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Traumatic asphyxia: a rare cause of impaired consciousness
*Corresponding author: Supreet Kaur, Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India. supgrewal@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Kaur S, Kondabala C, Dar P. Traumatic asphyxia: a rare cause of impaired consciousness. J Inj Acute Care. 2025;1:6. doi: 10.25259/JOIAC_13_2025
CASE DESCRIPTION
A 17-year-old male presented to the emergency department after being crushed under a tractor. A history of prolonged extrication (15 minutes) was noted. He presented to the hospital after 3 hours. On arrival, his SpO2 was 92 %, pulse was 94 per minute, and blood pressure was 104/60 mmHg. Endotracheal intubation was done in view of a threatened airway due to low Glasgow Coma Scale (GCS) score (E1V2M5). On commencement of mechanical ventilation, sudden hypoxia and hypotension were noted. With a clinical diagnosis of tension pneumothorax, an intercostal chest drain was inserted on the right side, which restored his saturation and blood pressure to normal levels. On secondary survey, congestion of the neck and face was noted, with petechial hemorrhages in the bilateral conjunctivae [Figure 1]. No retinal hemorrhage was seen on ophthalmoscopic examination. Enhanced computed tomography (CT) showed right-sided pneumothorax, with multiple upper lobar contusions. No rib or sternal fractures were noted. Non-contrast CT of the brain was normal. There was no evidence of hemotympanum on otoscopy.
- (a) Clinical image of a 17-year-old male with a diagnosis of traumatic asphyxia showing subconjunctival haemorrhage in both eyes (b) Inset showing magnified view of subconjunctival haemorrhage.
Diagnosis of traumatic asphyxia was made based on typical history and signs, and low GCS in the absence of radiological signs of traumatic brain injury. Extrinsic compression causes increased intrathoracic pressure, which is transmitted to the venous system of the head and neck, leading to stasis and rupture of smaller veins, causing petechial hemorrhages in the eyes and subcutaneous tissue. The patient was managed non-operatively. The chest drain was removed on day 4 after lung expansion. His GCS gradually improved, and on day 7, he was discharged with a full GCS score. Patient remains well on 3-months follow-up.
Learning points
In patients with low GCS, a mechanism of injury suggesting chest compression should alert the treating doctor to the possibility of traumatic asphyxia.
It is important to perform a primary survey as per advanced trauma life support (ATLS) principles, as these patients may have a threatened airway and associated thoracic injuries such as rib fractures, pulmonary contusions, and hemopneumothorax.
Traumatic asphyxia managed with oxygen supplementation and supportive care has a good prognosis.
Authors contributions:
SK: Study conception, manuscript preparation, final approval of manuscript; CK: Data acquisition, final approval of manuscript; PMUDD: Critical review of manuscript, final approval of manuscript.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest
Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil