Asphyxiation

Asphyxia is an extreme degree of shortness of breath, a severe pathological condition that occurs as a result of a sharp lack of oxygen (hypoxia), accumulation of carbon dioxide (hypercapnia) and leads to disruption of the nervous system of respiration and blood circulation. Subjectively, asphyxia is an extreme feeling of lack of air, often accompanied by fear of death. Synonyms: asphyxia (from the Greek asphyxia - no pulse). The term "apnea" (Greek apnoia - no breathing) is sometimes used to denote the most severe degree of asphyxia.

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Epidemiology

Modern epidemiological studies reveal a high prevalence of asthma: in the general population it exceeds 5%, and among children - more than 10%. In pediatric practice, the incidence of laryngeal and tracheal stenosis is high (stridor against the background of acute respiratory viral infections, allergies).

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Causes asphyxiations

One of the main causes of suffocation is bronchial asthma. Foreign bodies are most often the cause of suffocation in children aged 1-3 years, and in boys twice as often as in girls. Considering that suffocation also occurs in adults, in particular with cardiovascular diseases (especially in people with excess body weight), it can be said that suffocation is one of the most relevant syndromes in medical practice.

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Symptoms asphyxiations

When air passes through a narrowed section of the airways, a distant respiratory noise called stridor is formed. It can be inspiratory (in the inhalation phase), expiratory (in the exhalation phase) or mixed. If respiratory failure develops, stridor can be accompanied by cyanosis.

In classic cases of bronchial obstruction, an attack of suffocation occurs suddenly, gradually increases and lasts from several minutes to many hours. During an attack, the patient takes a forced position, usually sitting in bed, with his hands resting on his knees or the back of a chair, breathes frequently and noisily, with a whistle, his mouth is open, his nostrils flare, and his exhalation is prolonged. When exhaling, the veins of the neck swell, and during inhalation, the swelling of the veins decreases. At the end of the attack, a cough appears with difficult-to-separate, viscous, sticky, glassy sputum.

Asphyxiation in cardiac asthma can appear suddenly: the patient is in a forced position (sitting), has frequent gurgling breathing (25-50 per minute), and as it progresses – pink foamy sputum.

Sudden suffocation with orthopnea, deep, sometimes painful, inhalation and exhalation also occurs with pulmonary embolism or thrombosis, pulmonary edema, and bronchiolitis in children.

Bronchospasm, clinically similar to asthmatic, occurs in patients with carcinoid syndrome. Asphyxiation is accompanied by facial hyperemia, rumbling in the stomach, and bloating.

With spontaneous pneumothorax, an attack of suffocation occurs suddenly following pain in the affected half of the chest. Within 24 hours, the patient's condition improves somewhat, but shortness of breath and moderate pain persist.

The entry of a foreign body causes the appearance of an acute, paroxysmal, painful cough and suffocation or a sharp suffocation with minimal coughing, accompanied by fright or sharp anxiety, panic, fear of death. Redness of the face is replaced by cyanosis.

The development of croup is manifested by constant inspiratory dyspnea, hoarseness of the voice when the vocal cords are affected. True croup is characterized by a barking cough, gradually losing sonority (up to complete aphonia), and difficulty breathing, turning into asphyxia.

Hysteroid asthma can manifest itself in various ways.

• It can be a kind of respiratory spasm: very frequent, violent respiratory movements of the chest, sometimes accompanied by a groan: both inhalation and exhalation are intensified (breathing of a "cornered dog"). The duration of suffocation is measured in minutes, after some time the attack of suffocation resumes. It can be accompanied by convulsive crying or heart-rending laughter. Cyanosis does not occur.
• Another variant of hysterical suffocation is a violation of the contraction of the diaphragm: after a short inhalation with the rise of the chest and protrusion of the epigastric region, a complete cessation of breathing occurs for several seconds. Then the chest quickly returns to the expiratory position. During the attack, swallowing is difficult or even impossible (hysterical "lump in the throat"), sometimes pain appears in the epigastric region, probably due to contraction of the diaphragm.
• Psychogenic suffocation of the third type is associated with a spasm of the vocal cords. The attack of suffocation begins with wheezing breaths, but then the breathing movements slow down and become deep and strained, at the height of the attack a short-term cessation of breathing may occur.

Forms

Asphyxia can be classified by etiology. For example, "asphyxia due to bronchial obstruction" and "asphyxia due to paralysis of the respiratory muscles."

Classification of broncho-obstructive syndrome:

• allergic genesis (bronchial asthma, anaphylaxis, LA);
• autoimmune genesis (systemic diseases of connective tissue);
• infectious genesis (pneumonia, flu, etc.);
• endocrine (endocrine-humoral) genesis (hypoparathyroidism, hypothalamic pathology, carcinoid tumors, Addison's disease);
• obstructive (tumors, foreign bodies, etc.);
• irritative (from exposure to vapors of acids, alkalis, chlorine and other chemical irritants, from thermal irritants):
• toxic-chemical (poisoning with organophosphorus compounds, idiosyncrasy to iodine, bromine, aspirin, beta-blockers and other drugs):
• hemodynamic (thrombosis and pulmonary embolism, primary pulmonary hypertension, left ventricular failure, respiratory distress syndrome);
• neurogenic (encephalitis, mechanical and reflex irritation of the vagus nerve, consequences of contusion, etc.).

Choking can be acute or chronic, and depending on the severity, mild, moderate or severe.

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Diagnostics asphyxiations

Choking is an extreme degree of dyspnea. Accordingly, the diagnostic algorithm for dyspnea is also applicable to diagnostic search in case of choking.

The history of the onset of the disease will allow us to distinguish an asthma attack from stenosis of the larynx and trachea, or obstruction by a foreign body.

True croup begins with a sore throat and swelling of the pharynx, accompanied by severe intoxication.

False croup usually develops against the background of acute respiratory viral infections and other infectious diseases. It manifests itself as a rapidly developing and gradually increasing attack of difficulty breathing and coughing. In children, this often occurs at night.

Allergic edema of the respiratory tract may occur upon contact with a known or unknown allergen in a patient with an allergic anamnesis (previous allergy, allergy in relatives) or without previous indications of an atopic constitution. In the latter case, the edema is often pseudo-allergic. In hereditary AO, it is often possible to identify the presence of such a pathology, and sometimes - cases of sudden unexplained death in relatives. In addition, in this case, the edema can be provoked by mechanical action (solid food, endoscopy, etc.).

The sudden appearance of wheezing in a previously healthy person may also indicate aspiration. Aspiration of a foreign body should also be suspected in the presence of a prolonged and unexplained cough. If a foreign body enters the bronchi, a reflex spasm of the bronchioles is possible with the development of a typical picture of bronchospasm. Therefore, a final diagnosis is often possible only after bronchoscopy.

Attacks of acute respiratory failure in vocal cord dysfunction syndrome resemble suffocation in patients with bronchial asthma, but the sonorous wheezing (unlike bronchial asthma) that can be detected at a distance are heard mainly during inhalation. An attack of suffocation is provoked by loud talking, laughter, and the entry of food or water particles into the respiratory tract. There is no effect from taking bronchodilators, and taking inhaled glucocorticoids (in case of erroneous diagnosis of bronchial asthma) can aggravate the manifestations of the disease. Within the framework of Munchausen syndrome, there is a condition characterized by the closure of the vocal cords and the development of wheezing, imitating an attack of bronchial asthma. At the same time, there is no hyperreactivity and inflammation of the bronchi, as well as any organic changes in the respiratory tract.

The asthmatic variant of acute myocardial infarction is manifested by a clinical picture of pulmonary edema without pronounced ischemic pain.

Nocturnal paroxysmal dyspnea is typical for heart failure, often occurs against the background of previous dyspnea. In the anamnesis of such patients, diseases can be identified in which the left ventricle is predominantly affected: hypertension, aortic defect, myocardial infarction. Detailed anamnestic data and complaints characteristic of heart failure.

With spontaneous pneumothorax, suffocation is more common in men aged 20-40. Repeated episodes can often be detected, often on the same side. The right lung is affected somewhat more often than the left.

Pulmonary vasculitis is observed in approximately one third of patients with periarteritis nodosa. Clinically, it manifests itself as severe asthma attacks that join other syndromes of the disease; vasculitis is rarely the debut of periarteritis. But if coughing and asthma attacks occur at the onset of the disease, they are often mistaken for asthma symptoms. Dyspnea, periodically turning into severe asthmatic asthma attacks, sometimes occurs 6 months or a year before the development of other syndromes of periarteritis nodosa. If an asthma attack occurs at the height of the disease (against the background of fever, abdominal pain, arterial hypertension, polyneuritis), they are usually interpreted as a consequence of heart failure.

Pulmonary embolism occurs in elderly and senile patients who are on bed rest, as well as in patients of any age with signs of heart failure and phlebothrombosis of the lower extremities.

Acute opisthorchiasis or ascariasis in the stage of larval migration can also be a cause of suffocation (rare)

Who should I contact if I have an asthma attack?

Bronchial asthma, suspected mastocytosis require consultation with an allergist-immunologist.

If you suspect dysfunction of the vocal cords, stenosis of the larynx, or croup, you should consult an ENT specialist (in case of true croup, an infectious disease specialist).

In case of cardiovascular pathology - consultation with a cardiologist, in case of respiratory diseases - with a pulmonologist.

If a tumor origin of suffocation is detected, the patient should be referred to an oncologist.

For systemic diseases (nodular periarteritis), consult a rheumatologist.

In case of hysterical suffocation, consult a psychiatrist.

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Treatment asphyxiations

In cardiac asthma, to stop an attack of suffocation, it is necessary to administer parenteral diuretics - furosemide (lasix), cardiac glycosides (corglycon); peripheral vasodilators. An attack of suffocation can also be stopped by parenteral administration of a narcotic analgesic (morphine). If suffocation does not decrease against the background of such therapy, then it is highly likely that asphyxia has a different genesis.

In mastocytosis, asphyxiation is relieved, unlike in bronchial asthma, by histamine H1 receptor blockers.

In case of aspiration of vomit, and in some cases after removal of a foreign body, it is advisable to prescribe an antibiotic to prevent pneumonia. This is due to the fact that typical complications of aspiration are bronchitis and pneumonia.

For more information on methods of treating suffocation, read this article.