Airway management in a patient with blunt trauma neck: A concern for anesthesiologist (original) (raw)
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Airway Management for Penetrating Neck Trauma: A Case Report
Cureus
Penetrating neck injuries comprise 5-10% of traumatic injuries in adults and can cause immediate lifethreatening compromise. Performing awake fibreoptic intubation in cooperative patients when airway management is not time critical has been suggested as a method of securing these potentially complicated airways. We report a case of a male in his 20s who presented to the emergency service with neck trauma following a bicycle road accident. With the exception of a wound in the neck region, there were no alarming distress signs or symptoms of airway endangerment. Imagiological evaluation revealed a rupture of the right lateral tracheal wall. He was referred for urgent surgery. We performed intubation with video laryngoscopy assisted by a neck surgery team, keeping the patient breathing spontaneously and under deep sedation. After advancing the tube through the vocal cords, the surgeon explored the cervical wound, guiding the tube through the trachea. Keeping spontaneous ventilation and advancing the tracheal tube beyond the lesion under visualization is essential when managing a traumatized airway. Tracheal intubation using video laryngoscopy, assisted by a neck surgeon guiding the tube, and avoiding creation of a false passage can be a safe alternative to fibreoptic intubation in selected cases of tracheal laceration.
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017
Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails. Any delay at any step in the "failed airway" management algorithm may not save the critically ill dying patient. Here, we report a case of blunt trauma following high-velocity road traffic accident, presenting in the peri-arrest...
Extensive tracheal injury in penetrating neck trauma – a case report and management discussion
European Surgery-acta Chirurgica Austriaca, 2010
Zusammenfassung GRUNDLAGEN: Perforationsverletzungen am Hals können große Gefäße, die Trachea mit Intubationsproblemen, den Ösophagus oder das Rückenmark betreffen. METHODIK (FALLBERICHT): Penetrationstrauma am Hals im Rahmen eines Verkehrsunfalles mit ausgeprägter Tracheal-Lazeration mit rechtsseitigem Pneumothorax und respiratorischem Versagen. Die Bronchoskopie zeigte Trachealverletzungen an 2 Stellen. Der Patient wurde mit Doppellumen-Intubation beatmet, die Trachealverletzungen via rechter Thorakotomie und mittlerer Halsinzision versorgt. ERGEBNISSE: Unauffälliger postoperativer
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2003
I In nc ci id de en nc ce e Blunt injury to the lower airway is uncommon, due to anatomic protection by the mandible and sternum anteriorly, the spinal column posteriorly, and the mobility and the elasticity of the upper airway itself. The larynx or cervical trachea is injured in < 1% of patients admitted to the hospital for blunt trauma. 1 Over a ten-year period, Angood and co-workers reported that only 16 patients with laryngeal injury and four patients with cervical tracheal injury were treated at the Montreal General Hospital. 2 Of 46 patients with blunt upper airway injuries reported by Cicala and colleagues, 11 (24%) died and four (36%) of these deaths were primarily due to airway injury. Other authors reported that 21% of patients with blunt airway injuries died in the first two hours after admission. 4 R RE EF FR RE ES SH HE ER R C CO OU UR RS SE E O OU UT TL LI IN NE E R1
Management of Laryngo Tracheal Injury Our Experience
MOJ Clinical & Medical Case Reports, 2016
Laryngotracheal trauma is life-threatening. It is considered to be a rare occurrence but now it is more common due to high speed vehicle accident. Failure to recognize such injuries and promptly secure an airway may have fatal consequences. 1 We are reporting 3 cases of blunt trauma following which they developed absolute dysphagia, difficulty in breathing and difficulty in phonation. These patients were promptly and appropriately managed. Two patients were surgically managed and one patient was conservatively managed. They are on regular follow up and are doing well. Here we highlight a successful management of such rare cases.
A case series of penetrating laryngeal trauma managed without tracheotomy
Charles procedure for tissue destruction after silicone injection
Background: This study is a case series that involves two patients with penetrating laryngeal trauma managed without tracheotomy. Laryngeal trauma is a rare but potentially life-threatening injury. Injuries involving Zone II of the neck are classically managed with a tracheotomy. Our aim is to illustrate that in select cases Zone II laryngeal trauma can be surgically managed conservatively without tracheotomy or stenting. Case Presentation: The two patients presented in this study both had penetrating trauma to the anterior neck in zone 2. While they were not in distress, both had subcutaneous air, loss of laryngeal prominence on exam, and fracture of the thyroid cartilage. In both cases the airway was secured via awake fiberoptic intubation, neck exploration and fracture fixation performed using sutures and microplates via a single incision through an extension of the original traumatic wound. Esophagoscopy was performed at the time of exploration and a brief period of endotracheal intubation was used to manage the airway, avoiding the use of laryngeal stenting. Conclusion: In select cases zone II/Schaefer-Fuhrman group 3 laryngeal trauma can be surgically managed without tracheotomy or stenting, without compromising the basic tenets of airway management and patient safety. The above management led to a shorter hospital stay than advocated for in the literature and improved cosmetic outcome without any adverse voice or swallowing outcomes.
Airway management of an open penetrating neck injury
CJEM, 2015
Although penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. It is not known if RSI is safe in such patients, nor has there been reported use of videolaryngoscopy in patients with open PNI. Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such gui...
Pathophysiology and management of Airway Trauma
Trends in Anaesthesia and Critical Care, 2013
Trauma to the larynx and tracheo-bronchial tree can result from blunt or penetrating injury and is associated with a high mortality despite improvement in emergency services. Prompt diagnosis of impending respiratory failure and securing the airway without causing further damage remains the first priority in patients with laryngotracheal injury. The technique used for securing the airway should be tailored according to the state of the patient, site of injury and available facilities. In addition to discussing the ideal airway management techniques that should be used in these patients, the paper provides an overview of the common airway management techniques that have previously been used and are reported in literature.
Anaesthesia
Numeurous studies have pointed out that the timely airway securing is essential for the survival of polytraumatised patients. However, sometimes intubation is hard to perform due to the presence of a direct airway trauma. Direct airway trauma includes: maxillofacial trauma, mandibular trauma, laryngotracheal injuries, injuries of the distal airway, penetrating neck injuries and damage of the soft structures and bleeding. Depending on the injury type different intubation techniques can be used. The most usual intubation technique is direct laryngoscopy or blinded intubation. Intubation with the help of fiberoptic flexible bronchoscope gave the best results, but in the case of the impossible intubation techniques like urgent cricothyrotomy and tracheotomy can be used.