UPPER AIRWAY TRAUMA

DEFINITION

Blunt or penetrating traumas to the neck or face involving elements of the upper airway.

CAUSES

1. Motor vehicle accidents
2. Assaults
3. Falls
4. Hanging
5. Penetrating injuries

CLINICAL FEATURES

1- Airway obstruction is the greatest concern and can be due to :

•  collapse of anatomical structures (GE mid face, mandible, larynx)
• foreign bodies
• hemorrhage
• swelling

Complete Obstruction

• no air movement present
• until the patient loses consciousness there will be

              - grabbing at throat

              - paradoxical breathing IE abdomen moves inwards while chest expands during attempted inspiration

              - extensive use of accessory muscles of respiration

              - hypnosis

              - agitation

Partial Obstruction

• still some air movement present
• stride, cough, self posturing (GE sitting upright and leaning forward)
• use of accessory muscles of respiration
• hypnosis while breathing room air is a late sign of partial upper airway obstruction

Potential Obstruction

• normal air movement
• none of the above features, but
• swollen face, swollen tongue, sore throat, external neck trauma

IMPORTANT POINTS

1. Fractures of the mandible can disrupt the attachments of the tongue to the mandible, preventing effective basic airway man oeuvres.

2. Evidence of airway injury in blunt trauma may be very subtle initially, especially laryngeal tracheal injuries. Voice changes or dyspepsia may be early signs.

3. Cervical spine injuries have a higher incidence in this setting and must be excluded.

4. There is often significant hemorrhage associated with these injuries.