Pediatric emergency medicine trisk 3570 3570
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Direct blunt trauma may cause airway injury due to the anterior position
of the larynx and trachea.
Dyspnea, hemoptysis, and stridor suggest laryngeal airway injury.
Cervical emphysema, dysphagia, and progressive airway obstruction
characterize supraglottic injuries.
Hemoptysis and persistent air leak suggest injuries inferior to the glottis.
Early intubation should be considered for patients with facial and neck
burns.
Vascular injuries are less common compared to penetrating trauma, but
are also missed on routine examination. Maintain a high index of
suspicion.
The cervical spine should be immobilized if indicated by mechanism of
injury, inability to clinically clear, or in the presence of significant
head/neck trauma.
Current Evidence
Blunt trauma is often the result of a motor vehicle accident, although it can also
result from sports-related injuries; clothesline and handlebar injuries from
bicycles, motorcycles, all-terrain vehicles, and snowmobiles; strangulation;
hanging; direct blows; and various forms of child abuse ( Table 112.1 ). Pediatricspecific mechanisms of injury as well as the fact that children have a relatively
short neck, mobile laryngotracheal structures, and a superior-positioned larynx
protected by the mandibular arch make it less likely for children to sustain airway
fractures and may impact overall severity of injury. On the other hand, the small
and narrow airway increases the risk of airway-related morbidity secondary to
airway edema, bleeding, swelling, and obstruction. Blunt trauma is often
associated with extracervical injuries, especially maxillofacial, head, chest, and
aerodigestive injuries, but is less likely than penetrating trauma to involve
multiple structures within the neck or cause vascular damage.
The airway may be injured with direct blunt trauma in part as a result of the
anterior and relatively fixed position of the larynx and trachea. High-impact blunt
trauma to the trachea has been associated with a mortality rate of approximately
15%, although this is likely higher when one considers patients who die at the
scene but occurs infrequently in pediatric trauma patients. Laryngotracheal injury
severity is graded I–V depending on the extent of tissue damage. The anterior
neck is relatively well protected by bony structures, unless the neck is extended.
