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 | *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'' | ||
* | *Plain films, CT | ||
* | **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 | ===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 | ||
*High-flow O2 | *High-flow [[O2]] | ||
*May by time with nebulized | *May by time with nebulized [[epinephrine]] and IV [[dexamethasone]] | ||
*Anti-reflux medications (e.g. ranitidine, metoclopramide) | *Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]]) | ||
* | *[[Glycopyrrolate]] 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 | ||
* | *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
- 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