What is an Asphyxiant?

Asphyxia: As the body s breathing process is blocked or abnormal for some reason, the pathological state of tissue and cell metabolism disorders, dysfunction, and morphological structure damage caused by hypoxia and carbon dioxide retention caused by the lack of oxygen in various organs and tissues in the body is called asphyxia. When the body is severely hypoxic, organs and tissues can be extensively damaged and necrotic due to hypoxia, especially the brain. If the airway is completely blocked and you can't breathe, the heartbeat will stop for 1 minute. As long as the rescue is timely, the airway obstruction is lifted, breathing is restored, and heartbeat is restored. However, suffocation is one of the most important causes of death in critically ill patients.

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Asphyxiation

Main cause of suffocation

1 Mechanical asphyxia, caused by mechanical effects, such as suffocation, strangulation, neck constriction, obstruction of respiratory channels with objects, compression of the chest and abdomen, and acute asthma caused by edema or inhalation of food into the trachea;

2 Toxic suffocation, such as carbon monoxide poisoning, a large amount of carbon monoxide is inhaled into the lungs from the respiratory tract, enters the blood, and combines with hemoglobin to form oxyhemoglobin, which prevents the combination and dissociation of oxygen and hemoglobin, resulting in asphyxiation caused by tissue hypoxia;

3 Pathological asphyxia, such as loss of breathing area caused by drowning and pneumonia; Central apnea due to cerebral circulation disorders; Asphyxia of newborns and asphyxiation due to hypoxia in the air (such as being placed in a box, cabinet, or air The oxygen gradually decreases, etc.). Its symptoms are mainly intertwined with the irritation caused by the accumulation of carbon dioxide or other acidic metabolites and the symptoms of central paralysis caused by hypoxia.

Asphyxiation

(Statement one)

1 Due to the increased partial pressure of carbon dioxide, the respiratory center excites and strengthens in a short period of time, which causes breathing difficulties and loss of consciousness;

2 generalized spasm, vasoconstriction, elevated blood pressure, bradycardia, salivation, and hyperactive bowel movements;

3 The spasms suddenly disappear, the blood pressure decreases, the breathing gradually becomes shallower and slower, producing wheezing, and soon the breathing stops. When asphyxia occurs, if the patient's heart beats slightly, the cause of asphyxia should be immediately ruled out and artificial respiration should be performed. Losing the rescue time will inevitably make the cardiac arrest, the pupils dilated, the body reflexes disappear, and eventually death

(Statement 2)

1 Asphyxia. Respiratory disorders occur in the body, first of all, the obstacles to the inhalation of oxygen. Because there is still some residual oxygen in the body, the body is asymptomatic for a short time. This period usually lasts only 0.5 to 1 minute, and it is difficult for a weak person to support it, but a healthy or trained mountaineer or diving athlete can extend it for 3 to 5 minutes.

2 Inspiratory dyspnea. The body's metabolism consumes residual oxygen in the body and generates a large amount of carbon dioxide storage, which makes the body's hypoxia worse. Under the stimulation of carbon dioxide, the deepening of breathing is accelerated, but the most obvious is the inhalation process. The breathing is asthmatic, at this time the heartbeat speeds up and blood pressure rise. This period lasts about 1 to 1.5 minutes

3 Expiratory dyspnea. During this period, the body's carbon dioxide continued to increase, breathing increased, and exhalation was stronger than inspiratory exercise. At this time, the body's face was swollen and bruised, and the jugular veins were swollen, showing typical signs of asphyxia. And there may be loss of consciousness, muscle cramps, and even urination and defecation. This is the apnea period. During this period, the respiratory center changes from excitement to inhibition, the breathing becomes shallow, slow, or even temporarily stopped, the heartbeat is weak, blood pressure drops, muscle spasm disappears, and the state is like death. This period lasts about 1 minute.

4 Period of no breathing. Due to severe hypoxia and excessive carbon dioxide accumulation, the respiratory center was stimulated and excited again, breathing activity resumed temporarily, showing intermittent inhalation, and the wings flapped. At the same time, blood pressure drops, pupils dilate, and muscles relax. This period lasts one to several minutes.

5 Apnea period. Breathing stopped during this period, but there was still a weak heartbeat, which could last from several minutes to tens of minutes, and finally the heartbeat stopped and died.

It should be noted that at any stage of the suffocation process described above, sudden death may occur due to a cardiac arrest.

Choking performance

Breathing is extremely difficult, lips and face are blue and purple, heartbeat is accelerated and weak, the patient is in a coma or semi-coma state, cyanosis is obvious, breathing gradually becomes slow and weak, and then irregular, until breathing stops, heartbeat slows and stops. The pupils are dilated and the reflection of light disappears.

Choking First Aid

There are many reasons for suffocation, and the first aid for suffocation should be rescued according to its cause. The airway obstruction and the cause of hypoxia are removed, and some patients can recover quickly. The specific measures are as follows:

1. Rescue of the airway obstruction will lift the mandible or the forehead of the comatose patient's neck, straighten the head back, lift the tongue base, and make the airway unobstructed. Then use your fingers or an aspirator to dig out or extract the oropharyngeal vomit, blood clots, sputum, and other foreign objects. When the foreign body slides into the airway, the patient can be placed on his or her face, and the foreign body can be squeezed out by patting the back or pressing the abdomen.

2. Restraint for neck constriction should immediately release or cut neck restraint or rope. Stop breathing immediately with artificial respiration. If the patient has a weak breath, give a high concentration of oxygen.

3 Rescue when the smoke is suffocated, see "Rescue for fire".

4 The ambulatory semi-recumbent method for severely injured chest was given sputum suction and blood clots to keep the airway open, oxygen inhalation, pain relief, closed open chest wounds, fixed rib fractures, and rushed to the hospital for emergency treatment.

Choking symptoms

(A) hyaline membrane disease of newborn

(Two) wet lungs of newborns

More common in full-term cesarean section children with a history of intrauterine distress, often shortness of breath and cyanosis within 6 hours after birth, but the children are generally in good condition, symptoms disappear within about 2 days. Both lungs can hear medium and large wet rales, low breathing, X-rays of the lungs showing thickened lung texture, small pieces of particles or nodular shadows, and pleural fluid in the interpleural space or pleura. Emphysema is also common, but lung lesions recover well and often disappear within 3 to 4 days.

(Three) neonatal aspiration syndrome

(D) esophageal atresia in newborns

Neonatal esophageal atresia multi-purpose Gross five types before classification:

1. Type: The upper and lower sections of the esophageal atresia are two blind ends.

Type 2: The upper end of the esophagus is connected to the trachea, and the lower end is the mesh end.

Type 3: The upper part of the esophagus is blind, and the beginning of the lower part communicates with the trachea.

Type 4: The upper and lower sections of the esophagus communicate with the trachea.

Type 5: without esophageal atresia, but with fistula communicating with trachea. It can be seen that except for type I, the other types of esophageal atresia have tracheal fistulas.

When oral secretions of newborn babies increase, and cough, cyanosis and suffocation occur after feeding with water and milk, use a soft and moderate catheter to insert the esophagus through the nose or mouth. If the catheter returns automatically, the disease should be suspected, but the diagnosis must be clear Esophageal radiography was performed with lipiodol.

(V) Atresia of posterior nostril of newborn

There is severe difficulty in breathing and cyanosis after birth, and cyanosis reduces or disappears when opening mouth or crying. Breathing difficulties while closing her mouth and pumping. Due to the difficulty of feeding the patient, the patient does not gain weight or suffers severe malnutrition. According to the above manifestations, when the disease is suspected, a tongue depressor can be used to press the root of the tongue, and the child's dyspnea will be relieved. Or while maintaining the patient's mouth open, insert it through the front nostril with a thin catheter to observe whether it can enter the pharynx or use the stethoscope to align the left and right nostrils of the newborn respectively, and listen for air out, or use cotton silk to place in the front nostril Observe whether it is oscillating to determine whether the nostrils are ventilated. You can also inject a small amount of gentian violet or melan from the anterior nostril to see if it can flow to the pharynx. If necessary, lipiodol is dripped into the nasal cavity for X-ray examination.

(6) Submandibular and cleft palate deformities in newborns

When the baby is born, the mandible is small, sometimes accompanied by cleft palate, and the tongue sags behind the pharynx, making it difficult to inhale. Breathing difficulties in the supine position are particularly significant. When breathing, head tilted back, ribs sunken, inhalation accompanied by wheezing and paroxysmal bruising. Later, there will be malformations and weight loss. Sometimes the child is accompanied by other deformities. Such as congenital heart disease, horseshoe foot, and finger (toe), cataract or mental retardation.

(G) diaphragmatic hernia of newborn

After birth, he has dyspnea and persistent and paroxysmal cyanosis, accompanied by refractory vomiting. During the physical examination, the left chest breathing movement weakened, drum sounds or dullness appeared on the left side of the percussion, and auscultation breath sounds were low or disappeared. Bowel sounds are sometimes heard. Heart dullness and apical pulse move to the right. The scaphoid abdomen was diagnosed by X-ray chest-abdominal perspective or photo.

(8) Congenital laryngeal webs

Weeping after birth is faint, hoarse or silent. Inhalation is accompanied by larynx and chest soft tissue depression. Sometimes it is difficult to inhale and exhale. The diagnosis depends on laryngoscopy, and the laryngeal web can be seen directly.

(9) Congenital heart disease.

(10) Group B hemolytic streptococcus (GBS) pneumonia can be seen in preterm, near term and term neonates. The mother has a history of infection and premature rupture of amniotic membrane in late pregnancy. The clinical characteristics are the same as those of preterm infants with RDS and can be positive for bacterial culture. . Chest X-ray examination showed signs of inflammation of the lung lobe or segment and signs of alveolar collapse, clinical signs of infection, and the course of disease was 1 to 2 weeks. Treatment with a combination of broad-spectrum antibiotics, such as ampicillin plus gentamicin, for the first 3 days after birth, followed by 7-10 days of ampicillin or penicillin. The dosage should refer to the minimum inhibitory concentration to avoid loss of effect due to low dosage.

(11) Hereditary SP-B deficiency, also known as "congenital pulmonary surfactant protein deficiency," was discovered in the United States in 1993. There are currently more than 100 children diagnosed with molecular biology techniques worldwide. . The cause is a mutation in the base of the DNA sequence that regulates SP-B synthesis. The clinical manifestation is that children born at term have progressive dyspnea, which is not effective after any treatment intervention. There may be a family tendency. Lung pathological manifestations are similar to RDS in preterm infants. Lung biopsy reveals that SP-B protein and SP-B mRNA are deficient and can be accompanied by abnormal pre-SP-C synthesis and expression. The lung tissue pathology is similar to alveolar proteinosis. Treatment with exogenous pulmonary surfactant can only temporarily relieve symptoms. Children rely on lung transplantation, otherwise they will die within 1 year of age.

1. Bruises on the face and body of the newborn;

2. Superficial or irregular breathing

3 Heartbeat rules, strong and powerful, heart rate 80-120 beats / min

4 Responds to external stimuli and has good muscle tone;

5. Laryngeal reflexes are present.

6. With the above performance is mild asphyxia, Apgar score 4-7 points.

7. Pale skin and dark purple lips;

8. No breathing or only wheezing-like weak breathing;

9. Irregular heartbeat, heart rate <80 beats / min, and weak;

10 No response to external stimuli, relaxation of muscle tension;

11. Laryngeal reflex disappeared.

12. Having 7-11 items is severe asphyxia, Apgar score is 0-3 points.

General signs of suffocation

Asphyxiation

Facial bruises, cyanosis, swelling, petechiae, and corpse spots appear earlier and more prominently.

Asphyxia signs inside the body

Internal organ stasis, blood under the capsule, mucosal petechiae, emphysema, pulmonary edema, dark red fluid

Asphyxia histological changes

Mainly hypoxic changes, with obvious changes in brain, heart, lung and liver

Choking attention

Modern forensic works in the world no longer list the four changes of facial cyanosis, internal organ congestion, petechiae bleeding, and dark red fluidity as unique signs of mechanical asphyxiation, because of various natural diseases. These similar changes can be seen in the body