Pediatric emergency medicine trisk 3565 3565
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FIGURE 112.7 Tracheal injury. Seven-year-old male patient with extensive gas in the neck after
motor vehicle collision. Gas seen tracking through a laceration at the junction of the
cartilaginous and membranous portions of the trachea on the left (arrow ).
In addition to the usual assessment for hypovolemia, the patient should be
examined for expanding hematomas or other obvious external bleeding. External
bleeding should be treated with gentle compression. Attempts to clamp bleeding
vessels in the neck can injure the vessels and surrounding structures, as well as
jeopardize subsequent repair attempts. Two large-bore intravenous (IV) catheters
should be inserted, ideally on the side opposite to the injury if an obvious vascular
abnormality is identified. If a subclavian vein injury is suspected and there are no
contraindications, one of the IV catheters should be placed in the lower extremity.
A neurologic examination for signs of cerebral injury secondary to vascular
insufficiency, direct spinal cord, cranial or cervical nerve, or brachial plexus injury
should be completed. An abnormal or changing neurologic examination may
indicate progressive vascular insufficiency and the need for rapid surgical
evaluation. Rapid assessment by CT or magnetic resonance imaging (MRI),
followed by surgical intervention, will provide opportunity for optimal outcome.
Direct nerve injuries may not necessitate surgical repair.
