Airway trauma (Sources: OH's)

Question 1

What mechanisms result in airway trauma?

Answer 1

Blunt:
1. MVA where an extended neck hits the steering wheel or dashboard
2. ‘Clothes-line’ injury whereby e.g. a cyclist collides with a cable or wire
3. Assaults and strangulations
Penetrating:
1. Stab or gunshot

Question 2

Which injuries are commonly associated with airway injuries?

Answer 2

Thoracic spine, closed head injury, vascular injuries and maxillofacial injuries

Question 3

What are the clinical features of laryngotracheal injury?

Answer 3

Respiratory distress
Stridor
Noisy breathing
Neck tenderness
Hoarseness
Dysphonia
Cough
Dysphagia
Sub cut emphysema
Cervical ecchymosis
Haemopytsis
Abnormal laryngeal contour

Question 4

How should you manage the airway of a patient with airway injury?

Answer 4

The safest method is an awake tracheotomy
Cricothyroidotomy is not recommended as it may completely transect the airway - resulting of recoil of the airway in the chest
Cricoid pressure can result in the same - avoid
Blind intubation should be avoided as it can result in false passages
Maintain self-ventilation until after a tube has been passed beyond the injury
In an emergency gaping airway wounds (with tracheal transection) can be intubated under direct vision