Tracheal injury

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

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

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

See Also

External Links

References