Citation

Martin A, Miller JB, Walsh M, Prahlow JA. Inj. Extra 2011; 42(1): 1-3.

Copyright

(Copyright © 2011, Elsevier Publishing)

DOI

16/j.injury.2010.09.001

PMID

unavailable

Abstract

Positional asphyxia occurs when a person is trapped in a position that does not allow for adequate ventilation. In many situations, including the case presented, this type of asphyxia is caused by a seatbelt holding a victim in a head-down position when their car is inverted. Due to strict protocols for routine spinal immobilization in blunt trauma patients, as well as the fact that major vehicular damage frequently accompanies rollover incidents, extrication of victims trapped in an inverted position is often significantly delayed. A previous study comparing routine out-of-hospital spinal immobilization in situations where spinal immobilization is not routinely performed on trauma victims suggests a slightly lower rate of neurologic impairment in patients without spinal immobilization. Given the precarious situation when a patient is trapped in an inverted and life-threatening position, we suggest that it may be more important to quickly remove the victim from the life-threatening position than to spend valuable time attending to spinal immobilization techniques. Depending on the circumstances, it may even be advisable to carefully attempt to turn the vehicle back over with the entrapped patient still inside. We present a case of death due to positional asphyxia in a rollover vehicular incident in which there was absence of lethal anatomically demonstrable traumatic injuries at autopsy. In retrospect, it is probable that the victim would have survived had he been immediately extricated or had the involved vehicle been carefully rolled upright so that the victim was no longer in an inverted position.