Airway Blunt Injury - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Airway injury is a tear or a break in the windpipe (trachea) mainly due to abnormal penetration or blunt (non-penetration) forces and affects the person's ability to breathe. It is a relatively uncommon condition and often challenging to diagnose. Airway injury usually results from injuries associated with the head, neck, and chest. This condition requires prompt treatment and, if delayed to treat, could become fatal.

What Are Airway Injuries?

Airway injuries can be penetrating or blunt. They are a high-stakes, high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injuries can vary in injury patterns, requiring pre-practiced skills and protocols coordinating care between specialties.

What Are the Types of Airway Injuries?

The injuries in the airways could be categorized as:

• Blunt injuries are caused by the impact of a strong force from other objects or collisions.

• Penetration injuries are caused by sharp objects or gunshots piercing the skin and damaging the airway.

What Are the Causes of Airway Injury?

The trauma to the airways can result from either a cervical (neck) injury or a thoracic (chest) injury. So when there is a cervical or a thoracic injury, airway trauma should be considered an associated complication. The trauma to the cervical region is more evident and symptomatic, but the thoracic injuries are less noticeable and often missed. Airway injuries are very often due to cervical injuries.

Blunt injuries usually result from -

• Strangulation by hanging or compression of the neck.

• Clothesline injuries when the neck is flexed or extended suddenly.

• Crush injuries to the chest due to a vehicle hitting a pedestrian, falls, accidents, etc.

• Seatbelt compression injuries.

• Injuries caused inside the tracheal tube are due to inhalation of toxic gasses, fumes, etc., or aspiration of a foreign body, and damages caused during anesthetic procedures like intubation and tracheostomy.

Penetration injuries to the airways are commonly due to -

• Stab injuries.

• Gunshot wounds.

• Hitting or falling onto sharp objects.

What Are the Symptoms of Airway Injury?

The symptoms vary with the type of injury, injury site, and severity. The common symptoms that occur in an airway injury include -

• Tenderness and pain in the neck.

• Severely injured persons experience severe bleeding.

• The voice becomes strained, horse, or breathy to hear.

• Dysphagia (difficulty in swallowing food and even liquids).

• Hemoptysis (blood mixed sputum when clearing throat or coughing).

• Airway obstruction, making it difficult to breathe.

• Falling unconscious.

The symptoms that are noticed by a physician and often represent a severe airway injury include:

• Stridor (wheezing sounds that are caused due to disruption in the airflow).

• Cyanosis (bluish discoloration of the skin).

• Subcutaneous emphysema (air getting trapped in the subcutaneous layer present under the skin) is noticed in certain areas and commonly occurs in injuries associated with intubation.

• Dyspnea (shortness of breath).

• Hamman's sign or a mediastinal crunch - a sound of crunch with heartbeat resulting from an air-filled thoracic cavity when examined using a stethoscope.

How Is Airway Injury Diagnosed?

The diagnosis is made by radiographic examination other than the clinical evaluation of the symptoms.

The radiographic analysis requires -

• Neck and chest X-rays.

• CT (computed tomography) scan of the neck and chest.

• Bronchoscopy.

• Laryngoscopy.

The radiographic diagnosis of airway injuries shows damage in the trachea, injuries in the major blood vessels, and musculoskeletal damage, which may include:

• Pneumothorax (when the air exits the lungs and gets filled in the space separating the chest wall and the lungs).

• Pneumomediastinum (presence of air in the mediastinum - the layer that separates both the lungs).

• Cervical emphysema (air getting trapped in the subcutaneous tissues of the neck region).

How Is Airway Injury Treated?

The patient with an airway injury should be taken to the emergency room immediately. The treatment option varies depending on the severity of the damage.

• Before initiating the air supply, the oral cavity should be examined for blood clots, oral secretions, and any foreign objects such as avulsed teeth and removed to prevent aspiration.

• Any patient with airway trauma should be considered to have breathing difficulty until ruled out and should be provided oxygen.

• For minor injuries, without any severe symptoms or breathing difficulty, antibiotic therapy is given along with humidified oxygen to reduce the dryness in the upper airways. Monitoring the patient in the intensive care unit can help with the deterioration of the symptoms.

• For patients with breathing difficulty and partial collapse in the trachea, tracheostomy (a procedure in which an opening is made in the trachea and is intubated to promote artificial breathing) often manages the condition.

• In case of lung injuries or pneumothorax, a chest tube is inserted to remove the air from the thoracic cavity.

• In severe cases, surgery is indicated following the intubation, and in some cases, a stent is placed. The surgery is usually performed within 24 hours of the injury.

What Is the Prognosis of Airway Injury?

The prognosis of an airway injury depends upon the severity of the injury. The airway injury should be identified and treated appropriately, as delay in the treatment can worsen the prognosis. Proper care and timely management have shown promising results, even in severe cases. Intubation and surgical management have established a good prognosis.

What Is Post-treatment Care For Airway Injury?

• In some instances, follow-up surgeries are required after the emergency management.

• The neck is usually fixed in a flexed position for two to three weeks following the surgery to avoid strain in the surgical site.

• Antibiotics are prescribed to prevent infection.

• A headrest or a pillow should be placed under the patient's head and shoulders to maintain proper position.

• Maintaining proper hygiene and hydration.

What Are the Complications of Airway Injury?

• Scarring.

• Infections in the wound or the internal organs involved.

• Airway stenosis (narrowing) or obstruction could happen. Which often requires an artificial airway for a potentially long period.

• Pneumothorax can persist even after treatment.

• Abnormal aspirations could occur.

Conclusion:

When an airway injury is suspected, the patient should be examined for proper breathing showing response to stimuli. The patient should be taken to the emergency room as soon as possible. Though airway injuries have shown high fatality rates, proper and timely treatment has an excellent healing rate.