Asphyxia | A condition of low oxygen in body

Asphyxia is a condition when the body does not get enough oxygen that results in unconsciousness and often death occurs. It is also known as anoxia. It may also be called as anoxemia and hypoxia.

Introduction:

The word asphyxia is derived from Greek asphyxia stopping of pulse “a” mean not and “sphyzein” mean to throb.

In normal breathing, we take in oxygen. Our lungs send oxygen into our blood .which then goes to our tissues. Our cells use it to prepare energy if the process of breathing in oxygen or breathing out carbon dioxide not occurs normally we can lose our life.

Anoxia means a complete lack of oxygen.

Hypoxia means oxygen availability is decreased.

Hypoxemia term is used for decreased concentration of oxygen in arteries.

Ischemia term is used to the poor blood supply to cells or lungs result in interrupted metabolism and cell organ death happens.

Example:

An example of hypoxia is choking.

Asphyxia results in generalized hypoxia, which affects mainly tissues and organs.

Types of Asphyxia:

Physical Asphyxia

It causes when a force or object keeps you from breathing. Many hazards lead to it. It is called physical or mechanical.

Examples:

Some examples of physical hypoxia are as following:

Choking:

When food or an object gets attach or stuck in the throat or air duct and blocks air, and the air may not enter into the lungs. In some cases airflow is entirely blocked, in other cases, only some amount of air can pass to the lungs which results in oxygen deprivation.

Although oxygen stored in the lungs and blood can keep a person alive for a few minutes but after breathing stops death occur. Deaths due to choking often occur in very young (One-year-old children) and in the elderly (75 years adults). Food shape in the pharynx such as bananas, gelatinous candies, etc.

Symptoms:

Coughing, watery eyes, red face, irritating behavior, gagging, and ability to talk at al or with full volume decreases.

Aspiration:

It is distinct from choking. It happens when foreign objects go to the wrong pipe and enter into the airway or lungs. It may occur during eating or drinking. Drowning is the most common type of aspiration. About 2.6 million cases happened in 2013 because of pulmonary aspiration or foreign particle in an air duct.

Suffocation (Smothering):

It is a state of death being a lack of oxygen. It can happen when something covers the face and breathing not occurs. It also occurs where oxygen supply is not sufficient in close airtight spaces etc.

It can be accidental when the baby is playing with cloth or polythene bags. It can occur during baby feeding by the mother’s breast. Suicide behavior is also found in it.

Strangulation:

It is the shutdown of air movement in the vessel or duct and suppresses the normal function of the body part.

Strangulation can be divided into three types based on mechanism:

Suicidal

Ligature

Manual

Suicidal/hanging:

It is a type of strangulation that includes suspension by the neck. It can be of two kinds

Complete

Incomplete

Complete Hanging:

When the entire body of the sufferer hangs down the ground and the total weight of the sufferer is at the neck the hanging is called complete hanging.

Incomplete Hanging:

The weight of a sufferer is not carried by the neck when some part of the body touches the floor.

Based on the knot, there are two types of hanging.

  1. Archetypal hanging
  2. Non-archetypal hanging

Archetypal Hanging:

The loop/tie of the binder should be on the backside of the neck it is called archetypal hanging.

Non-archetypal Hanging:

The loop of the binder at any site other than the posterior side of the neck is non-archetypal hanging.

Other ways of hanging:

Judiciary or legal

Murder

By chance hanging

Erotic or reproductive

Cause of Death:

The wound to the spinal cord

Closure of the jugular system

Blockage of carotid arteries

Fracture of cervical

Postmortem report characteristics in case of death:

Spots of the ligature on the neck

Fracture of the hyoideum (U-shaped bone)

Bloated face with tongue and bulging eyes

The flow of urine, seminal fluid, and feces

Hanging is mostly suicidal. Homicidal hanging cases are less. Accidental hanging cases are also frequent.

Dribbling of saliva from the mouth

The blood vessel rupture and blood flow from the middle ear.

Ligature strangulation:

It does not involve the suspension of the body.it involves the use of a cord-like object such as a rope or belt.

Cause of death:

Respiratory hindrance, venous constriction, and vagal blockage

General Findings:

The face is swollen and spotted.

The eyes are protruding

The tongue is caught between the teeth’s which is swollen and protruding.

Ligature marks depend on the diameter, kind of the ligature. If the ligature is thin mark will be deeper.

Internal Findings:

Fracture of thyroid cartilages and injury of blood vessels is not common. Hyoid bone fractures are not ordinary.

Manual strangulation:

It is strangling with fingers, hands, or other appendages sometimes with unsharpened objects. It is also known as throttling. In this type, death is unexpected and sudden.

Detection for manual strangulation:

Injury of the larynx and hyoid bone occurs.

Cuticle wounds and cutaneous abrasions are found.

Suicide is possible by strangling someone by ligature.

Children may strangle themselves during enjoyment with friends during play incidentally. Or working near a machine maybe someone strangled.

Drug Overdose:

It affects breathing. A high dose slows the breathing and the body does not get enough oxygen.

Birth Asphyxia:

Sometimes fetal may get too little oxygen during pregnancy maybe because of deprivation of oxygen in the mother’s blood or problems with the placenta. It can occur due to maternal hemodynamics, placenta and umbilical cord, uterine conditions, and infection.

Seizure:

It causes asphyxia in many ways. The epileptic seizure may make breathing unexpectedly or suddenly pause, and lower oxygen in the body to life-threatening levels. It is an uncontrolled electrical disturbance in the brain. It has many types but it varies from person to person due to their beginning procedure in the brain. Mostly it can be controlled with medicines. Common seizures live for 30 seconds to 2 minutes.

Symptoms:

Gazing

Loss of consciousness

Emotional symptoms including anxiety terror

Non-permanent confusion

Jerking motion of legs and arm

Chemical Asphyxia:

In this type, a chemical keeps oxygen from reaching body cells.

Chemicals that can cause asphyxia are as following:

Carbon monoxide:

This is odorless, colorless gas that comes from the incomplete burning of fuels. We breathe in this gas too much increased amount of carbon monoxide reduces the amount of oxygen in red blood cells in our body by replacing oxygen.

Cyanide:

If we breathe in such an environment that contains smoke or chemicals containing cyanide we intake cyanide during breathing. A large amount of cyanide stops cells from using oxygen and eventually cells die. It is rare but has a large potential for death. The cyanide involves crystalline solids, hydrogen cyanide gas, potassium cyanide, and sodium cyanide that can be poisonous.

Hydrogen Sulfide:

This gas has a bad smell like a rotten egg. It is found in sewage; sulfur hot springs, natural gas, and livestock areas. If we breathe in too much it stops the oxygen from entering cells like cyanide. Hydrogen sulfide irritates the respiratory and mucous membrane of the body. It causes difficulty in breathing for some asthmatics.

Sexual Asphyxia:

Partial asphyxia disturbs the cerebral with the feelings of sex. Compression on the trachea or carotids leads to hallucinations of erotic nature. It is commonly seen in young males. The place of the victim owns a house, bed-room or bathroom or any other place.

Proper use of lithium carbonate to immediately destroy life endangered behavior occurring in 26 years old male. Due to this syndrome at least 250 deaths occur in the United States only. The sufferer is 11 to 60 years ago. A lonely autoerotic activity is seen only in males. 

They use chemical and mechanical methods to increase sexual pleasure. Sexual asphyxia can result in death due to a lack of awareness. The un-married, young people mostly practice this.

Drowning:

It is a type of asphyxia death because of the aspiration of fluid into the airway by wetting of the body into the water of fluid medium. Complete immersion does not need to occur immersion or submersion of mouth and nose is enough for it. In freshwater 90 percent drowning occurs and in seawater 10 percent occurs. People have drowned in rivers, lakes, and swimming pools while children have drowned in toilets and bathtubs.

Classification of drowning:

Typical drowning

Atypical drowning

Typical Drowning:

Resistance in air passages and lungs by the breathing of fluid is known as wet drowning.

Typical symptoms are found at autopsy.

Atypical Drowning:

It is a state in which very little or no inhalation of fluid or water in the air duct.

It is dry drowning. Acute laryngeal blockage happens due to the entry of water into the nasopharynx and larynx. Avery small amount of water enters the lungs.

The best case for resuscitation, it is the way of solving problems such as heartbeat and deficiency of puff. It is a vital portion of trauma surgery and emergency medicine.

Immersion syndrome:

The death from cardiac arrest due to sudden influence with very cold water. The victims are young people with an excess dose of alcohol. It may arise from falling or diving with feet or duck diving by the unawareness of swimmers. They fall into an unconscious state and death occurs in a few minutes.

Submersion of the unconscious:

It can be seen commonly in a patient suffering from diseases like epilepsy, heart problems, and head injury during fall. Lungs ballooning may be absent. 

Secondary Drowning/Near Drowning:

This type of infection causes due to in breathing of polluted water. The water irritates the lungs. This term is used to describe drowning complications, oxygen deprivation, tired heart muscles, and cerebral edema. Late-stage hypotension, heart arrhythmia, and respiratory distress may lead to death.

The symptoms are as follows.

Constant cough, tired breathing, acute fatigue, vomiting, mood changes, irritation, and difficulty in breathing

Diagnosis of drowning:

Voluminous lungs

Gravel or soil in hand

Diatoms (single-celled algae) in tissues

Fetal Asphyxia:

This type of asphyxia occurs in the fetus. It causes intervention in placental movement, suppression of the umbilical cord, and before a detachment of the placenta.

Local Asphyxia:

This type of Asphyxia affects the limited parts of the body due to insufficient supply of blood. The parts of the body which affected are hands fingers toes or feet.

Traumatic Asphyxia:

It is a rare but severe condition in which compression on the thoracic cavity and chest do not expand normally and respiration not occurs. A 44-year-old Caucasian man developed this type of asphyxia with horrible injury into a heavy vehicle and he remained unconscious for a time that is not known. 

The traumatic asphyxia treatment should so with special attention and awareness and establishes the oxygen flow. 

Olivier described this type of asphyxia over 17 years ago and his observation was on the dead bodies of people squashed during the crowd in Paris on Bastille Day. They did the addition of other characteristics such as hyperpyrexia, mental dullness, tachypnea, contusion, and hemoptysis to prescribed characteristics. 

This is rare and maybe note less Laird and Bormann discovered hospital and clinic patients just 7 cases out of 107,000 in 30 months, 75,000 involved in major accidents.

Causes of asphyxia

Asphyxia can be caused by any of the following:

Airway Obstruction

Choking from blood vomiting or broken teeth.

Electrical shocks or accidents

The occurrence of gas poisoning

Carbon monoxide is released from home appliances car exhaust or other toxic fumes.

Blockage of respiratory muscles in strychnine poisoning

Whooping cough (pertussis)

Chest compression during the road accident

Severe asthma attack

It can also be caused by breaking the windpipe of the patient.

This disease is produced when people contact bad chemicals as pulmonary agents and other blood chemicals etc.

The disease sleep apnea is also caused by exasphyxia.

It is also caused by exposure to chlorine gas.

Paralysis of the respiratory center may be by narcotics and anesthetics.

Signs and Symptoms of Asphyxia

It can lead to any of the following symptoms:

Fast or rapid pulse

Hypertension (high blood pressure)

Swelling of veins on head and neck

Paralysis

Convulsions

Difficulty in breathing

Slowly losing consciousness

Inability to breathe

Irregular heart rate

Developing a bluish tint to the skin

Too much acid in the blood

Seizures

Complications from Asphyxia:

Long-term results of asphyxia are, brain death, coma, and patient death

According to the World Health Organization, due to birth asphyxia 4 million deaths occurred yearly, showing 38 percent death of children under 5 years old. In under-developed countries such as Bangladesh, Afghanistan, Benin, Chad etc.23 percent of newborn babies’ deaths happened due to birth asphyxia. It is also one of the big causes of babies’ deaths in the first week after delivery.

Ante partum (events occurs before childbirth), intrapartum (event occurs before childbirth) and fetal are the risk factors of birth asphyxia.

Birth asphyxia added 16.52 percent hospital admissions and 21percent death of infants in Pakistan. Pakistan being the developing country faced the birth asphyxia and its complications. Pakistan has no wide range of data on risk factors of birth asphyxia so people should give awareness and educate about the risk factors and their handling.

First Aid Management for Asphyxia:

It is essential to give first aid. CPR stands for Cardiopulmonary Resuscitation. This technique is used to fix the oxygenated blood need to vital parts when a person not breathes effectively or fails to breathe.

How to give proper first aid to the patient?

Call for emergency medical services quickly.

Remove the victim from the water safely.

Take the patient in that place where the air is fresh.

Remove any object blocking the airway, which is the cause of suffocation.

Help the patient to sit upright.

Remove or lose any tight thing or cloth around the patient neck especially.

If the patient is in an unconscious state and not breathing any pulse then perform the CPR.

To-Do CPR:

Keep one hand on the center of the chest and keep the second hand on top of first. Give 30 compressions on the chest.

Raise the chin upward and backward to prevent the blocking of airways.

Repeat the cycle of 2 rescue breaths and 30 chest compressions until the signal of circulation is received.

Do not leave the patient of Asphyxia alone anytime.

Birth Asphyxia:

Birth asphyxia is dangerous depending on the amount of lack of oxygen and how it is long-lasting. Birth asphyxia is the cause of severe damage to organs, brain, permanent disability even death.

If there is a pregnant woman health care team should have complete knowledge about birth asphyxia, signs, treatments, and complexities. They should provide the best way to prevent this disease. But it is a bitter reality that many cases of hypoxia occur due to the negligence of doctors and nurses. They make an unexpected error during pregnancy because of carelessness or lack of knowledge about the symptoms and treatments.

Birth Asphyxia Symptoms:

Doctors should keep an eye on the babies’ vital symptoms for asphyxia even after delivery.

Birth asphyxia symptoms include:

The pale, bluish, or gray color of the skin, failure to breathe, weak pulse rate, weak muscles

Acidosis (an increased hydrogen ion concentration)

Diagnosis:

The asphyxia patients PH is less than 7.00

The patient Apgar score maybe 0 but a score of 7, 8, or 9 is normal and is a sign that a newborn baby is healthy.

The blood pressure of asphyxia patient comes to down.

The patient feels the hindrance of respiration.

The blood flow contains low blood in the intestine of the patient.

Treatment:

The disease asphyxia has the following treatments.

It is based on patient age and health and complete medical report.

It is also based on the overall condition of the patient in the body.

Treatment for birth asphyxia:

Proper treatment depends on the symptoms of the body and the condition of asphyxia.  First Doctors should know about the cause of asphyxia and restore the normal supply of blood.

  While in case of mild asphyxia, breathing should be maintained until the baby can own breathe. In this case, babies can recover from this disease.

In cases of severe asphyxia the proper treatment includes:

Maintain the body cooling

Maintain the life-supporting organs hear pump or a heart-lung pump

Dialysis should be done.

Medicines should be used such as blood pressure medicine or anti-seizure drugs.

There should be intravenous fluids and nutrition supplies.

Support the breathing which may involve the use of nitric acid or specially designed breathing machinery or apparatus.

Birth Asphyxia Complications:

The complications of birth asphyxia include:

CP:

It appears. It is a clutch of problems. During earlier childhood, the abnormal movement appears.

Symptoms:

Symptoms change among people often symptoms include

 Stiff muscles

 Poor muscles

 Tremors

 The problem of vision, hearing, swallowing, and speaking is found.

ADHD:

Attention deficit hyperactivity disorder appears. A person with this disease has differences in the development of the brain and this affects the attention and even ability to sit and self-control.

Fetal Distress:

Fetal distress condition occurs in which a baby experience with the lack of oxygen during pregnancy.

The development is delayed.

Seizure disorders occur.

Physical disability occurs which may be permanent.

HIE:

HIE stands for hypoxic-ischemic encephalopathy. It is also known as neonatal encephalopathy. These are symptoms of neurological function in the starting days of newborn infants.

PVL:

PVL stands for per ventricular leukomalacia. It is a type in which holes create in the mind because small areas of the brain died.

Prevention from Asphyxia:

  1.     Incorrect practice should avoid
  2.     Maintain pre-eclampsia correctly
  3.     Permit collaboration during labor and birth
  4.     Use photographs for vigilant labor monitoring
  5.     Use medicines to control blood pressure
  6.     Care for women and newborns
  7.     Prevent ovarian hyperstimulation syndrome (OHSS)
  8.     Clean delivery to prevent baby from the infection.
  9.     If there is twin delivery management of 2nd twin
  10. Women should take good quality of food during labor and medicines
  11. Proper hydration and nutrition during labor
  12. Oxytocin should under control
  13. Ensure second stage management based on the maternal and fetal situation

 

 

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