Asphyxia

"Oxygen deprivation" redirects here. For other uses, see Hypoxia (disambiguation).

"Smother" and "Suffocation" redirect here. For other uses, see Smother (disambiguation) and Suffocation (disambiguation).

For the Tsk Tsk Tsk album, see Asphixiation: What is This Thing Called Disco?.

Asphyxia
Synonyms	Asphyxiation
The knee-on-belly position compresses the chest, making it difficult for the person on the bottom to breathe.
Specialty	Critical care medicine
Frequency	9.8 million unintentional (2015)[1]
Deaths	35,600 (2015)[2]

Asphyxia or asphyxiation is a condition of severely 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.^[2][1] The word asphyxia is from Ancient Greek α- "without" and σφύξις sphyxis, "squeeze" (throb of heart).^[3]

Contents

• 
  1 Cause
  
  • 
    1.1 Smothering
    
  
  
  • 
    1.2 Compressive asphyxia
    
  
  
  • 
    1.3 Perinatal asphyxia
    
  
  


• 
  2 See also
  


• 
  3 References
  


• 
  4 Further reading
  


• 
  5 External links
  

Cause

Situations that can cause asphyxia include but are not limited to: 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:

• Acute respiratory distress syndrome


• 
  Carbon monoxide inhalation, such as that from a car exhaust and the smoke's emission from a lighted cigarette: carbon monoxide has a higher affinity than oxygen to the hemoglobin in the blood's red blood corpuscles, bonding with it tenaciously, and, in the process, displacing oxygen and preventing the blood from transporting oxygen around the body


• Contact with certain chemicals, including pulmonary agents (such as phosgene) and blood agents (such as hydrogen cyanide)


• Drowning


• Drug overdose


• Exposure to extreme low pressure or vacuum to the pattern (see space exposure)


• 
  Hanging, whether suspension or short drop hanging


• Self-induced hypocapnia by hyperventilation, as in shallow water or deep water blackout and the choking game
  


• Inert gas asphyxiation


• 
  Congenital central hypoventilation syndrome, or primary alveolar hypoventilation, a disorder of the autonomic nervous system in which a patient must consciously breathe; although it is often said that persons with this disease will die if they fall asleep, this is not usually the case


• Respiratory diseases


• Sleep apnea


• A seizure which stops breathing activity


• Strangling


• Breaking the wind pipe.


• Prolonged exposure to chlorine gas
  

Smothering

"Smother" redirects here. For other uses, see Smother (disambiguation).

Smothering is the 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] In accidents, the term 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]

See also

• 
  Underwater diving portal
  

• Asphyxiant gas


• Erotic asphyxiation


• Hypercapnia


• Respiratory acidosis

References

1. 
   ^ ^ab 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. 
   ^ ^ab 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. Retrieved 19 July 2015. 
   


4. 
   ^ ^ab Ferris, J.A.J. "Asphyxia". pathology.ubc.ca. Archived from the original (DOC) on June 14, 2006. Retrieved March 1, 2006. 
   


5. 
   ^ ^ab DiMaio, Vincent; DiMaio, Dominick (2001). Forensic Pathology, Second Edition. Selected Pages from CHAPTER 8 and from Deaths Occurring Following the Application of Choke or Carotid Holds. www.charlydmiller.com. URL last accessed March 2, 2006.
   


6. 
   ^ "Burking Law & Legal Definition". definitions.uslegal.com. 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". 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. 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. 
    ^ ^ab 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, Norway.gr
    

Further reading

• 
  Sir James Kay-Shuttleworth (1834). The Physiology, Pathology, and Treatment of Asphyxia. Longman, Rees, Orme, Brown, Green & Longman. 
  


• 
  Elsner R (September 1989). "Perspectives in diving and asphyxia". Undersea Biomed Res. 16 (5): 339–44. PMID 2678664. 
  

External links

Classification	D ICD-10: R09.0, T71 ICD-9-CM: 799.0 DiseasesDB: 969

Look up smother in Wiktionary, the free dictionary.

• 
  Media related to Asphyxia at Wikimedia Commons


• Cross-side to chest compression choke

v t e Symptoms and signs relating to the respiratory system (R04–R07, 786)
Medical examination and history taking
Auscultation	Stethoscope Respiratory sounds Stridor Wheeze Crackles Rhonchi Stertor Squawk Pleural friction rub Fremitus Bronchophony Terminal secretions Elicited findings Percussion Pectoriloquy Whispered pectoriloquy Egophony
Breathing	Rate Apnea Prematurity Dyspnea Hyperventilation Hypoventilation Hyperpnea Tachypnea Hypopnea Bradypnea Pattern Agonal respiration Biot's respiration Cheyne–Stokes respiration Kussmaul breathing Ataxic respiration Other Respiratory distress Respiratory arrest Orthopnea/Platypnea Trepopnea Aerophagia Asphyxia Breath holding Mouth breathing Snoring
Other	Chest pain In children Precordial catch syndrome Pleurisy Nail clubbing Cyanosis Cough Sputum Hemoptysis Epistaxis Silhouette sign Post-nasal drip Hiccup COPD Hoover's sign asthma Curschmann's spirals Charcot–Leyden crystals chronic bronchitis Reid index sarcoidosis Kveim test pulmonary embolism Hampton hump Westermark sign pulmonary edema Kerley lines Hamman's sign Golden S sign

v t e Consequences of external causes (T66–T78, 990–995)
Temperature	Elevated Hyperthermia Heat syncope Reduced Hypothermia Immersion foot syndromes Trench foot Tropical immersion foot Warm water immersion foot Chilblains Frostbite Aerosol burn Cold intolerance Acrocyanosis Erythrocyanosis crurum
Radiation	Radiation poisoning Radiation burn Chronic radiation keratosis Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy Radiation acne Radiation-induced cancer Radiation recall reaction Radiation-induced erythema multiforme Radiation-induced hypertrophic scar Radiation-induced keloid Radiation-induced morphea
Air	Hypoxia/Asphyxia Barotrauma Aerosinusitis Decompression sickness High altitude Altitude sickness Chronic mountain sickness HAPE HACE
Food	Starvation
Maltreatment	Physical abuse Sexual abuse Psychological abuse
Travel	Motion sickness Seasickness Airsickness Space adaptation syndrome
Adverse effect	Hypersensitivity Anaphylaxis Angioedema Allergy Arthus reaction Adverse drug reaction
Other	Electric shock Drowning Lightning injuries
Ungrouped skin conditions resulting from physical factors	Dermatosis neglecta Pinch mark Pseudoverrucous papules and nodules Sclerosing lymphangitis Tropical anhidrotic asthenia UV-sensitive syndrome environmental skin conditions Electrical burn frictional/traumatic/sports Black heel and palm Equestrian perniosis Jogger's nipple Pulling boat hands Runner's rump Surfer's knots Tennis toe Vibration white finger Weathering nodule of ear Wrestler's ear Coral cut Painful fat herniation Uranium dermatosis iv use Skin pop scar Skin track Slap mark Pseudoacanthosis nigricans Narcotic dermopathy

v t e Diving medicine, physiology, physics and environment
Diving medicine	Injuries and disorders Pressure Oxygen Freediving blackout Hyperoxia Hypoxia (medical) Oxygen toxicity Inert gases Atrial septal defect Avascular necrosis Decompression sickness Dysbaric osteonecrosis High-pressure nervous syndrome Hydrogen narcosis Isobaric counterdiffusion Nitrogen narcosis Taravana Uncontrolled decompression Carbon dioxide Hypercapnia Hypocapnia Aerosinusitis Air embolism Alternobaric vertigo Barodontalgia Barostriction Barotrauma Compression arthralgia Decompression illness Dental barotrauma Dysbarism Ear clearing Frenzel maneuver Valsalva maneuver Immersion Asphyxia Drowning Hypothermia Immersion diuresis Instinctive drowning response Laryngospasm Salt water aspiration syndrome Swimming-induced pulmonary edema List of signs and symptoms of diving disorders Cramps Diving disorders Motion sickness Surfer's ear Treatments Diving chamber Diving medicine Hyperbaric medicine Hyperbaric treatment schedules In-water recompression Oxygen therapy Fitness to dive
Diving physiology	Artificial gills (human) Blood–air barrier Blood shift Breathing Circulatory system CO₂ retention Cold shock response Dead space (physiology) Decompression (diving) Decompression theory Diving reflex Gas exchange History of decompression research and development Lipid Maximum operating depth Metabolism Normocapnia Oxygen window in diving decompression Perfusion Physiological response to water immersion Physiology of decompression Pulmonary circulation Respiratory exchange ratio Respiratory quotient Respiratory system Systemic circulation Tissue (biology)
Diving physics	Ambient pressure Amontons' law Anti-fog Archimedes' principle Atmospheric pressure Boyle's law Breathing performance of regulators Buoyancy Charles's law Combined gas law Dalton's law Diffusion Force Gay-Lussac's law Henry's law Hydrophobe Hydrostatic pressure Ideal gas law Molecular diffusion Neutral buoyancy Oxygen fraction Partial pressure Permeation Pressure Psychrometric constant Snell's law Solubility Solution Supersaturation Surface tension Surfactant Torricellian chamber Underwater vision Weight
Diving environment	Algal bloom Breaking wave Ocean current Current (stream) Ekman transport Halocline List of diving hazards and precautions Longshore drift Rip current Stratification Surf Surge (wave action) Thermocline Tides Turbidity Undertow (water waves) Upwelling
Researchers in diving medicine and physiology	Arthur J. Bachrach Albert R. Behnke Paul Bert George F. Bond Robert Boyle Albert A. Bühlmann John R Clarke William Paul Fife John Scott Haldane Robert William Hamilton Jr. Leonard Erskine Hill Brian Andrew Hills Felix Hoppe-Seyler Christian J. Lambertsen Simon Mitchell Charles Momsen John Rawlins R.N. Charles Wesley Shilling Edward D. Thalmann Jules Triger
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