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AIRWAY TRAUMA

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AIRWAY TRAUMA & ITS EMERGENCY MANAGEMENT MODERATOR : PROF. RAJESHWARI PRESENTORS : DR. CHITRA DR. GURURAJ www.anaesthesia.co.in anaesthesia.co.in_at_gmail.com – PowerPoint PPT presentation

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Title: AIRWAY TRAUMA


1
AIRWAY TRAUMA ITS EMERGENCY MANAGEMENT
  • MODERATOR PROF. RAJESHWARI
  • PRESENTORS DR. CHITRA
  • DR. GURURAJ

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om
2
TOPICS
  • Airway anatomy
  • Definition
  • Incidence
  • Classification
  • Mechanisms
  • Airway injuries
  • Associated injuries
  • Concerns

3
ANATOMY
4
ANATOMICAL CONSIDERATIONS
  • Every major vital structure is represented
  • Platysma is the anatomical landmark that
    determines whether penetrating neck trauma is
    superficial or deep
  • Attachment of larynx to trachea is by the
    cricotracheal ligament
  • Cricotracheal ligament is quite weak is the
    most likely point of airway separation

5
PEDIATRIC AIRWAY
  • Cricoid shielded by mandible
  • Cartilage pliable
  • More susceptible to edema hematoma

6
DEFINITION
  • An injury that directly involves the airway in
    any location from nasopharynx to bronchioles
  • Such trauma may involve actual damage to the
    airway or injure bony or vascular structure that
    distorts airway anatomy

7
INCIDENCE
  • Laryngotracheal injuries occur in 0.03 2.8
  • 70 80 patients who sustain airway injuries
    die before reaching medical care
  • Of those patients who do survive to reach
    tertiary care 21 die during the first two hours
    of admission
  • Cervical spine injury occurs in 4 of all trauma
    patients

8
CLASSIFICATION
  • According to site of injury
  • Supraglottic
  • Transglottic
  • Cricoid
  • Tracheal

9
CONTD
  • According to the mechanism of injury
  • Blunt trauma
  • Penetrating trauma
  • Superficial
  • deep

10
CONTD
  • According to severity
  • Group 1 minor endolaryngeal hematoma , edema ,
    laceration without detectable fracture
  • Group 2 edema , hematoma , minor mucosal
    disruption without exposed cartilage non
    displaced fracture on CT
  • Group 3 massive edema , mucosal disruption ,
    displaced fracture , exposed cartilage , cord
    immobility

11
CONTD
  • Group 4 group 3 two or more fracture lines ,
    skeletal instability or significant anterior
    commissure trauma
  • Group 5 complete laryngotracheal separation
  • Group 1 , 2 mild
  • Group 3 moderate
  • Group 4 , 5 severe

12
CONTD
  • According to areas
  • Zone 1 cephalad border of clavicle to cricoid
    cartilage
  • Zone 2 cricoid cartilage to angle of mandible
  • Zone 3 angle of mandible to base of skull

13
(No Transcript)
14
MECHANISM OF BLUNT TRAUMA
  • Motor vehicle accidents , clothesline injury ,
    strangulation injuries
  • Frontal impact MVA ? victims head is forced
    back , neck is hyperextended the exposed larynx
    hits the edge of the dashboard is crushed
    against the cervical spine
  • Strangulation injuries manual compression or
    hanging

15
INJURIES
  • Tearing of thyroarytenoid ligaments
  • Separation of false VC from true VC
  • Edema of arytenoids
  • Displacement of arytenoids
  • Fracture of thyroid cartilage
  • Separation of epiglottis from larynx

16
CONTD.
  • Cricoid injury
  • Recurrent laryngeal nerve injury
  • Laryngotracheal disruption
  • Tear of trachea or bronchi
  • Concurrent cervical spine injuries , oesophageal
    injuries , pneumothorax , blunt thoracic trauma

17
MORTALITY RATES
  • Thyroid cartilage injuries 11
  • Tracheal injuries 25
  • Cricoid injuries 43
  • Intrathoracic tracheal injuries or bronchial
    injuries higher mortality rates

18
PENETRATING NECK TRAUMA
  • Zone 1 3 7
  • At risk structures
  • Subclavian vessels , brachiocephalic veins ,
    common carotid arteries , jugular veins , aortic
    arch
  • Trachea
  • Oesophagus
  • Apices of lung

19
CONTD
  • Cervical spine
  • Cervical nerve roots
  • Spinal cord

20
ZONE 2 INJURIES
  • 82
  • At risk structures
  • Carotid artery , vertebral artery , jugular vein
  • Pharynx
  • Larynx
  • Trachea
  • Oesophagus
  • Cervical spine

21
CONTD.
  • One third patients with zone 2 injuries require
    emergency airway management
  • Airway compromise occurs due to
  • Laryngeal injury
  • Hematoma
  • Subcutaneous emphysema

22
ZONE 3 INJURIES
  • 15
  • At risk structures
  • Salivary glands
  • Oesophagus
  • Trachea
  • Cervical spine
  • Carotid artery , jugular vein , 9 12 cranial
    nerves

23
ASSOCIATED INJURIES
  • Vascular injuries 25 40
  • Injury to pharnyx , oesophagus 5 15
  • Mortality
  • 20 in penetrating trauma
  • 40 in blunt trauma

24
THERMAL INJURY
  • Facial perioral swelling ? pharyngeal
    obstruction
  • Thermal injury to upper airway ? laryngeal
    obstruction
  • Chemical injury to lung ? impaired gas exchange

25


  • Suspect oropharyngeal airway obstruction
    whenever full thickness facial anterior
    cervical burns are present
  • Suspect laryngeal thermal injury when
    carbonaceous material is present in the mouth ,
    nares or pharynx

26
LOWER AIRWAY BURNS
  • Unusual because of heat absorptive properties of
    upper airway
  • Due to steam inhalation , chemical burns ,
    inhalation of burning gases
  • Maximal airway edema may be delayed for upto 24
    hours

27
CERVICAL SPINE INJURIES
  • Occur in
  • 2 8 of blunt trauma victims
  • 4.5 of motor vehicle accidents
  • 5 15 of head injury patients
  • 4 5 of high velocity type of facial fractures

28
CONTD
  • Diagnosis delayed or missed in 25 of patients
  • No neurological deficits on arrival in 5 10
    of patients with cervical spine injury
  • Lateral view cervical spine films 30 missed
  • AP , lateral , transoral odontoid ? detects 99

29
TRANSPORT
  • Cervical collar , spine board , sandbags to
    stabilise cervical spine
  • During intubation , anterior portion of cervical
    collar should be removed
  • Apply cricoid pressure manual in line
    stabilization intubate orally

30
ASSOCIATED FACTORS
  • Aspiration risk
  • Intraocular injury
  • Intracranial injury
  • Thoracic trauma

31
ASPIRATION
  • Aspiration risk due to
  • Ingested foods immediately before trauma
  • Altered level of consciousness
  • Cranial nerve injury attenuation of gag reflex
  • Injury , pain , anxiety ? delay gastric emptying
  • Gastric dilatation
  • Blood aspiration

32
PREVENTION
  • Metoclopramide
  • H 2 blockers
  • Sodium citrate
  • NG tube aspiration
  • Cricoid pressure
  • Secure airway

33
INTRACRANIAL INTRAOCULAR INJURIES
  • Direct trauma to the brain
  • Secondary brain injury hypoxia, hypotension
  • Injury to the globe

34
THORACIC TRAUMA
  • Blunt thoracic trauma - higher mortality than
    penetrating thoracic trauma
  • Rib fracture
  • Flail segments
  • Chest wall contusion
  • Pulmonary contusion

35
CONTD
  • Hemothorax
  • Pnemothorax
  • Pneumomediastinum
  • Interstitial emphysema
  • Bronchial tear
  • Intrapulmonary bleed
  • Air emboli

36
POINTS TO REMEMBER
  • Larngotracheal trauma is a rare but potentially
    lethal injury
  • Patients may appear deceptively normal for
    several hours after injury
  • ER physicians , general surgeons , thoracic
    surgeons , anesthesiologists otolaryngologists
    should be well versed in the manifestations
    management of airway injuries

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.com
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