic ways: to remove the accumulated slime, blood, water, food masses, foreign matters by means of trakhealny aspiration, a bronkhoskopiya, special receptions; to weaken the loop squeezing a neck, to eliminate a language zapadeniye etc. In the absence of independent breath and warm activity pass to performing warm and pulmonary resuscitation – an artificial respiration and the closed massage of heart. In the presence of indications and technical capability the trakheostomiya or an intubation of a trachea with transfer of the patient to hardware IVL can be made. Development of fibrillation of ventricles forms the basis for an electric defibrillation.
In certain cases serve as prime measures for elimination of asphyxia or drainage of a pleural cavity. For the purpose of decrease in venous pressure bloodletting is carried out. First aid at toxic asphyxia consists in introduction of antidotes. After restoration of ventilation of lungs and warm activity medicamentous correction of water and electrolytic and acid-base balance, maintenance of function of cardiovascular and respiratory systems, dehydrational therapy (for the purpose of prevention of hypostasis of a brain and lungs), blood transfusion and krovezameshchayushchy solutions (is made at plentiful blood loss). If other diseases (infectious, nervous were the reason of asphyxia, etc.) performing their pathogenetic treatment is necessary.
Forecast and prevention
At sharply progressing asphyxia the forecast extremely serious - is available high risk of a lethal outcome; at long development – more favorable. However even when it is possible to restore the vital functions, consequences of asphyxia can have an effect during the near or remote future after the patient's getting out of critical condition. The outcome of asphyxia is in many respects predetermined by timeliness of carrying out and volume of resuscitation actions. As prevention of asphyxia serves prevention of situations which can cause suffocation: early treatment of potentially dangerous diseases, prevention of injuries of thorax, aspiration of liquid substances and alien objects, suicides; exception of contact with toxic substances (including treatment of toxicomania and drug addiction), etc. After the postponed asphyxia patients quite often need careful departure and long observation of experts.