Tracheal injury: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0865 TracheaAnatomy.png|thumb|Tracheal anatomy.]] | |||
*Usually occurs at junction of trachea and cricoid cartilage | *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== | ==Clinical Features== | ||
*Subcutaneous emphysema | *[[Respiratory distress]] | ||
*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]] | |||
*Subcutaneous emphysema | |||
*Cervical ecchymosis | |||
*[[Hemoptysis]] | |||
*Tracheal deviation or abnormal laryngeal contour | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
== | ==Evaluation== | ||
''Investigate only once airway secure'' | |||
*Plain films, CT | |||
**Air in soft tissues | |||
**[[Pneumomediastinum]], [[pneumothorax]] | |||
**[[cervical spine fractures and dislocations|Cervical spine fractures]] | |||
**Hematomas, cartilage fractures | |||
**Evaluate for other injuries | |||
==Management== | ==Management== | ||
===While preparing to secure airway=== | |||
*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia) | |||
*Keep patient breathing spontaneously for as long as possible | |||
*High-flow [[O2]] | |||
*May by time with nebulized [[epinephrine]] and IV [[dexamethasone]] | |||
*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]]) | |||
*[[Glycopyrrolate]] to reduce secretions | |||
===''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== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
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[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Pulmonary]] |
Latest revision as of 13:48, 10 April 2021
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
- Respiratory distress
- Hoarseness, dysphonia, cough, stridor, dysphagia
- Subcutaneous emphysema
- Cervical ecchymosis
- Hemoptysis
- Tracheal deviation or abnormal laryngeal contour
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Investigate only once airway secure
- Plain films, CT
- Air in soft tissues
- Pneumomediastinum, pneumothorax
- Cervical spine fractures
- Hematomas, cartilage fractures
- Evaluate for other injuries
Management
While preparing to secure airway
- Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
- Keep patient breathing spontaneously for as long as possible
- High-flow O2
- May by time with nebulized epinephrine and IV dexamethasone
- Anti-reflux medications (e.g. ranitidine, metoclopramide)
- Glycopyrrolate to reduce secretions
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