Blunt trauma to the upper airway is a potentially fatal injury. It is often difficult to diagnose and frequently presents to anaesthetists as an airway emergency. The management of the injury requires careful choice of anaesthetic technique. This choice will be influenced by the expertise of the surgeon and anaesthetist involved and the results of preoperative investigations such as X-rays, CT scans and indirect laryngoscopy. Three cases are presented for discussion, each different in mechanism, site of injury and anaesthetic management. CASE 1 An eighteen-year-old female was brought to the casualty room following a motorcycle accident in which she was thrown onto the road, striking her neck on the kerbside. There was no loss of consciousness. On arrival, she was alert but dyspnoeic. She could speak only in a whisper and loud inspiratory stridor, mild tachypnoea and a tracheal tug were present. There was marked tenderness over the thyroid cartilage and subcutaneous air was palpable bilaterally in the neck. Her blood pressure was normal and chest auscultation was unremarkable. A fractured right tibia and large laceration over the left knee were noted. Bruising and tissue crepitus over the right infra-orbital region suggested facial fractures. Arterial blood gas measurements on room air revealed a P a02 of 66 mmHg and P aco2 of 34
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