Difference between revisions of "Tracheal injury"

(AIRWAY MANAGEMENT)
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==Clinical Features==
 
==Clinical Features==
*Respiratory distress
+
*[[Respiratory distress[[
*Hoarseness, dysphonia, cough, stridor, dysphagia
+
*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]]
 
*Subcutaneous emphysema
 
*Subcutaneous emphysema
 
*Cervical ecchymosis
 
*Cervical ecchymosis
*Hemoptysis
+
*[[Hemoptysis]]
 
*Tracheal deviation or abnormal laryngeal contour
 
*Tracheal deviation or abnormal laryngeal contour
  
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*Plain films, CT
 
*Plain films, CT
 
**Air in soft tissues
 
**Air in soft tissues
**Pneumomediastinum, pneumothorax
+
**[[Pneumomediastinum]], [[pneumothorax]]
**Cervical spine fractures
+
**[[cervical spine fractures and dislocations|Cervical spine fractures]]
 
**Hematomas, cartilage fractures
 
**Hematomas, cartilage fractures
 
**Evaluate for other injuries
 
**Evaluate for other injuries
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*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
 
*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
 
*Keep patient breathing spontaneously for as long as possible
 
*Keep patient breathing spontaneously for as long as possible
*High-flow O2
+
*High-flow [[O2]]
*May by time with nebulized [[epinepherine]] and IV [[dexamethasone]]
+
*May by time with nebulized [[epinephrine]] and IV [[dexamethasone]]
 
*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])
 
*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])
*[[Glycopyrolate]] to reduce secretions
+
*[[Glycopyrrolate]] to reduce secretions
  
 
===''AIRWAY MANAGEMENT''===
 
===''AIRWAY MANAGEMENT''===
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*Inhalational induction/intubation (keep patient breathing spontaneously)
 
*Inhalational induction/intubation (keep patient breathing spontaneously)
 
*Awake tracheostomy
 
*Awake tracheostomy
*Considure intubating through open wound if transected trachea visible
+
*Consider intubating through open wound if transected trachea visible
  
 
==Disposition==
 
==Disposition==
 
*Admit
 
*Admit
 +
 
==See Also==
 
==See Also==
 
*[[Thoracic Trauma]]
 
*[[Thoracic Trauma]]

Revision as of 19:53, 13 October 2019

Background

  • Usually occurs at junction of trachea and cricoid cartilage
  • direct trauma to airway is rare due to protection by sternum and mandible
  • Associated with cervical spine injury, head injury, multisystem trauma

Common causes

  • Motor vehicle accident: extended neck impacts on steering wheel or dashboard
  • "clothes line injury", assaults/strangulation
  • Penetrating trauma (usually stabbings or gunshot wounds)

Clinical Features

Differential Diagnosis

Thoracic Trauma

Evaluation

Investigate only once airway secure

Management

While preparing to secure airway

AIRWAY MANAGEMENT

Avoid cricoid pressure!

  • Awake fiberoptic intubation
  • Awake direct laryngoscopy/intubation
  • Inhalational induction/intubation (keep patient breathing spontaneously)
  • Awake tracheostomy
  • Consider intubating through open wound if transected trachea visible

Disposition

  • Admit

See Also

External Links

References