We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Tracheal injury
From WikEM
Contents
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 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
