Asphyxia

Asphyxia
Other names: Asphyxiation
The neck contains several vulnerable targets for compression including the carotid arteries.
SpecialtyCritical care medicine
ComplicationsComa
Frequency9.8 million unintentional worldwide (2015)[1]
Deaths35,600 worldwide (2015)[2]

Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body that arises from abnormal breathing. An example of asphyxia is choking. Asphyxia causes generalized hypoxia, which affects primarily the tissues and organs. There are many circumstances that can induce asphyxia, all of which are characterized by an inability of an individual to acquire sufficient oxygen through breathing for an extended period of time. Asphyxia can cause coma or death.

In 2015, about 9.8 million cases of unintentional suffocation occurred which resulted in 35,600 deaths.[1][2] The word asphyxia is from Ancient Greek α- "without" and σφύξις sphyxis, "squeeze" (throb of heart).[3]

Cause

Situations that can cause asphyxia include but are not limited to: airway obstruction, the constriction or obstruction of airways, such as from asthma, laryngospasm, or simple blockage from the presence of foreign materials; from being in environments where oxygen is not readily accessible: such as underwater, in a low oxygen atmosphere, or in a vacuum; environments where sufficiently oxygenated air is present, but cannot be adequately breathed because of air contamination such as excessive smoke.

Other causes of oxygen deficiency include but are not limited to:

Smothering

Smothering is a mechanical obstruction of the flow of air from the environment into the mouth and/or nostrils, for instance, by covering the mouth and nose with a hand, pillow, or a plastic bag.[4] Smothering can be either partial or complete, where partial indicates that the person being smothered is able to inhale some air, although less than required. In a normal situation, smothering requires at least partial obstruction of both the nasal cavities and the mouth to lead to asphyxia. Smothering with the hands or chest is used in some combat sports to distract the opponent, and create openings for transitions, as the opponent is forced to react to the smothering.

In some cases, when performing certain routines, smothering is combined with simultaneous compressive asphyxia. One example is overlay, in which an adult accidentally rolls over onto an infant during co-sleeping, an accident that often goes unnoticed and is mistakenly thought to be sudden infant death syndrome.[4] Other accidents involving a similar mechanism are cave-ins or when an individual is buried in sand or grain.

In homicidal cases, the term burking is often ascribed to a killing method that involves simultaneous smothering and compression of the torso.[5] The term "burking" comes from the method William Burke and William Hare used to kill their victims during the West Port murders. They killed the usually intoxicated victims by sitting on their chests and suffocating them by putting a hand over their nose and mouth, while using the other hand to push the victim's jaw up. The corpses had no visible injuries, and were supplied to medical schools for money.[6]

Compressive asphyxia

See also: Positional asphyxia

Compressive asphyxia (also called chest compression) is mechanically limiting expansion of the lungs by compressing the torso, hence interfering with breathing. Compressive asphyxia occurs when the chest or abdomen is compressed posteriorly.[7] "Traumatic asphyxia" or "crush asphyxia" usually refers to compressive asphyxia resulting from being crushed or pinned under a large weight or force. An example of traumatic asphyxia includes cases where an individual has been using a car-jack to repair a car from below, and is crushed under the weight of the vehicle.[5] Pythons, anacondas, and other constrictor snakes kill through compressive asphyxia. In cases of co-sleeping ("overlay"), the weight of an adult or large child may compress an infant's chest, preventing proper expansion of the chest. Risk factors include large or obese adults, parental fatigue or impairment (sedation by drugs or alcohol) of the co-sleeping adult and a small shared sleeping space (for example, both adult and infant sharing a couch).

In fatal crowd disasters, compressive asphyxia from being crushed against the crowd causes the large part of the deaths, rather than blunt trauma from trampling. This is what occurred at the Ibrox disaster in 1971, where 66 Rangers fans died; the 1979 The Who concert disaster where 11 died; the Luzhniki disaster in 1982, when 66 FC Spartak Moscow fans died; and at the Hillsborough disaster in 1989, 96 Liverpool fans were crushed to death in an overcrowded terrace, 95 of the 96 victims died from compressive asphyxia, with 93 dying directly from it and 2 others dying from related complications.[8] In confined spaces, people push and lean against each other; evidence from bent steel railings in several fatal crowd accidents have shown horizontal forces over 4500 N (equivalent to a weight of approximately 450 kg, or 1014 lbs). In cases where people have stacked up on each other forming a human pile, estimations have been made of around 380 kg (838 lbs) of compressive weight in the lowest layer.[9]

"Positional" or "restraint" asphyxia is when a person is restrained and left alone prone, such as in a police vehicle, and is unable to reposition himself or herself in order to breathe. The death can be in the vehicle, or following loss of consciousness to be followed by death while in a coma, having presented with anoxic brain damage. The asphyxia can be caused by facial compression, neck compression, or chest compression. This occurs mostly during restraint and handcuffing situations by law enforcement, including psychiatric incidents. The weight of the restraint(s) doing the compression may contribute to what is attributed to positional asphyxia. Therefore, passive deaths following custody restraint that are presumed to be the result of positional asphyxia may actually be examples of asphyxia occurring during the restraint process.

Chest compression is also featured in various grappling combat sports, where it is sometimes called wringing. Such techniques are used either to tire the opponent or as complementary or distractive moves in combination with pinning holds,[10] or sometimes even as submission holds. Examples of chest compression include the knee-on-stomach position; or techniques such as leg scissors (also referred to as body scissors and in budō referred to as do-jime;[11] 胴絞, "trunk strangle" or "body triangle")[12] where a participant wraps his or her legs around the opponent's midsection and squeezes them together.[13]

Pressing is a form of torture or execution that works through asphyxia, e.g. burking.

Perinatal asphyxia

Main article: Perinatal asphyxia

Perinatal asphyxia is the medical condition resulting from deprivation of oxygen (hypoxia) to a newborn infant long enough to cause apparent harm. It results most commonly from a drop in maternal blood pressure or interference during delivery with blood flow to the infant's brain. This can occur as a result of inadequate circulation or perfusion, impaired respiratory effort, or inadequate ventilation.[14] There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air.[14] It has been demonstrated that high concentrations of oxygen lead to generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia.[15] Research by Ola Didrik Saugstad and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen.[16][17]

Mechanical asphyxia

Classifications of different forms of asphyxia vary among literature, with differences in defining the concept of mechanical asphyxia being the most obvious.[18]

In DiMaio and DiMaio's 2001 textbook on forensic pathology, mechanical asphyxia is caused by pressure from outside the body restricting respiration.[18] Similar narrow definitions of mechanical asphyxia have occurred in Azmak's 2006 literature review of asphyxial deaths and Oehmichen and Auer's 2005 book on forensic neuropathology.[18] According to DiMaio and DiMaio, mechanical asphyxia encompasses positional asphyxia, traumatic asphyxia, and "human pile" deaths.[18]

In Shkrum and Ramsay's 2007 textbook on forensic pathology, mechanical asphyxia occurs when any mechanical means cause interference with the exchange of oxygen and carbon dioxide in the body.[18] Similar broad definitions of mechanical asphyxia have occurred in Saukko and Knight's 2004 book on asphyxia, and Dolinak and Matshes' 2005 book on forensic pathology.[18] According to Shkrum and Ramsay, mechanical asphyxia encompasses smothering, choking, positional asphyxia, traumatic asphyxia, wedging, strangulation and drowning.[18]

Sauvageau and Boghossian propose in 2010 that mechanical asphyxia should be officially defined as caused by "restriction of respiratory movements, either by the position of the body or by external chest compression", thus encompassing only positional asphyxia and traumatic asphyxia.[18]

See also

  • Asphyxiant gas – Nontoxic or minimally toxic gas which can displace oxygen in breathing air – Nontoxic or minimally toxic gas which can displace oxygen in breathing air
  • Erotic asphyxiation – Intentional restriction of oxygen to the brain for sexual arousal – Intentional restriction of oxygen to the brain for sexual arousal
  • Hypercapnia – Abnormally high tissue carbon dioxide levels – Abnormally high tissue carbon dioxide levels
  • Respiratory acidosis – Medical condition – Medical condition

References

  1. 1 2 GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  2. 1 2 GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  3. ↑ "Asphyxia Origin". Online Etymology Dictionary. Archived from the original on 6 September 2015. Retrieved 19 July 2015.
  4. 1 2 Ferris, J.A.J. "Asphyxia". pathology.ubc.ca. Archived from the original (DOC) on June 14, 2006. Retrieved March 1, 2006.
  5. 1 2 DiMaio, Vincent; DiMaio, Dominick (2001). Forensic Pathology, Second Edition. Selected Pages from CHAPTER 8 Archived 2021-02-24 at the Wayback Machine and from Deaths Occurring Following the Application of Choke or Carotid Holds Archived 2016-05-13 at the Wayback Machine. www.charlydmiller.com. URL last accessed March 2, 2006.
  6. ↑ "Burking Law & Legal Definition". definitions.uslegal.com. Archived from the original on 2018-06-24. Retrieved 2015-08-07.
  7. ↑ Jones, Richard. Strangulation Archived 2006-04-30 at the Wayback Machine. www.forensicmed.co.uk. URL last accessed February 26, 2006.
  8. ↑ "Hillsborough inquests: The 96 who died". Archived from the original on March 19, 2018. Retrieved February 22, 2018.
  9. ↑ Fruin, John. "The Causes and Prevention of Crowd Disasters". crowddynamics.com. Archived from the original on February 21, 2006. Retrieved March 3, 2006.
  10. ↑ Ohlenkamp, Neil Principles of Judo Choking Techniques Archived 2008-12-21 at the Wayback Machine. judoinfo.com. URL last accessed on March 3, 2006
  11. ↑ Do-jime is a prohibited technique in Judo, (The Kodokan Judo Institute. Kodokan.Org classification of techniques Archived 2012-04-15 at the Wayback Machine. www.kodokan.org. URL last accessed March 4, 2006.) and is considered a 'slight infringement' according to IJF rules, Section 27: Prohibited acts and penalties, article 21. It should not be confused with do-osae, which is a colloquial term for the guard position.
  12. ↑ International Judo Federation. IJF Referee Rules Archived 2012-04-15 at the Wayback Machine. www.ijf.org. URL last accessed March 6, 2006
  13. ↑ Lewis, Bill. Katsuhiko Kashiwazaki – Shimewaza (Book Review) Archived February 15, 2006, at the Wayback Machine. www.bjj.org. URL last accessed March 4, 2006.
  14. 1 2 Davis, PG; Tan, A; O'Donnell, CPF; Schulze, A (2004). "Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis". The Lancet. 364: 1329–1333. doi:10.1016/S0140-6736(04)17189-4. PMID 15474135.
  15. ↑ Kutzsche, S; Ilves, P; Kirkeby, OJ; Saugstad, OD (2001). "Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets". Pediatric Research. 49: 834–842. doi:10.1203/00006450-200106000-00020. PMID 11385146.
  16. ↑ ILCOR Neonatal resuscitation Guidelines 2010
  17. ↑ Norwegian paediatrician honoured by University of Athens Archived 2015-04-14 at the Wayback Machine, Norway.gr
  18. 1 2 3 4 5 6 7 8 Sauvageau, Anny; Boghossian, Elie (1 September 2010). "Classification of Asphyxia: The Need for Standardization". Journal of Forensic Sciences. 55 (5): 1259-1267. doi:10.1111/j.1556-4029.2010.01459.x.

Further reading

Classification
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