2017-18 HSC Section 3 Green Book

Reprinted by permission of Paediatr Anaesth. 2016; 26(2):132-138.

Pediatric Anesthesia ISSN 1155-5645

REV I EW ART I CLE

Airway management in laryngotracheal injuries from blunt neck trauma in children Debnath Chatterjee 1 , Rita Agarwal 2 , Lalit Bajaj 3 , Sarena N. Teng 4 & Jeremy D. Prager 5 1 Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA 2 Department of Anesthesiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA 3 Department of Emergency Medicine, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA 4 Department of Anesthesiology, Ochsner Hospital for Children, New Orleans, LA, USA 5 Department of Otolaryngology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

Summary

Keywords pediatric laryngotracheal injuries; blunt neck trauma; tracheal transection; laryngotracheal separation; airway management Correspondence D. Chatterjee, Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B090, Aurora, CO 80045, USA Email: debnath. chatterjee@childrenscolorado.org

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway man- agement is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tra- cheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

Section Editor: Mark Thomas

Accepted 7 September 2015

doi:10.1111/pan.12791

Introduction

Case report

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare. Presenting symptoms can be nonspecific and a high index of clinical suspicion may be required for early diagnosis. The initial airway management of children with suspected laryngotracheal injuries remains controversial. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture follow- ing a clothesline injury to the anterior neck. This review article discusses the mechanisms of injury and clinical presentation of laryngotracheal injuries from blunt neck trauma in children. A proposed treatment algorithm for the initial airway manage- ment of pediatric patients with blunt neck trauma is presented.

A helmeted 12-year-old boy sustained a clothesline injury to his anterior neck from a steel cable while riding a dirt bike at 50 km per hour in a rural area. The steel cable struck him on the upper chest and rolled onto his anterior neck. As per witnesses, the patient lost con- sciousness for about 30 s and had difficulty phonating on regaining consciousness. Upon arrival at the scene, the paramedics noted that the patient was breathing spontaneously, following commands and moving all four extremities. His oxygen saturations remained in the 80 – 90% range despite administration of oxygen via facemask. He had bruising in his anterior neck without any evidence of subcutaneous emphysema. Being in a remote rural area, a decision was made to transport the patient via helicopter to the nearest hospital, which was

© 2015 John Wiley & Sons Ltd Pediatric Anesthesia 26 (2016) 132–138

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