A Car Crash Complicating Influenza – Mayo Clinic Proceedings hypoxia anoxia

A healthy 45-year-old man had acute onset of fever, chills, myalgias, and a nonproductive cough. The cough was severe and prolonged at times, with 1 paroxysm producing severe light-headedness followed by a brief loss of consciousness. On the second day of the illness, the patient experienced a severe coughing paroxysm while driving home from work. He felt extremely light-headed and nauseous and abruptly lost consciousness; his car crossed 4 lanes of traffic and hit a hillside. The patient was admitted to the hospital with several non–life-threatening orthopedic injuries. He was febrile and complained of nonproductive cough and myalgias.


Physical examination revealed an obese man with scattered wheezes and trauma-induced ecchymoses.Hypoxia anoxia A direct fluorescent antibody test performed on a nasopharyngeal swab specimen was positive for influenza A virus; chest radiography revealed no infiltrate. The patient was treated supportively and was discharged from the hospital without incident. He was counseled to avoid driving during subsequent respiratory infections associated with coughing.

Cough syncope, first described by charcot in 1876, classically occurs in moderately obese, middle-aged men, similar to the patient described in this report. 1 x 1 aaronson, DW, rovner, RN, and patterson, R. Cough syncope: case presentation and review. J allergy. 1970;

46: 359–363

Abstract | full text PDF | pubmed | scopus (14) see all references in fact, in 1 series, 97% of 270 cases of cough syncope occurred in males, 2 x 2 kerr, A jr and derbes, VJ.Hypoxia anoxia the syndrome of cough syncope. Ann intern med. 1953;

39: 1240–1253

Crossref | pubmed see all references and these patients are often described as “hearty, robust, and large chested.” 1 x 1 aaronson, DW, rovner, RN, and patterson, R. Cough syncope: case presentation and review. J allergy. 1970;

46: 359–363

Abstract | full text PDF | pubmed | scopus (14) see all references why obesity and male sex predispose to cough syncope is unclear, but redundant oropharyngeal tissue could result in transient airway obstruction and subsequent hypoxia during vigorous coughing. In addition, during a coughing paroxysm, intrathoracic pressure increases and obstructs venous outflow, culminating in an acute decline in cardiac output, blood pressure, and cerebral perfusion that leads to loss of consciousness. 1 x 1 aaronson, DW, rovner, RN, and patterson, R.Hypoxia anoxia cough syncope: case presentation and review. J allergy. 1970;

46: 359–363

Abstract | full text PDF | pubmed | scopus (14) see all references another proposed mechanism of cough syncope is decreased cerebral blood flow as a consequence of elevated cerebrospinal fluid pressure from acute increases in cerebrovascular resistance. 3 x 3 boudoulas, H, nelson, SD, schaal, SF, and lewis, RP. Diagnosis and management of syncope. In: RW alexander, RC schlant, V fuster,

(eds.)

Hurst’s the heart. 9th ed. McGraw-hill,

New york, NY; 1998: 1059–1080

See all references in addition, reflexinduced bradycardia or heart block may occur in some patients. Rarely, coughing may precipitate syncope in the presence of a hypersensitive carotid sinus. 4 x 4 marinella, MA.Hypoxia anoxia in: frequently overlooked diagnoses in acute care. Hanley belfus,

Philadelphia, pa; 2003: 39–42

See all references because syncope that occurs during driving may lead to devastating consequences, physicians should counsel patients (especially overweight males) with influenza or other respiratory illnesses to avoid driving or to pull off the road if they experience uncontrollable coughing.