0071643192.pdf

EXAM

■ Dysphonia

■ Stridor

■ Tenderness

■ SQ emphysema

■ Loss of anatomic landmarks

DIAGNOSIS

■ CXR, PA and lateral soft-tissue neck films, and C-spine films, or CT of neck

■ Look for SQ emphysema, narrowing of subglottic airway, and hyoid bone

fractures.

■ Follow up suspected injuries with laryngoscopy and bronchoscopy.

TREATMENT

■ Early intubation versus tracheostomy, ideally in the operating room by the

most experienced personnel, being careful to prevent creation of a false lumen

■ Cricothyroidotomy may worsen the injury.

Pharyngoesophageal Injuries

SYMPTOMS/EXAM

Often asymptomatic initially, but may lead to life-threatening mediastinal infec-

tions. May also see:

■ Hematemesis

■ Odynophagia

■ SQ emphysema

■ Blood in saliva or nasogastric tube

DIAGNOSIS

■ Plain film CXR and neck films may show pneumomediastinum or retro-

pharyngeal air.

■ Sensitivity of endoscopy or esophagography alone are poor; these tests

together have improved sensitivity.

TREATMENT

■ Broad spectrum ABX with anaerobic coverage

■ NPO: Do not place NGT blindly.

■ Surgical repair is required for full-thickness injuries.

Vascular Injuries

Vessels may develop pseudoaneurysm and dissection with secondary thrombosis

leading to occlusion or emboli via the following mechanisms:

■ Hyperextension: Artery compressed against C-spine

■ Hyperflexion: Artery compressed between C-spine and mandible

■ Direct impact: Including seatbelt across lateral neck

■ Intraoral trauma

■ Basilar skull fractures damaging intracranial portion

SYMPTOMS/EXAM

■ Pulsatile hematoma

■ Bruits

TRAUMA

Intubation of patients with

laryngotracheal injuries may

create a “false lumen” and

loss of airway.

Esophageal injuries are rare

but are the most commonly

missed injuries of the neck.