Asphyxia is the name given to a lack of oxygen in the body. It occurs as a result of trauma or disease.
What is asphyxia?
Asphyxia is a condition of oxygen deficiency in the cardiovascular system and tissues. In asphyxia, there is a severe disruption of the cardiovascular system. Literally translated from ancient Greek, the meaning of the term is “cessation of the pulse beat”. Weak and shallow breathing is a sign of circulatory weakness. An insufficient amount of the respiratory gases oxygen and carbon dioxide is exchanged. Too little oxygen is transported by the blood cells in the arteries. Sufficient supply to the tissues is no longer ensured: As a result, the partial pressure of oxygen decreases. This process takes place in the arteries as well as in the entire tissue. The asphyxia becomes visible: mucous membranes and skin turn blue (cyanosis). To make matters worse, the carbon dioxide that has not been exhaled accumulates in the blood and tissues. The result is a clouding of consciousness. This can extend to coma and lasts until the causes of the oxygen deficiency are eliminated. If there is an accumulation of carbon dioxide, this is registered by the brain stem. A very strong fear of suffocation occurs.
Causes
The causes of asphyxia are severe trauma such as burial or swimming accidents. In addition, airway obstruction, heart failure, and respiratory paralysis play a role as causes. In spills, a sudden strong compression of the chest takes place. The resulting pressure forces blood out of the chest cavity and into the head and neck. As a result, blue-red discolorations appear on the neck and head. Hemorrhages occur under the skin. The eyes are bloodshot. The brain is also undersupplied with oxygen. Cerebral hemorrhages and cerebral edema occur. The strong external force often leads to further severe injuries to the internal organs. Immediate resuscitation efforts and extensive initial care should be given. Mortality in asphyxia is high. Strangulation causes narrowing of the trachea. The result is asphyxia. Asphyxia occurs in swimming accidents with drowning. If the water temperature is below 28 degrees Celsius, the body temperature of 37 degrees cannot be maintained without risk because the core body temperature drops by releasing energy to the environment. Muscle tremor occurs to warm the core body temperature. With the muscle tremors, cramps occur simultaneously; coordinated powerful swimming movements can no longer be performed. Mental control of the situation decreases at the same time. Lack of oxygen leads to an undersupply of brain and tissues, while massive amounts of water are swallowed. There is a desperate attempt at breaths under coughing and gasping, unconsciousness and respiratory arrest. The obstruction of the airway results in asphyxia. Causes of asphyxia are thus in unconscious persons the falling back of the tongue due to the lack of muscular control. Cancerous growths in the larynx and trachea can cause airway obstruction. The lower airways can also be affected by obstruction: Here, increased mucus production in chronic obstructive bronchitis leads to asphyxia. In bronchial asthma, spasm of the bronchial muscles is added to the increased mucus production. COPD also causes obstruction of the airways, leading to asphyxia. An allergic reaction to insect bites, nuts, or fruit can cause airway obstruction and asphyxia within a very short time. In heart failure, too little blood is pumped into the circulation as measured by the unit of time. As a result, there is an undersupply of oxygen to the arterial blood vessels, tissues, and asphyxia. Respiratory paralysis results in asphyxia. In central respiratory paralysis, the respiratory center in the brain is affected. The control of inhalation and exhalation is disturbed, respectively stopped. Triggers for this are poisoning by drugs such as narcotics and barbiturates, a cerebral infarction, a craniocerebral trauma, general hypothermia of the tissue or non-traumatic bleeding into the brain substance. In peripheral respiratory paralysis, the respiratory muscles are affected: thus, the supplying nerves themselves or neuromuscular conduction are impaired. Curare or botulin are potent neurotoxins that cause peripheral respiratory paralysis.Other possibilities are infectious diseases such as whooping cough, tetanus, polio or rabies. Degenerative muscle diseases such as spinal muscular atrophy can lead to paralysis of the respiratory center in advanced stages, resulting in asphyxia.
Symptoms, complaints, and signs
Symptoms of asphyxia include shortness of breath, an accelerated heartbeat, cyanosis, and convulsions. Under asphyxia, the regulation of inhalation and exhalation is disturbed. There is a shortened duration of inhalation and massive problems with inhalation. The organism tries to inhale more oxygen with the help of diaphragm, respiratory muscles and intercostal muscles. A whistling breathing sound is heard as a result of the disturbed inhalation. If a foreign body has been inhaled or food is stuck in the esophagus, the body tries to get rid of it with massive coughing or retching. General restlessness, trembling, sweating, panic and death attacks occur. The strong stimulus of the sympathetic nervous system is also responsible for initially existing accelerated heartbeat and high blood pressure as an attempt to ensure the supply of the organism under the conditions. Due to the existing imbalance of inhalation and exhalation, respectively the accumulation of carbon dioxide in the tissues, cyanosis occurs. Skin and mucous membranes are discolored bluish. At the same time, with the undersupply of oxygen to the brain, clouding of consciousness occurs.
Course
Asphyxia represents a life-threatening emergency that, if untreated, leads to respiratory arrest, cardiac arrest, and death.
Complications
In the worst cases, asphyxia results in death. Those affected suffer primarily from shortness of breath and panic that erupts as a result. Also, breathing in and out is usually no longer possible in the usual way. Most patients try to breathe in more oxygen during asphyxia, which often leads to gasping for breath and a panicky situation. The affected person may suffer from dizziness and headaches due to the lack of oxygen, and in some cases fainting occurs. The shortage of oxygen causes trembling and sweating. Often the patient is in fear of death. If asphyxia is not treated, the lack of oxygen usually causes damage to the organs and extremities. These turn blue. The brain in particular is damaged, so that consequential damage and mental impairment cannot be avoided. The longer the oxygen deficiency is present, the more the organs are destroyed. Treatment of asphyxia is usually carried out by the emergency physician and is designed to stabilize the patient and establish normal breathing. Different complications can occur here, depending on the cause of the asphyxia. If there is a foreign body or water in the lungs, a tracheotomy is necessary. If asphyxia is not treated, death will result.
When should you see a doctor?
Asphyxia is a medical emergency and must be treated immediately. If there is acute danger to life as a result of a swimming accident or spill, an emergency physician must be called. Signs of asphyxia include symptoms such as shortness of breath, difficulty coughing or retching, and an accelerated heartbeat, as well as panic attacks and fear of death. When these symptoms occur, there is an acute need for action. The rescue service must care for the affected person and take him to the hospital for further treatment. Until professional help arrives, first aiders must perform appropriate first aid measures to preserve the life of the affected person. Depending on the cause, external wounds should be staunched and breathing and circulation stabilized. If the victim is responsive, the legs should be elevated. Sometimes it is also necessary to sedate the casualty to prevent hyperventilation and a general worsening of the situation. If an early response is made to asphyxia, the chances of recovery are usually good. In most cases, however, the affected person must undergo lengthy treatment and extensive rehabilitation.
Treatment and therapy
Asphyxia is always associated with a severe disorder of the cardiovascular system. If there is a possibility of surviving the asphyxia, measures are aimed at helping the organism to return to normal. As part of first aid, the following measures should be taken immediately: Unconscious persons are placed in the stable lateral position.The head is hyperextended to prevent obstruction of the airway by vomit or the tongue falling back. If no breathing can be detected, mouth-to-mouth resuscitation or chest compressions are started. Subsequent measures include ventilation with oxygen by mask or intubation and monitoring of parameters such as arterial blood pressure, electrocardiogram, control of respiratory rhythm, measurement of saturation levels of oxygen and carbon dioxide. In the case of burials and severe craniocerebral trauma, in addition to asphyxia, attention must be paid to potentially additional life-threatening injuries and blood loss from internal organs. External wounds can be staunched during first aid procedures. Paramedics and emergency physicians have further opportunities to adeptly intervene on the way to the hospital to stabilize breathing and circulation. If there are further internal injuries or broken bones, immediate emergency surgery in the hospital is indicated. The casualty in the water is brought ashore as quickly as possible. Stable side position or resuscitation are necessary. A large gush of water may be vomited. The body temperature must be stabilized and raised, also the circulation. If blood pressure is low, the circulation must be stabilized. If the affected person is responsive, the legs can be elevated. In as upright a sitting position as possible – possibly supported – a dextrose solution can be drunk in small sips, with the head pointed straight ahead. Causes of low blood pressure are medically clarified and remedied if possible. Nerve toxins such as drugs in high doses or anesthetics can paralyze the respiratory center. Once the basic functions of breathing and circulation are restored, the body is detoxified and, if necessary, readjusted with medication. In some degenerative muscle diseases such as spinal muscular atrophy, the end result is cardiac muscle weakness, paralysis of the respiratory center, and death. When staying at high altitudes, as in mountain climbing, the person must descend to lower altitudes as far as he or she is able, so that breathing stabilizes. If he does not have the strength to do so, mountain rescue is activated. To prevent oxygen deprivation and unconsciousness from occurring indoors at events, provide good ventilation and limit the number of participants. The cough reflex is so strong that foreign bodies are coughed up. If they are too large, they must be surgically removed. Before that, a tracheotomy may be necessary. The lack of oxygen can leave permanent damage to the brain. This can extend into a waking coma. Provided sleep-wake rhythm, respiratory-circulatory and digestive functions are preserved, spasticity – for example, tetraspasticity – may remain. The need for and extent of rehabilitation is determined. These rehabilitative measures aim to re-initiate learning functions and integrate them with what is already present. Permanent damage may affect the central and peripheral nervous systems, for example, speech and swallowing function or perception.
Outlook and prognosis
Asphyxia is a medical emergency that, without prompt medical attention, will result in the patient’s death. Respiratory distress and loss of consciousness are among the symptoms. In this state, the affected person is no longer able to help himself. He is inevitably dependent on first aid from other people. These people must immediately call an emergency physician and follow the instructions for first aid. If the patient is alone in this condition, he will very likely die within the next few minutes. If he is denied immediate help or ventilation is not adequately provided, likewise. The chances of recovery depend on the cause of the asphyxia, the timing of adequate intensive care treatment, and the patient’s age and general health. If pre-existing conditions are present and the affected person is at an advanced age, the risk of lifelong impairments and functional disorders increases. The sooner adequate care can be provided and the healthier the patient, the better his or her chances of recovery. The time during which the organism was not supplied with oxygen is essential in determining the prognosis. A few minutes are enough to trigger a permanent impairment. The consequential damages of asphyxia are often irreparable. However, individual improvements can be achieved with various therapeutic options.
Prevention
Spills can be prevented by following workplace and household safety procedures; natural disasters cannot. When warnings are issued, it is obvious to try to stay out of these areas. The risk of Sudden Infant Death Syndrome is reduced if the baby is breastfed and grows up in a smoke-free environment. A bedroom temperature of 16 – 18 degrees, sleeping in a sleeping bag in the supine position without a cap, and removing nests will protect against overheating. An air-permeable but firm mattress also helps regulate body heat. Bathing accidents can be avoided if bathing rules are followed. These include not going into waters that are too cold or going into unfamiliar waters with cold currents. Dips in ice also fall into this category. Ice thickness should be sufficient to avoid ice collapses after several days of severe freezing without a thaw. Youth should be educated that fainting games are not an aspirational way to test their limits. Circulation is stabilized when circulation is poor by eating a healthy, varied diet, drinking enough fluids, and exercising such as hiking, swimming, or biking. Sufficient sleep is important. Hot baths or saunas should be avoided. Some medications bring with them the side effects of acting on the respiratory center. When possible, the benefits and risks of the medication should be weighed against the risk of the condition for which it is being taken. To avoid altitude sickness, the climber must acclimatize slowly. He must ascend a little more during a tour than he descends, thus slowly gaining altitude. No one will be able to avoid choking. There have been emergencies with swallowed eggs – of course, food should be chewed sufficiently. There should be no crumbs, feathers or small items in the bed to be breathed on during sleep. It goes without saying that in the environment of small children, every effort should be made to prevent the swallowing and inhalation of small parts lying around or coming off.
Aftercare
Asphyxia can be managed by avoiding common life risks. Those affected by the choking condition include miners and swimmers in bodies of water. They should follow standard safety precautions and not take unnecessary risks. Thus, the responsibility for preventing a recurrence of asphyxia falls mainly on the patients themselves. Doctors, on the other hand, can only react acutely and treat possible secondary damage as part of follow-up care. Early detection examinations, as known from tumor diseases, are not possible. Rehabilitation measures are usually concerned with relearning general skills. For example, the speech and nerve centers are often disturbed. Mental intelligence is severely impaired as a result of oxygen deprivation. After suffocation, there is no immunity to recurrence. Persons of advanced age in particular, as well as men and women with previous illnesses, suffer disproportionately often from the consequences of asphyxia. Since their ability to regenerate is limited, unlike that of young people, it is not uncommon for them to become nursing cases. They can no longer cope with everyday life on their own. Service providers and the close family circle are included in the aftercare. This is followed by regular check-ups. Medications are intended to alleviate secondary damage and must be adjusted from time to time.
What you can do yourself
Asphyxia is life-threatening and must be treated immediately by a physician. However, patients themselves are usually unconscious or at least incapacitated. First responders must call 911 immediately if asphyxia is suspected. In addition, a number of other first aid measures are required to increase the victim’s chances of survival. Asphyxia often occurs after bathing accidents and spills. In the case of bathing accidents, the affected person must be taken out of the water immediately. Subsequently, the lifeguard or other supervisory personnel should be informed in addition to the emergency physician, if available, since these persons usually have qualified training as first aiders. Unconscious persons should first be placed in the recovery position. Since the airways may be blocked by the fallen back tongue or vomit, the head of the unconscious person must be hyperextended.If the patient is no longer breathing on his own, mouth-to-mouth resuscitation should be performed and cardiac massage should be started. Furthermore, it is extremely important to wrap the unconscious person in a blanket to normalize the body temperature. If the affected person survives the asphyxia, permanent damage may remain in the brain due to the lack of oxygen, affecting learning function or speech, among other things. Patients can actively promote their convalescence by starting recommended rehabilitation measures as soon as possible and following them consistently.
