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March 31, 2015: In Chadora, Budgam, Kashmir, 16 died while a building collapsed due to heavy rains. Sixteen human beings died beneath the surface of debris of a collapsed building.
What was the cause and manner of death in this situation? What is Asphyxia? What are the symptoms and signs of asphyxia? What caused asphyxia in this situation? What should have emergency responders, including emergency medical specialists, done in this situation? Is there a difference between asphyxia and hypoxia? What is the difference between asphyxia and hypoxia? What is anoxia? What does a pulse oximeter show about hypoxia? What are the causes of asphyxia? What is the treatment for asphyxia? |
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March 31, 2015: In Chadora, Budgam, Kashmir, 16 died while a building collapsed due to heavy rains. Sixteen human beings died beneath the surface of debris of a collapsed building.
What was the cause and manner of death in this situation? Asphyxia. Their supply of oxygen was cut off. The human bodies beneath the surface of debris in this situation ran out of air. Trauma in this situation is a less likely cause of death. What is Asphyxia? Asphyxia means there is a deficient supply of oxygen to the body, most importantly, the brain. This can arise from abnormal breathing, or when the supply of oxygen is cut off, for example, due to a person being stuck beneath the surface of debris, drowning, or suffocating (to block the air passages or have the air passages blocked). 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. What are the symptoms and signs of asphyxia? If a human body is recovered from beneath the surface of debris due to a building or house collapse, there may be no breathing or pulse. There might be debris around the mouth and nostrils. One should attempt cardiopulmonary resuscitation. If the person is breathing and has a pulse, the following signs of asphyxia can be found: Breathing difficulty Rapid pulse High blood pressure Cyanosis (the lips and face appear blue) Convulsions What caused asphyxia in this situation? Sixteen people died beneath the surface of debris after a building collapsed, causing asphyxia. What should have emergency responders, including emergency medical specialists, done in this situation? Dig out the people from the debris within minutes (3-10 minutes) of the incident. Act quickly. Turn the victims face down, with head to one side and arms stretched beyond the head. Remove debris and mud from the nose, mouth and throat. Start artificial ventilation immediately. Make an airway for each individual victim. Start 100% oxygen. If the breathing and pulse are there, you have saved this individual. If the breathing and pulse are not there, start cardiopulmonary resuscitation. Is there a difference between asphyxia and hypoxia? Yes. What is the difference between asphyxia and hypoxia? Asphyxia means there is a deficient supply of oxygen to the body that arises from abnormal breathing or when the supply of oxygen is cut off. Hypoxia means there is a deficiency of available oxygen in the blood and bodily tissues. What is anoxia? Anoxia means severe hypoxia; the absence of oxygen in inspired gases, arterial blood or in the tissues. What does a pulse oximeter show about hypoxia? Spo2 means there is peripheral capillary oxygen saturation. SpO2 should always be 95% or greater at all times and during anaesthesia with all ages of patients. When the SpO2 falls below 90%, the patient is becoming seriously hypoxic. This needs immediate attention. Start to check the patient if the SpO2 is 94% or below. What are the causes of asphyxia? Causes of Asphyxia Choking Foreign body Suffocation Toxin fumes 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, specifically 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 Ondine's curse, central alveolar 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 Smothering Compressive asphyxia Perinatal asphyxia Suffocation by smoke Suffocation by poisonous gases Asthma Artificial Respiration What is the treatment for asphyxia? Treatment of asphyxia is dependent on the underlying cause. Here are further guidelines: www.qureshiuniversity.com/asphyxia.html March 31, 2015: In Chadora, Budgam, Kashmir, 16 died while a building collapsed due to heavy rains. Sixteen human beings died beneath the surface of debris of a collapsed building. What should have emergency responders, including emergency medical specialists, done in this situation? Dig out the people from the debris within minutes (3-10 minutes) of the incident. Act quickly. Turn the victims face down, with head to one side and arms stretched beyond the head. Remove debris and mud from the nose, mouth and throat. Start artificial ventilation immediately. Make an airway for each individual victim. Start 100% oxygen. If the breathing and pulse are there, you have saved this individual. If the breathing and pulse are not there, start cardiopulmonary resuscitation. A. Drowning Drowning is the result of complete immersion of the nose and mouth in water (or any other liquid). Water enters the windpipe and lungs, clogging the lungs completely. Management The aim of _______ is to drain out water (or other matter) from lungs and to give artificial respiration. 1.Act quickly. Remove seaweeds and mud from the nose and throat. Start artificial ventilation immediately. This is possible even when the casualty is in water. 2.Turn the victim face down with head to one side and arms stretched beyond his head. Infants or children could be help upside down for a short period. 3.Raise the middle part of the body with your hands round the belly. This is to cause water to drain out of the lungs. 4.Give artificial respiration until breathing comes back to normal. This may have to go on for as long as two hours. 5.Remove wet clothing. 6.Keep the body warm, cover with blankets. 7.When victim becomes conscious, give hot drinks viz coffee or tea. 8.Do not allow him to sit up. 9.After doing the above, remove quickly to hospital as a stretcher case. B. Strangulation and Hanging 1.Cut or remove the band constricting the throat. 2.If suspended, raise the body and loosen or cut the rope. 3.Give artificial respiration. 4.To do the above do not wait for the policeman. C. Choking (Asphyxia due to obstruction in wind pipe) This is most common with children. A marble, a weed or a button may get stuck in the air passage. In adults too, food may go down the wrong way and cause choking. Management in the case of an adult. When victim is standing, the _______ should stand behind to victim and wrap his arms around the waist. Grasp the fist with your other hand and place the thumb of the fist against the abdomen (belly) slightly above the navel and below the rib cage. Press your fist into the victim's abdomen with a quick upward thrust. Repeat several times if necessary till the foreign body is expelled out of the windpipe. When the victim is sitting, the _______ stands behind the chair and performs the same manoeuvre. If the victim is lying, turn him supine (face up). Facing the victim, kneel astride the victim's legs. With your hands one on top of another, place the heel of your bottom hand over the abdomen (belly) between the naval and the ribcage. Press into the victim's abdomen with a quick upward thrust repeat several times, if necessary. Should the patient vomit, place him on his side and wipe to prevent asphyxia. Following the expulsion of food particle/foreign body it may be necessary to give artificial respiration. Management in case of an infant 1.Hold the child upside down by the legs and smack his/her back hard three or four times. 2.If not successful, lay the child prone with his head hanging downwards over the knee and give sharp smacks between shoulders. 3.It still not successful, induce vomiting by passing two fingers right to the back of the throat. D. Swelling within the throat Swelling within the throat may occur as a result of trying to drink very hot liquids or swallowing corrosive poisons or may be due to inflammation. Management 1.Make the patient sit up. 2.If breathing continues to be normal or is restored to normal give ice to suck, or cold water to sip. 3.Butter, olive oil or medicinal paraffin may also be given. 4.Apply cloth wrung out of hot water to the front of the neck. 5.If breathing has stopped, give artificial respiration. E. Suffocation by smoke 1.Protect yourself by a towel or a cloth (preferably wet) over your mouth and nose. 2.Keep low and remove the casualty as quickly as possible away from the area. F. Suffocation by Poisonous Gases Carbon Monoxide (lighter than air) This gas is present in car-exhaust fumes, in household coal gas: during incomplete combustion of charcoal stoves and in coal mines. Management The ________ treatment consists in removing the person from the area, applying artificial respiration and giving pure oxygen, if available. 1.Ensure circulation of fresh air before entering the room by opening the doors and windows. 2.Before entering the enclosed space take two or three deep breaths and hold your breath as long as you can. 3.Crawl along the floor (as the gas is lighter than air) 4.Remove the casualty as quickly as possible to fresh air. 5.Loosen his clothes at neck and waist and give artificial respiration, if asphyxiated. Carbon-dioxide and other (heavier than air) This gas is found in coal mines, deep unused wells and sewers. Various other gases such as leaking refrigerator gases; compressed gases used for cooking and lighting may also cause suffocation. Management 1.Observe all the precautions mentioned above. 2.Enter in an upright position (as the gas is heavier than air and collects near the floor) 3.Remove the casualty as quickly as possible to fresh air. 4.Wherever ventilation is not possible and deadly poisonous gas is suspected, use a gas mask to protect yourself. G. Asthma This is a condition where sudden constriction of airways causing difficulty in breathing, especially in breathing out. Allergy, infection, anxiety or tension can trigger an attack. Management 1.Reassure the patient 2.Make them sit up in bed or chair and allow him to lean forward with a couple of pillows and/or a small table on which to rest his head. 3.Ensure fresh air by opening the windows. 4.Seek medical aid from a nearby doctor. Artificial Respiration (Respiratory Resuscitation) There have been several methods of artificial respiration practiced in _______. Up to the II World War, Sylvester’s method was felt to be the best. During this war mouth-to-mouth (to-nose) method was discovered and found to be the best and easiest method to be used under most conditions. Asphyxia of a severe degree is found along with unconsciousness. General causes are: a.The tongue may have fallen back into the throat. b.Vomit or spittle may have collected in the throat, or c.Some foreign material (like weeds, mud etc.), may have collected and obstructed the air passages. Therefore, when a casualty is unconscious make sure he is breathing freely. Begin to work immediately as every minute counts. Do not delay. Treatment when not breathing. 1.Loosen all clothing at waist, chest and neck. 2.Tilt the head backwards, while supporting the back of neck with your palm. This will lift the tongue to its normal position. Thus the air passage will be cleared and the casualty may begin to breathe after a gasp. Pass resuscitube if one is available readily. 3.If breathing does not being after the above treatment, help movements of chest and lungs four or five times. This will be usually enough to start breathing. If breathing does not start even now, mouth-mouth (to-nose) breathing should be begun. Mouth-to-Mouth 1.Place the casualty on his back. Hold his head tilted back. 2.Take a deep breath with mouth open widely. 3.Keep nostrils of casualty pinched. 4.Cover the mouth of the casualty with your mouth snugly. 5.Watching the chest, blow into his lungs, until the chest expands. Withdraw your mouth; note that the chest falls back (It is hygienic to cover the mouth of casualty with your handkerchief or some clean cloth). 6.Repeat the above 15 to 20 times a minute. 7.If the casualty is young (baby or a child), the operations are as above, but your open mouth should cover both the mouth and nose of the casualty. Blow gently. 8.If the chest does not rise (as in 5 above) look for an obstruction. a.Turn the casualty to a side and thump his back. This will make the obstructing material come to the front of throat. Open the mouth and remove it with your finger covered with a piece of cloth. b.If a child, hold it up by the feet and thump the back. 9.Use mouth-to-nose respiration if mouth-to-mouth is not possible, but now the casualty's mouth should be closed by the _______ thumb. 10.If the heart is working, continue artificial respiration until normal breathing occurs. Send for an ambulance. 11.If the heart is not working, you will notice the following a.The face is blue or pale. b.Pupils are dilated. c.Heart beats and pulse at root of neck (carotid) are not felt 12.Then treat as follows: a.Place the casualty flat on his back on a hard surface (bench, table etc.) b.Give a smart hit with the edge of your hand on the lower and left angle of the sternum. This usually stimulates the heart to work. c.In case the heart does not work, persist the striking for 10-15 seconds, at the rate of one stroke a second, feel for the pulse becomes regular and continuous to stop beating. d.All the while artificial respiration has to go on. Note: important a.Even if the casualty is breathing, but the breathing is not normal, it is wise to start artificial respiration. b.Do not begin thumping the heart or compression until you are sure that the heart has stopped beating. External Heart Compression (if there are two trained person) a.This should go on along with artificial respiration therefore ask the ________ giving mouth-to-mouth breathing to sit to the right of the casualty and place yourself on the left side. b.Feel and mark the lower part of the sternum. c.Place the heel of your hand on the body, making sure that the palm and fingers are not in contact with the Chest. d.Place the heel of the other hand over it. e.With your right arm, press the sternum backward towards the spine. (It can be pressed back 1 to 1.5 inches in adults.) 1.Adults should be given about 60 pressures a minute. For children from two to ten years 3 pressures with one hand (heel) will be enough; but pressure should be 80-90 times a minute. For babies up to two years, 2 pressures with two fingers are good enough applied 100 times per minute. 2.Press firmly but carefully; carelessness may cause injury to ribs and deeper tissues. 3.If the treatment is effective, a.Colour will become normal b.Pupil will contract as improvement begins and c.Carotid pulse begins with each pressure. 4.When pulse is not restored, continue compression till the patient reaches hospital. 5.Inflation's of lungs to heart pressure should be as 2:15. If there is only one ________, he has to be very smart and active. Finish 15 heart compressions, rush to head-side, give two inflation's to the lungs, and get back to the heart and give 15 compressions. 6.Repeat these If there are two __________, No.1 makes 5 heart compressions and then No.2 given one lung inflation. These are repeated, At the same time No.1 can watch the pupils and No.2 can feel the carotid pulse. |