Diaphragm in Winding Injuries

· Being winded involves a blow to the epigastrium or chest. It typically induces an involuntary forced expiration followed by a brief (but terrifying) involuntary apnea but sometimes syncope and respiratory arrest (Damar Hamlin injury). Please note that although commotio cordis has been concluded by just about everybody, traumatic diaphragm spasm offers an alternative explanation.

· Like the tympanic membrane of the ear, the diaphragm serves as a hermetic seal between two anatomic compartments under different air pressures (chest and abdominal cavities) (Figs. 1 and 2).

· A pressure increase in one cavity causes a decrease in the other, and vice-versa, with the diaphragm buffering between extremes.

· The tympanic membrane can tear from extreme air pressure changes, like SCUBA diving barotrauma. Similarly, the diaphragm can rupture from significant internal air pressure changes caused by high velocity impacts to the abdomen or chest, typically, motor vehicle collisions and falls from significant heights.

· Being “winded” (celiac or solar plexus syndrome) occurs by a relatively low velocity blunt (non-penetrating) blow to the upper abdomen (epigastrium) or chest where, instead of the widely held notion of excessive celiac plexus nerve stimulation causing symptoms, diaphragm excitation itself occurs (automaticity). For example, from bodily collisions, a punch or kick to the epigastrium (or blow by a hockey stick or baseball bat) or perhaps a slip and fall onto the back. Anyone who has experienced this has probably learned to protect themselves from the extreme discomfort, by flexing their abdominal muscles in anticipation of a strike (to absorb some of the force).

· The kinetic force of low velocity blunt abdominal/chest trauma is transmitted to the diaphragm, triggering neuromuscular excitation in the form of brief spasms (“traumatic DS”, t-DS) or prolonged cramp (“traumatic DCC”, t-DCC). The latter occurs in higher energy impacts. Apnea occurs and its duration dictates symptoms and survivability based on the degree of subsequent hypoxemia and potential for cardiac arrest. Syncope and collapse may precede cardiac arrest. If death occurs, it would be ruled a “traumatic cardiac arrest”, potentially missing the respiratory etiology.

· The concern in t-DS not the pain or even the involuntary forced expiration, but rather the apnea that persists for an uncomfortable few seconds thereafter. Unfortunately, although t-DS has been reported in the literature to be the mechanism, supporting evidence was not provided

So, does anybody know how "celiac/solar plexus syndrome" got its name here? There's nothing I could find online. Do you agree it might be incorrect? Also, do you agree it's concerning that some deaths could incorrectly be ruled "traumatic cardiac arrest" when the true cause was respiratory arrest?