Pediatric emergency medicine trisk 3564 3564
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scenario, intubation should only be attempted if the airway is completely
obstructed. Attempts at intubation from above may separate a tenuously attached
trachea and larynx, resulting in a total loss of the airway, with the trachea
commonly retracting substernally into the chest ( Fig. 112.7 ). Attempts at
cricothyrotomy in patients with direct laryngeal trauma may result in retrotracheal
placement of the airway. Cricothyrotomy may be helpful in patients who have
severe facial or other neck injuries that preclude intubation from above. Intubation
may be attempted through an open laryngeal wound if present, although, if
possible, a tracheostomy should not be performed through injured tissue. The
flexible fiberoptic bronchoscope may be helpful in evaluating the patency of the
airway and establishing the artificial airway. If patient condition allows, rigid
bronchoscopy can also be useful in securing an airway in these patients. Care
should be taken to ensure correct positioning and securing of the artificial airway,
as the usual landmarks and adjacent tissues may be injured or altered.
Breathing abnormalities may suggest associated injuries. Missiles to the neck
may also pass through or lodge in the chest. Zone I injuries of the neck can easily
involve the lung apices and result in hemothorax, pneumothorax, or
pneumomediastinum. Further penetration may lead to cardiac tamponade. A chest
radiograph is helpful in the assessment. A normal physical examination and chest
radiograph are likely sufficient to obviate the need for arteriography in this
population.
