Emergency Airway Management in Neck Trauma

Abstract

Airway management in patients who have sustained direct trauma to the airway is among the most challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway obstruction. Immediate, definitive airway management is needed when the patient cannot protect his airway or is unable to sufficiently oxygenate or ventilate. Emergent or urgent airway management is specified when a patient develops respiratory distress or when symptoms are progressing rapidly. In addition, airway management often is indicated when the patient appears clinically stable, but the clinician anticipates clinical decline (e.g., smoke inhalation, edema, subcutaneous air, hematoma) or feels that an unprotected airway presents a risk to the patient who requires transport to another facility or to radiology for extensive diagnostic studies. The higher rate of complicated airways in this population mandates that the clinician has to be prepared to use advanced airway techniques, including a surgical airway.

Damage Control of Laryngotracheal Trauma: The Golden Day

“…Other symptoms such as dysphonia, neck pain, and hemoptysis have been described. Physical examination edema, crushing of the thyroid cartilage bulge, abnormal palpation of the laryngeal outline, crepitation, subcutaneous emphysema, blowing wound, or decreased respiratory rate can be observed 1,17,18 .…”