Difference between revisions of "Tracheal injury"

(While preparing to secure airway)
Line 34: Line 34:
*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 [[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

Revision as of 10:24, 8 September 2016


  • 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


Investigate only once airway secure

  • Plain films, CT
    • Air in soft tissues
    • Pneumomediastinum, pneumothorax
    • Cervical spine fractures
    • Hematomas, cartilage fractures
    • Evaluate for other injuries


While preparing to secure airway


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


  • Admit

See Also

External Links