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Asphyxia or asphyxiation is a condition of deficient supply of
oxygen Oxygen is a chemical element; it has chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen group (periodic table), group in the periodic table, a highly reactivity (chemistry), reactive nonmetal (chemistry), non ...
to the body which arises from abnormal
breathing Breathing (spiration or ventilation) is the rhythmical process of moving air into ( inhalation) and out of ( exhalation) the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxy ...
. Asphyxia causes generalized hypoxia, which affects all the tissues and organs, some more rapidly than others. There are many circumstances that can induce asphyxia, all of which are characterized by the inability of a person 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. The word asphyxia is from
Ancient Greek Ancient Greek (, ; ) includes the forms of the Greek language used in ancient Greece and the classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...
"without" and , "squeeze" (throb of heart).


Causes

Situations that can cause asphyxia include but are not limited to:
airway obstruction Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. Airway obstructions can occur either in the upper airway or lower airway. The upper airway consists of the nose, throat, and larynx. The lower ai ...
(such as from
asthma Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...
, 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 Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin co ...
* Alcohol poisoning * Carbon monoxide inhalation, such as that from a car exhaust and the smoke produced by a lit
cigarette A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into Rolling paper, thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhale ...
: carbon monoxide has a higher affinity than oxygen to the
hemoglobin Hemoglobin (haemoglobin, Hb or Hgb) is a protein containing iron that facilitates the transportation of oxygen in red blood cells. Almost all vertebrates contain hemoglobin, with the sole exception of the fish family Channichthyidae. 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 Phosgene is an organic chemical compound with the formula . It is a toxic, colorless gas; in low concentrations, its musty odor resembles that of freshly cut hay or grass. It can be thought of chemically as the double acyl chloride analog of ...
) and blood agents (such as
hydrogen cyanide Hydrogen cyanide (formerly known as prussic acid) is a chemical compound with the chemical formula, formula HCN and structural formula . It is a highly toxic and flammable liquid that boiling, boils slightly above room temperature, at . HCN is ...
) *
Choking Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen de ...
by obstruction of a foreign body in the airway (for example: when eating) *
Cyanide poisoning Cyanide poisoning is poisoning that results from exposure to any of a number of forms of cyanide. Early symptoms include headache, dizziness, fast heart rate, shortness of breath, and vomiting. This phase may then be followed by seizures, slo ...
*
Drowning Drowning is a type of Asphyxia, suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incidents. Most instances of fatal drowning occur alone or in situations where othe ...
*
Drug overdose A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Retrieved on September 20, 2014.
* Exposure to extreme low pressure or
vacuum A vacuum (: vacuums or vacua) is space devoid of matter. The word is derived from the Latin adjective (neuter ) meaning "vacant" or "void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressur ...
from
spacesuit A space suit (or spacesuit) is an environmental suit used for protection from the harsh Space environment, environment of outer space, mainly from its Vacuum (outer space), vacuum as a highly specialized pressure suit, but also its temperatu ...
damage (see
space exposure The effects of spaceflight on the human body are complex and largely harmful over both short and long term. Significant adverse effects of long-term weightlessness include muscle atrophy and osteoporosis, deterioration of the Human skeleton, ske ...
) *
Hanging Hanging is killing a person by suspending them from the neck with a noose or ligature strangulation, ligature. Hanging has been a standard method of capital punishment since the Middle Ages, and has been the primary execution method in numerou ...
, whether suspension or short drop hanging * Self-induced hypocapnia by
hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blo ...
, as in shallow water or deep water blackout and the
choking game The choking game, or fainting game, also sometimes referred to as Space Monkeys, is the act of intentionally cutting off oxygen to the brain with the goal of inducing temporary Syncope (medicine), loss of consciousness and euphoria. A related inte ...
* 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 people with this disease will die if they fall asleep, this is not usually the case. *
Respiratory diseases Respiratory diseases, or lung diseases, are pathology, pathological conditions affecting the organs and tissues that make gas exchange difficult in Breathing, air-breathing animals. They include conditions of the respiratory tract including the t ...
*
Sleep apnea Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive Apnea, pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor vent ...
* A
seizure A seizure is a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous neuronal firing. Depending on the regions of the brain involved, seizures can lead to changes in movement, sensation, behavior, awareness, o ...
which stops breathing activity * An
allergic reaction Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...
*
Strangling Strangling or strangulation is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain by restricting the flow of oxygen through the trachea. Fatal strangulation typically occur ...
* Breaking the wind pipe * Prolonged exposure to chlorine gas


Smothering

Smothering is a mechanical obstruction of the flow of air from the environment into the mouth or nostrils, for instance, by covering the mouth and nose with a hand, pillow, or a plastic bag. 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 A combat sport, or fighting sport, is a contact sport that usually involves one-on-one combat. In many combat sports, a contestant wins by scoring more points than the opponent, submitting the opponent with a hold, disabling the opponent (''knocko ...
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 Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and ...
. Other accidents involving a similar mechanism are cave-ins, or when an individual is buried in sand, snow, dirt, or grain. In homicidal cases, the term burking describes a killing method that involves simultaneous smothering and compression of the torso. 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.


Compressive asphyxia

Compressive asphyxia (also called chest compression) is mechanically limiting expansion of the lungs by compressing the torso, preventing breathing. " Traumatic asphyxia" or "crush asphyxia" usually refers to compressive asphyxia resulting from being crushed or pinned under a large weight or force, or in a
crowd crush Crowd collapses and crowd crushes are catastrophic incidents that can occur when a body of people becomes dangerously overcrowded. When numbers are up to about five people per square meter, the environment may feel cramped but manageable; when nu ...
. An example of traumatic asphyxia is a person who jacks up a car to work on it from below, and is crushed by the vehicle when the jack fails. Constrictor snakes such as boa constrictors kill through slow compressive asphyxia, tightening their coils every time the prey breathes out rather than squeezing forcefully. In cases of an adult co-sleeping with an infant ("overlay"), the heavy sleeping adult may move on top of the infant, causing compression asphyxia. In fatal crowd disasters, compressive asphyxia from being crushed against the crowd causes all or nearly all deaths, rather than
blunt trauma A blunt trauma, also known as a blunt force trauma or non-penetrating trauma, is a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when a ...
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 FC Spartak Moscow (, ) is a Russian professional association football, football club based in Moscow. Having won 12 Soviet Top League, Soviet championships (second only to FC Dynamo Kyiv, Dynamo Kyiv) and 10 Russian Premier League, Russian champ ...
fans died; the
Hillsborough disaster The Hillsborough disaster was a fatal crowd crush at a football match at Hillsborough Stadium in Sheffield, South Yorkshire, England, on 15 April 1989. It occurred during an FA Cup semi-final between Liverpool and Nottingham Forest in the tw ...
in 1989, where 97
Liverpool Liverpool is a port City status in the United Kingdom, city and metropolitan borough in Merseyside, England. It is situated on the eastern side of the River Mersey, Mersey Estuary, near the Irish Sea, north-west of London. With a population ...
fans were crushed to death in an overcrowded terrace, 95 of the 97 from compressive asphyxia, 93 dying directly from it and 3 others from related complications; the 2021 Meron crowd crush where 45 died; the
Astroworld Festival crowd crush On November 5, 2021, a fatal Crowd collapses and crushes, crowd crush occurred during the Astroworld Festival, an annual musical event hosted by American rapper Travis Scott at NRG Park in Houston, Texas. Eight people were pronounced dead on th ...
in 2021, where 10 died; and the Seoul Halloween crowd crush in 2022, where at least 159 died during
Halloween Halloween, or Hallowe'en (less commonly known as Allhalloween, All Hallows' Eve, or All Saints' Eve), is a celebration geography of Halloween, observed in many countries on 31 October, the eve of the Western Christianity, Western Christian f ...
celebrations. In confined spaces, people are forced to push against each other; evidence from bent steel railings in several fatal crowd accidents has shown horizontal forces over 4500 N (equivalent to a weight of approximately 450 kg or 1000 lbs). In cases where people have stacked up on each other in a human pile, it has been estimated that those at the bottom are subjected to around 380 kg (840 lbs) of compressive weight. "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 themself 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 a technique used in various
grappling Grappling is a fighting technique based on throws, trips, sweeps, clinch fighting, ground fighting and submission holds. Grappling contests often involve takedowns and ground control, and may end when a contestant concedes defeat. Shou ...
combat sports, where it is sometimes called wringing, either to tire the opponent or as complementary or distractive moves in combination with pinning holds, or sometimes even as
submission holds A grappling hold, commonly referred to simply as a hold that in Japanese is referred to as ''katame-waza'' ( "grappling technique"), is any specific grappling, wrestling, judo, or other martial art grip that is applied to an opponent. Grappli ...
. 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 is a Japanese language, Japanese term describing modern Japanese martial arts. It is commonly translated as "Martial Way", or the "Way of Martial Arts". Etymology is a compound of the root ( or ; ), meaning "war" or "martial"; and ( or ; ), ...
referred to as ''do-jime''; 胴絞, "trunk strangle" or "body triangle") where a participant wraps his or her legs around the opponent's midsection and squeezes them together. Pressing is a form of
torture Torture is the deliberate infliction of severe pain or suffering on a person for reasons including corporal punishment, punishment, forced confession, extracting a confession, interrogational torture, interrogation for information, or intimid ...
or
execution Capital punishment, also known as the death penalty and formerly called judicial homicide, is the state-sanctioned killing of a person as punishment for actual or supposed misconduct. The sentence ordering that an offender be punished in ...
using compressive asphyxia.


Perinatal asphyxia

Perinatal asphyxia is the medical condition resulting from deprivation of
oxygen Oxygen is a chemical element; it has chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen group (periodic table), group in the periodic table, a highly reactivity (chemistry), reactive nonmetal (chemistry), non ...
( hypoxia) to a newborn infant long enough to cause apparent harm. It results most commonly from a drop in maternal
blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...
or interference during
delivery Delivery may refer to: Biology and medicine *Childbirth *Drug delivery *Gene delivery Business and law *Delivery (commerce), of goods, e.g.: **Pizza delivery ** Milk delivery ** Food delivery ** Online grocer *Deed ("delivery" in contract law), a ...
with blood flow to the infant's
brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
. This can occur as a result of inadequate circulation or
perfusion Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ (anatomy), organ or a tissue (biology), tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion may also refer t ...
, impaired respiratory effort, or inadequate
ventilation Ventilation may refer to: * Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation ** Mechanical ventilation, in medicine, using artificial methods to assist breathing *** Respirator, a ma ...
. There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air. It has been demonstrated that high concentrations of oxygen lead to generation of oxygen
free radicals In chemistry, a radical, also known as a free radical, is an atom, molecule, or ion that has at least one unpaired electron, unpaired valence electron. With some exceptions, these unpaired electrons make radicals highly chemical reaction, chemi ...
, which have a role in reperfusion injury after asphyxia. 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.


Mechanical asphyxia

Classifications of different forms of asphyxia vary among literature, with differences in defining the concept of mechanical asphyxia being the most obvious. In DiMaio and DiMaio's 2001 textbook on forensic pathology, mechanical asphyxia is caused by pressure from outside the body restricting respiration. Similar narrow definitions of mechanical asphyxia have occurred in Azmak's 2006 literature review of asphyxial deaths and Oehmichen and Auer's 2005 book on forensic neuropathology. According to DiMaio and DiMaio, mechanical asphyxia encompasses positional asphyxia, traumatic asphyxia, and "human pile" deaths. In Shkrum and Ramsay's 2007 textbook on forensic pathology, mechanical asphyxia occurs when any mechanical means cause interference with the exchange of oxygen and carbon dioxide in the body. Similar broad definitions of mechanical asphyxia have occurred in Saukko and Knight's 2004 book on asphyxia, and Dolinak and Matshes' 2005 book on forensic pathology. According to Shkrum and Ramsay, mechanical asphyxia encompasses smothering, choking, positional asphyxia, traumatic asphyxia, wedging, strangulation and drowning. Sauvageau and Boghossian propose in 2010 that mechanical asphyxia should be officially defined as caused by "restriction of respiratory movements, either by the position of the body or by external chest compression", thus encompassing only positional asphyxia and traumatic asphyxia.


First aid

If there are symptoms of mechanical asphyxia, it is necessary to call the
Emergency Medical Services Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to d ...
. In some countries, such as the US, there may also be self-acting groups of voluntary first responders who have been trained in first aid. In case of mechanical asphyxia, first aid can be provided on your own.


First aid for choking on food

In case of choking on a foreign body: * Stand behind the affected person and wrap your arms around him/her. * Push inwards and upwards under the ribs with a sudden movement by your second hand. * If the performed actions were not effective, repeat them until you free respiratory tract of the affected person from a foreign body.


See also

* * * *


References


Further reading

* *


External links

*
Cross-side to chest compression choke
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