Blunt Trauma Neck with Complete Tracheal Transection - A Diagnostic and Therapeutic Challenge to the Trauma Team

Abstract

Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails. Any delay at any step in the "failed airway" management algorithm may not save the critically ill dying patient. Here, we report a case of blunt trauma following high-velocity road traffic accident, presenting in the peri-arrest state, in whom we noticed "failed airway" which turned out to be due to complete tracheal transection. In our patient, although we had secured the airway immediately, he had already sustained hypoxic brain damage. This scenario emphasizes the importance of prehospital care in developing countries.

Keywords: Cannot intubate cannot ventilate; complete tracheal transection; surgical airway.

Figure 1

Image of surgical airway

Figure 2

Coronal section of computed tomography neck and thorax showing bilateral extensive subcutaneous emphysema, with multiple rib fractures and pneumomediastinum

Figure 3

Computed tomography thorax axial view showing left side hemopneumothorax

Figure 4

Intra-operative anastomosis of fractured thyroid cartilage, multiple displaced fracture fragments of cricoid cartilage, with complete cricotracheal separation

Figure 5

After anatomizing all fractured segments, end tracheostomy was done on second tracheal ring

Figure 6

On day 3 repeat computed tomography brain revealed diffuse cerebral edema with multiple watershed infarcts suggestive of hypoxic brain injury