Tracheal injury

Revision as of 17:16, 5 September 2016 by ClaireLewis (talk | contribs) (Management)

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

  • 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

Disposition

See Also

External Links

References