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Airway Injury
Priority, as usual, is to assessing and securing a
potentially obstructed airway. Injury to the larynx
and trachea is fairly uncommon in stab wounds to the
neck, though they are at significant risk in gunshot
wounds that traverse the midline.
Immediate airway compromise is suggested by respiratory
distress and stridor, with abnormal see-saw motion of
the chest wall and abdomen as the patient tries to generate
a negative intra-thoracic pressure against the obstruction.
Complete obstruction will require an immediate surgical
cricothyroidotomy, or tracheostomy if the cricoid area
is involved in the injury site.
Injuries to the trachea may present with hoarseness
and dysphonia, haemoptysis and subcutaneous emphysema.
Laryngeal injuries may have associated crepitus following
fracture/dislocation of the laryngeal cartilages. The
only indication of an airway injury may be subcutaneous
emphysema on the lateral neck radiograph.
The original, apparently benign, nature of an airway
injury may lead to subsequent complete obstruction with
progression of oedema and haemorrhage. Patients must
be monitored closely in a critical care environment.
Early or even prophylactic intubation of the trachea
may be employed, especially if the patient is to be
moved to less safe environments, such as the angiography
suite. Unnecessary interventions which may precipitate
airway compromise, such as placement of a nasogastric
trube should also be avoided until the airway has been
secured.
Diagnosis is confirmed by direct or flexible largyngoscopy
and tracheoscopy. Again, these manoeuvers may lead to
complete airway obstruction and should be performed
in the appropriate environment, with personnel and equipment
capable of performing an emergent intubation or a surgical
airway as necessary.
References
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