Asphyxia
Description:
The condition of the accruing suffocation leading to a lack of oxygen of blood and fabrics (hypoxia) and to accumulation in them of carbon dioxide (hypercapnia).
Asphyxia symptoms:
The clinical picture of asphyxia depends on its reason. At acute strangulyatsionny and obturatsionny asphyxia the respiratory movements gain convulsive character, but there is no breath as takony. Quickly sharp cyanosis of the person develops, consciousness is lost, there are general spasms. The involuntary urination and defecation are possible. The cardiac standstill comes in 2 — 3 min.
At gradually accruing obturatsionny asphyxia breath becomes rare, deep, hoarse or whistling in the beginning. Respiratory noise are heard at distance, at a breath auxiliary muscles strain. Then breath becomes frequent, superficial, arrhythmic. At first pulse becomes frequent, arterial and venous pressure increases, dizziness, blackout are observed. Then pulse is slowed down, consciousness is lost, arterial and venous pressure decreases, spasms develop. Further there comes the apnoea. As a result of decrease in content of oxygen and accumulation in an organism of carbon dioxide blood gains dark red color, there can be a fibrillation of ventricles of heart.
If the lung prelum is the cornerstone of asphyxia, breath becomes frequent and superficial at once. The struck half of a thorax during a breath lags behind or even sinks down (at a multiple fracture of edges). At traumatic asphyxia without concussion of the brain consciousness is kept, but excitement, the expressed cyanosis and puffiness of the person, multiple hemorrhages in skin, a conjunctiva and a sclera of eyes are noted.
Asphyxia reasons:
Main reasons for asphyxia:
1) a prelum of upper respiratory tracts from the outside during the hanging, strangulation (strangulyatsionny asphyxia), neck injuries;
2) hit foreign firm or liquids in upper respiratory tracts and a trachea that results in their partial or full obstruction (mechanical obturatsionny asphyxia);
3) retraction of language at the patient lying on spin or struck being in coma;
4) pathological processes in a throat and a trachea (hypostasis, a hematoma, a burn, a tumor, a laryngospasm);
5) accumulation in a pleural cavity of air (tension pneumothorax), blood (hemothorax), liquids (hydrothorax); a rupture of a diaphragm with moving to a pleural cavity of abdominal organs;
6) traumatic prelum of a thorax, stomach, and sometimes and all trunk firm or loose bodies (traumatic asphyxia). Also acute disorders of function of respiratory muscles at an injury of upper parts of a spinal cord, some intoxications (residual action of muscle relaxants, botulism, poisoning, etc.), convulsive syndromes (tetanus, the epileptic status, an eclampsia) and other diseases (myasthenic crisis, poliomyelitis, the ascending polyradiculoneuritis, etc.) can be the reasons of asphyxia.
Treatment of Asphyxia:
At asphyxia immediate holding intensive resuscitation, therapeutic and surgical actions is necessary. First of all it is necessary to recover passability of respiratory tracts at their prelum or obturation (removal of a loop or elimination of the subject squeezing the victim's neck, removal from respiratory tracts of foreign bodys). For maintenance of passability of respiratory tracts and for the purpose of fight against quickly accruing anoxemia it is necessary to eliminate retraction of a root of language. For this purpose the head of the patient is given the provision of the maximum occipital extension, or enter an air duct into an oral cavity, or push forward a mandible for its corners, or bring language out of an oral cavity, having imposed on it tongue forceps. Recovery of breath which becomes equal and silent testifies to efficiency of manipulation. It is also necessary to remove the emetic masses and blood from a mouth and a stomatopharynx, foreign bodys from upper respiratory tracts by means of the receptions increasing pressure in a thorax and respiratory tracts are lower than the place of their obstruction (drawing abrupt blows by a palm on interscapular area and abrupt pressing on epigastric area — Geymlikh's reception) or special tools during a direct laringoskopiya; at pheumothorax — to apply an occlusive bandage.
After recovery of passability of respiratory tracts start artificial ventilation of the lungs by method from a mouth in a mouth in the beginning, then by means of portable and stationary respirators. If there came the cardiac standstill, along with an artificial respiration begin a cardiac massage. Artificial ventilation of the lungs is continued to a complete recovery of consciousness of the patient, sometimes by several hours and even days. It is especially important after the postponed strangulyatsionny and traumatic asphyxia. The spasms arising in these cases and sharp motive excitement eliminate with repeated introduction against the background of an artificial respiration of muscle relaxants of short action (a miorelaksin, Dithylinum), and in the most hard cases — muscle relaxants of long action (tubarin).
The nurse or paramedic who are especially working independently are sometimes forced to carry out manipulations which in usual conditions are carried out only by doctors — a trachea intubation, drainage of a pleural cavity, conduction novocainic blockade, etc. In some emergency situations (throat hypostasis, a prelum her tumor, a hematoma) asphyxia can be effectively eliminated only by means of a tracheostomy which is carried out only by the doctor. In desperate situations the paramedic can resort to a transdermal puncture of a trachea a thick needle with introduction in it of a catheter and the subsequent carrying out discontinuous jet ventilation of the lungs by air-oxygen mix or oxygen. The midwife can meet need to carry out treatment of asphyxia of the newborn which is shown by a condition of a long apnoea at the birth.
Treatment of asphyxia at such diseases as botulism, tetanus, various ekzotoksikoza, demands along with the mentioned general medical actions of performing specific therapy.
