Suffocation

Suffocation is an extreme degree of dyspnea, a severe pathological condition resulting from a sharp lack of oxygen (hypoxia), the accumulation of carbon dioxide (hypercapnia) and leading to disruption of the nervous system of respiration and circulation. Subjective suffocation is a sense of air shortage, expressed to an extreme degree, often accompanied by a fear of death. Synonyms: asphyxia (from the Greek asphyxia - lack of pulse). The term "apnea" is sometimes used to refer to the most severe degree of choking (Greek arnoia - lack of breathing).

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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 stenosis of the larynx and trachea is high (stridor on the background of ARI, allergies).

[2], [3], [4], [5],

Causes of the suffocation

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 boys are twice as likely as girls. Given that suffocation is also found in the adult population, in the frequency of cardiovascular diseases (especially in people with overweight), we can say that suffocation is one of the most urgent syndromes of medical practice.

[6], [7], [8], [9], [10]

Symptoms of the suffocation

When air passes through the narrowed part of the respiratory tract, a distant respiratory noise is formed, called a stridor. It can be inspiratory (in the inspiratory phase), expiratory (in the exhalation phase) or mixed. With the development of respiratory failure, the stridor may be accompanied by cyanosis.

With bronchial obstruction in the classic cases, the attack of suffocation arises suddenly, gradually increases and lasts from several minutes to many hours. During the attack the patient takes a forced position, usually sitting in bed, hands leaning on the knees or the back of the chair, breathing often and noisily, with a whistle, his mouth is open, the nostrils swell, the exhalation is elongated. When the exhalation swells the veins of the neck, during the inhalation, the swelling of the veins decreases. At the end of the attack appears a cough with hard-to-separate, viscous, viscous, vitreous sputum.

Choking with cardiac asthma can appear suddenly: the patient has a forced position (sedentary), frequent bubbling breath (25-50 per minute), with progression - pink foamy sputum.

Sudden choking with orthopnea, deep, sometimes painful, inhaling and exhaling, also occurs with embolism or thrombosis of the pulmonary artery, pulmonary edema, bronchiolitis in children.

Bronchospasm is clinically similar to asthmatic, it happens in patients with carcinoid syndrome. Asphyxia is accompanied by flushing of the face, rumbling in the abdomen, bloating.

With spontaneous pneumothorax, the attack of suffocation arises suddenly after the pain in the affected half of the chest. During the day, the well-being improves somewhat, but shortness of breath and moderate soreness persists.

The ingress of a foreign body causes the appearance of an acute, paroxysmal, painful cough and suffocation or a sharp choking with minimal cough, accompanied by fear or severe anxiety, panic, fear of death. Reddening face replaced by cyanosis.

Development of croup is manifested by constant inspiratory dyspnea, hoarseness of the voice in the defeat of the vocal cords. The true croup is characterized by a barking cough, gradually losing its sonority (up to the full aphonia), and difficulty breathing, turning into asphyxia.

Hysteroid asthma can manifest itself in different ways.

• It can represent a kind of respiratory cramp: very frequent, rapid breathing movements of the chest, sometimes they are accompanied by a groan: exhaled and inhaled and exhaled (the breath of the "driven dog"). The duration of asphyxiation is measured in minutes, after a while the attack of asthma resumes. Can be accompanied by convulsive crying or hysterical laughter. Cyanosis does not happen.
• The hysterical choking of another variant is a violation of contraction of the diaphragm: after a short inhalation with a rise in the chest and protrusion of the epigastric region, the respiratory system stops completely for several seconds. Then the chest quickly returns to the expiratory position. During an attack, swallowing is difficult or even impossible (a hysterical "lump in the throat"), sometimes pain appears in the epigastric region, probably as a result of contraction of the diaphragm.
• Psychogenic choking of the third type is associated with spasm of the vocal cords. The attack of suffocation begins with wheezing, but then the respiratory movements slow and become deep and strained, at the height of the attack, a brief stop of breathing can occur.

Forms

Choking can be classified by etiological signs. For example, "choking due to bronchial obstruction", and "choking due to paralysis of respiratory muscles".

Classification of bronchial obstruction syndrome:

• allergic genesis (BA, anaphylaxis, LA);
• autoimmune genesis (systemic connective tissue diseases);
• infectious genesis (pneumonia, influenza, etc.);
• endocrine (endocrine-humoral) genesis (hypoparathyroidism, hypothalamic pathology, carcinoid tumors, Addison's disease);
• obturation (tumors, foreign bodies, etc.);
• Irritative (from the effect of vapors of acids, alkalis, chlorine and other chemical irritants, on thermal stimuli):
• 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, the effects of concussion, etc.).

Suffocation can be acute and chronic, and on the wall of gravity - light, of medium severity and heavy.

[11], [12], [13], [14]

Diagnostics of the suffocation

Choking is an extreme degree of dyspnea. Accordingly, the diagnostic algorithm for shortness of breath is also applicable for diagnostic search in case of suffocation.

The history of the onset of the disease will distinguish the attack of asthma from stenosis of the larynx and trachea, obturation by a foreign body.

The true croup begins with sore throat and edema of the throat area, accompanied by severe intoxication.

False groats usually develop against the background of ARVI and other infectious diseases. It manifests itself in a rapidly arising and gradually intensifying attack of labored breathing and coughing. At children it happens more often at night.

Allergic edema of the respiratory tract can occur when contact with a known or unknown allergen in a patient with an allergic history (having an allergy in the past, an allergy from relatives) or without previous indications of an atopic constitution. In the latter case, edema is more often pseudoallergic. With a hereditary AO, it is often possible to identify the presence of such a pathology, and sometimes - cases of sudden unexplained death from relatives. In addition, in this case, edema can be triggered by mechanical action (hard food, endoscopy, etc.).

The sudden appearance of wheezing in a healthy person before this can also speak of aspiration. Aspiration of a foreign body should also be assumed in the presence of a prolonged and unexplained cough. When a foreign body enters the bronchi, a reflex spasm of bronchioles is possible with the development of a typical bronchospasm pattern. Therefore, the final diagnosis is often possible only after bronchoscopy.

Attacks of acute respiratory failure in the syndrome of dysfunction of the vocal cords resemble suffocation in AD patients, but audible rattles (unlike asthma), which are determined at a distance, are heard mainly on inspiration. The attack of choking is provoked by loud talk, laughter, the ingestion of food particles by them with water in the respiratory tract. There is no effect on taking bronchodilators, and taking inhaled glucocorticoids (with erroneous diagnosis of asthma) can exacerbate the manifestations of the disease. In the Munchausen syndrome, there is a condition characterized by the closure of the vocal cords and the development of wheezing, simulating an attack in asthma. At the same time there are no hyperreactivity and inflammation of the bronchi, as well as any organic changes in the airways.

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

Night paroxysmal suffocation is characteristic of heart failure, often occurs against the background of previous dyspnoea. In the history of such patients, it is possible to identify diseases in which the left ventricle mainly suffers: hypertension, aortic malformation, myocardial infarction. Detailed anamnestic data and complaints characteristic of heart failure.

In spontaneous pneumothorax, suffocation is more common in men 20-40 years of age. It is often possible to identify repeated episodes, more often on the same side. The right lung is more often affected than the left one.

Pulmonary vasculitis is observed in about a third of patients with nodular periarteritis. Clinically manifested by severe attacks of suffocation, which are associated with other syndromes of the disease, the debut of periarteritis vasculitis rarely appears. But in case of attacks of cough and suffocation in the beginning of the disease, they are often mistaken for asthma. Shortness of breath, periodically transient in severe asthmatic attacks of suffocation, occurs sometimes for 6 months. Or a year before the development of other syndromes of nodular periarteritis. If the attack of suffocation occurs in the midst of a disease (against a background of fever, abdominal pain, hypertension, polyneuritis), they are usually interpreted as a consequence of heart failure.

Thrombemolia of the pulmonary artery occurs in elderly and senile patients on bed rest, as well as in patients of any age with signs of heart failure, phlebothrombosis of the lower extremities.

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

Who should I contact if there is an attack of suffocation?

Bronchial asthma, suspicion of mastocytosis require consultation of an allergist-immunologist.

If there is a suspicion of dysfunction of the vocal cords, stenosis of the larynx, croup, consultation of the ENT doctor is necessary (with a true croup of infectious diseases).

In the case of cardiovascular disease - consultation of a cardiologist, respiratory diseases - a pulmonologist.

When detecting the tumor genesis of suffocation, the patient should be referred to an oncologist.

With systemic diseases (nodular periarteritis), a consultation of a rheumatologist.

With hysteroid choking, consult a psychiatrist.

[15], [16], [17], [18], [19], [20], [21],

Treatment of the suffocation

With cardiac asthma, a parenteral injection of diuretics, furosemide (lasix), cardiac glycosides (korglikon), is necessary to stop a suffocation attack; peripheral vasodilators. The attack of asthma can also be suppressed by the parenteral administration of a narcotic analgesic (morphine). If, on the background of such therapy, suffocation does not decrease, then chances are high that asphyxia has a different genesis.

When mastocytosis suffocation, unlike bronchial asthma, blocking the H1-receptor histamine.

When aspirating the vomit, and in some cases after removing the foreign body for the prevention of pneumonia, it is advisable to prescribe an antibiotic. This is due to the fact that the typical complications of aspiration are bronchitis and pneumonia.

For more information about the methods of treating suffocation, see this article.