Asphyxia

Suffocation:

Air in lungs

O2 falls

CO2 rises

Arterial blood

p O2 falls

p CO2 rises

All cells in the body

O2 falls

CO2 rises.

Causes of asphyxiation

Trauma

Maxillofacial injury, local oedema

Scalds/burns

Compression of chest/windpipe, hanging, strangulation.

Injury to lungs/chest - pneumothorax, eg. fracture displaced ribs, stab injury

Blunt trauma may cause inflammation

Foreign body

Partial or complete airway obstruction

Blood or foreign material in airway

Aspiration of food or gastric contents

Drowning

Suffocation - plastic bags

Retained secretions, depression of cough, pneumonia, cystic fibrosis

Inflammation

Oedema round tracheal or other structures

Allergy - stings/drugs/foods - angio neurotic oedema

Secondary to infection, eg epiglottitis

Secondary to caustic or thermal injury

Congenital lesions

Subglottic stenosis

Aggravated by superimposed infections

Progressive abnormality

Neoplasms

Benign

Malignant

Paralysis

Electric shock

Venoms or toxins

Of vocal cords, eg neuromuscular dysfunction

Ventilatory failure

Fits

Drugs - opiates, alcohol

Paralysis

Reduced O₂ in air, in a balloon > 10,000 feet

Cyanide poisoning

Coma

Head injury

Chest wall fracture

Chronic lung disease

CNS dysfunction

Carbon monoxide

Signs of Asphyxiation

Inability to breath or speak, patient may grasp throat

Increased depth or rate of respiration

Congestion and cyanosis of head and neck

Loss of consciousness and then respiration

Treatment and first aid in choking

1. If coughing - do nothing, they should clear it themselves.

2. Back slaps - position the head forward and slap back, (4 times). The head should be lower than the lungs. Slap between patients shoulder blades with the heal of your hand. Lie toddlers over your knee, hold babies upside-down. You must hit them hard to be of any use.

3. Clear obstruction with fingers - work your finger back along the sides of the mouth to avoid pushing the object further in, once your finger is behind it flick it out quickly in case it is re-inhaled.

4. Abdominal thrust - clench your fist between the patients navel and bottom of the sternum and place the other hand over it. Use a fist on its own for children and two fingers for babies best performed from behind the patient, but may be carried out with the patient on their back.

5. Artificial respiration - if the patient stops breathing

6. Cricotrachiostomy - last resort by suitably trained people

Take medical opinion after blows or thrusts have been administered

Prevention of choking

Keep small objects out of the way of toddlers

Make sure bits will not come off toys

Do not eat and talk at the same time

Chew food well before swallowing

Give dysphagic patient blended meals

Eat sitting up

Check food for small hard pieces like fish bones

Other care

Check and clear airway, dentures, food, vomit etc.

Oxygen

Suction

Prepare for intubation and IPPV

Drugs, adrenaline, naloxone, other emergency drugs