Tracheal injury: Difference between revisions
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==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 epinepherine and IV dexamethasone | |||
*Anti-reflux medications (e.g. ranitidine, metoclopramide) | |||
*glycopyrolate to reduce secretions | |||
===''AIRWAY MANAGEMENT''=== | |||
*Awake fiberoptic intubation | |||
*Awake direct laryngoscopy/intubation | |||
*Inhalational induction/intubation (keep patient breathing spontaneously) | |||
*Awake tracheostomy | |||
*Considure itubating through open wound if transected tracea visible | |||
==Disposition== | ==Disposition== | ||
Revision as of 17:16, 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
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Investigate only once airway secure
- Chest x-ray
- CT scan (neck/c-spine, chest), lateral c-spine x ray, ultrasound
- 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
- Awake fiberoptic intubation
- Awake direct laryngoscopy/intubation
- Inhalational induction/intubation (keep patient breathing spontaneously)
- Awake tracheostomy
- Considure itubating through open wound if transected tracea visible