Tracheal injury: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 21: | Line 21: | ||
==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 | |||
**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 | ||
| Line 32: | Line 35: | ||
*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 | ||
===''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 | ||
*Considure | *Considure intubating through open wound if transected trachea visible | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Thoracic Trauma]] | *[[Thoracic Trauma]] | ||
Revision as of 17:20, 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
- 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 epinepherine and IV dexamethasone
- Anti-reflux medications (e.g. ranitidine, metoclopramide)
- Glycopyrolate to reduce secretions
AIRWAY MANAGEMENT
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
Disposition
- Admit