Asphyxia
Asphyxia: Excerpt from Handbook of Diseases
A condition of insufficient oxygen and accumulating carbon dioxide in the blood and tissues due to interference with respiration, asphyxia results in cardiopulmonary arrest. Without prompt treatment, it’s fatal.
Causes
Asphyxia results from any condition or substance that inhibits respiration:
hypoventilation as a result of narcotic abuse, medullary disease or hemorrhage, pneumothorax, respiratory muscle paralysis, or cardiopulmonary arrest
intrapulmonary obstruction, as in airway obstruction, severe asthma, foreign-body aspiration, pulmonary edema, pneumonia, and near drowning
extrapulmonary obstruction, as in tracheal compression from a tumor, strangulation, trauma, or suffocation
inhalation of toxic agents, as in carbon monoxide poisoning, smoke inhalation, and excessive oxygen inhalation.
Signs and symptoms
Depending on the duration and degree of asphyxia, common signs and symptoms include anxiety, dyspnea, agitation and confusion leading to coma, altered respiratory rate (apnea, bradypnea, or occasional tachypnea), decreased breath sounds, central and peripheral cyanosis (cherry-red mucous membranes in late-stage carbon monoxide poisoning), seizures, and fast, slow, or absent pulse.
Diagnosis
Patient history and laboratory test results support the diagnosis. Pulse oximetry reveals decreased hemoglobin (Hb) saturation with oxygen except in patients with carbon monoxide poisoning where Hb is bound by the toxicant, falsely elevating the saturation value. Arterial blood gas analysis, the most important test, indicates decreased partial pressure of oxygen (less than 60 mm Hg) and increased partial pressure of carbon dioxide (greater than 50 mm Hg). Chest X-rays may show a foreign body, pulmonary edema, or atelectasis. Toxicology tests may show drugs, or chemicals. Abnormal Hb levels may also be detected in a complete blood count. Pulmonary function tests may indicate respiratory muscle weakness.
Treatment
Asphyxia requires immediate respiratory support — with cardiopulmonary resuscitation, endotracheal intubation, and supplemental oxygen as needed. The underlying cause must be remedied: bronchoscopy for extraction of a foreign body; a narcotic antagonist, such as naloxone, for narcotic overdose; gastric lavage for poisoning; and limited, graded use of supplemental oxygen for carbon dioxide narcosis caused by excessive oxygen therapy.
Special considerations
Respiratory distress is frightening, so reassure the patient during treatment.
Give prescribed medications.
Suction carefully, as needed, and encourage deep breathing.
Closely monitor vital signs and laboratory test results.
CLINICAL TIP: To prevent drug-induced asphyxia, warn patients about the danger of taking alcohol with other central nervous system depressants.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Asphyxia
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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