Hong Kong Journal of Emergency Medicine Traumatic asphyxia: a rare clinical syndrome 創傷性窒息：一個罕見的臨床綜合徵 M Kartal, E Goksu, O Yigit, AG Aydin Traumatic asphyxia is a rare clinical syndrome characterised by cyanosis, oedema and petechial haemorrhage of the face, neck and upper chest due to the sudden, transient and severe thoraco-abdominal compression trauma. The huge increase in intra-thoracic pressure caused by the compression constitutes all the symptoms. Although mortality and morbidity due to traumatic asphyxia can happen, most of the patients survive without any sequel. Herein, we report three cases of traumatic asphyxia assessed in our emergency department. (Hong Kong j.emerg.med. 2014;21:185-188) 創傷性窒息是由突然、短暫和嚴重的胸腹擠壓傷引起的罕見臨床綜合徵，特點是面、頸及上胸部的發 紺、水腫和點狀出血。擠壓造成胸內壓力大幅增加導致所有的症狀。雖然創傷性窒息可能造成傷亡，多 數病人生存，並且沒有任何後遺症。我們在此報告在我們急診室診治的三例創傷性窒息。 Keywords: Cyanosis, retrobulbar hemorrhage, purpura, thoracic injuries 關鍵詞：紫紺、眼球後出血、紫癜、胸創傷 Correspondence to: Mutlu Kartal, MD Akdeniz University School of Medicine, Department of Emergency Medicine, 07059 Antalya, Turkey Email: mkartal@akdeniz.edu.tr Erkan Goksu, MD Ozlem Yigit, MD Alp Giray Aydin, MD Introduction Traumatic asphyxia is a rare clinical syndrome. Although the exact mechanism is controversial, traumatic asphyxia patients presented to the emergency department after sudden, high energised thoracoabdominal compression trauma. 1-3 Cutaneous petechial haemorrhage of the face, neck and upper chest occurred due to the compression. Additionally, cervicofacial subcutaneous oedema, cyanosis and blue discolouration of face and neck can be seen depending on the contributing effect of 'fear response' including deep aspiration and closure of the glottis. The huge increase in central venous pressure caused by the compression of the chest transmitted to the head and neck capillaries. The pressure to the eye, and hence subconjunctival haemorrhages and bulbar injuries are almost always due to the relative lack of tissue support around this area. 1,4 Although most of the cases survive with good prognosis, some patients died or were left with a morbidity in spite of the clinical treatment modalities. Herein, we report three cases of traumatic asphyxia assessed in our emergency department. Case 1 A 30-year-old automobile mechanic presented to the emergency department after his chest was being crushed under an automobile while running repairs. He was fully conscious and cooperative on admission. Petechial and purpuric haemorrhages were seen at his upper chest and neck. His right shoulder was deformed and his face was found intensively oedematous and cyanotic (Figure 1). Despite the lack of a direct blow