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
*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
*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==
*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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==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 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==

Latest revision as of 13:48, 10 April 2021

Background

Tracheal anatomy.
  • 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