Difference between revisions of "Tracheal injury"

(Management)
Line 21: Line 21:
 
==Evaluation==
 
==Evaluation==
 
''Investigate only once airway secure''
 
''Investigate only once airway secure''
*Chest x-ray
+
*Plain films, CT
*CT scan (neck/c-spine, chest), lateral c-spine x ray, ultrasound
+
**Air in soft tissues
*Evaluate for other injuries
+
**Pneumomediastinum, pneumothorax
 +
**Cervical spine fractures
 +
**Hematomas, cartilage fractures
 +
**Evaluate for other injuries
  
 
==Management==
 
==Management==
==While preparing to secure airway:
+
===While preparing to secure airway===
 
*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
Line 32: Line 35:
 
*May by time with nebulized epinepherine and IV dexamethasone
 
*May by time with nebulized epinepherine and IV dexamethasone
 
*Anti-reflux medications (e.g. ranitidine, metoclopramide)
 
*Anti-reflux medications (e.g. ranitidine, metoclopramide)
*glycopyrolate to reduce secretions
+
*Glycopyrolate to reduce secretions
  
 
===''AIRWAY MANAGEMENT''===
 
===''AIRWAY MANAGEMENT''===
 +
''Avoid cricoid pressure!''
 
*Awake fiberoptic intubation
 
*Awake fiberoptic intubation
 
*Awake direct laryngoscopy/intubation
 
*Awake direct laryngoscopy/intubation
 
*Inhalational induction/intubation (keep patient breathing spontaneously)
 
*Inhalational induction/intubation (keep patient breathing spontaneously)
 
*Awake tracheostomy
 
*Awake tracheostomy
*Considure itubating through open wound if transected tracea visible
+
*Considure intubating through open wound if transected trachea visible
  
 
==Disposition==
 
==Disposition==
 
+
*Admit
 
==See Also==
 
==See Also==
 
*[[Thoracic Trauma]]
 
*[[Thoracic Trauma]]

Revision as of 17:20, 5 September 2016

Background

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

Clinical Features

  • Respiratory distress
  • Hoarseness, dysphonia, cough, stridor, dysphagia
  • Subcutaneous emphysema
  • Cervical ecchymosis
  • Hemoptysis
  • Tracheal deviation or abnormal laryngeal contour

Differential Diagnosis

Thoracic Trauma

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 epinepherine and IV dexamethasone
  • Anti-reflux medications (e.g. ranitidine, metoclopramide)
  • Glycopyrolate to reduce secretions

AIRWAY MANAGEMENT

Avoid cricoid pressure!

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

Disposition

  • Admit

See Also

External Links

References