Airway trauma - NYSORA

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Airway trauma

Learning objectives 

  • Recognize airway trauma
  • Management of airway trauma

Definition and mechanism

  • A life-threatening condition resulting from blunt and penetrating injuries to the neck and chest, as well as from medical procedures that may injure the airway
  • Maxillofacial, neck, or laryngeal trauma
  • Airway obstruction or obstruction by blood, secretions, tissue edema, debris, and vomitus
  • Airway trauma can be associated with cervical spine injury which will worsen during intubation

Signs and symptoms

  • Neck pain
  • Hoarseness
  • Dysphagia
  • Cough
  • Dysphonia
  • Laryngeal dyspnea
  • Loss of consciousness
  • Stridor
  • Cyanosis
  • Hypoxemia
  • Hamman’s sign or a mediastinal crunch (a crunching, rasping sound, heard over the precordium in mediastinal emphysema)

Blunt airway injury

Anatomical territoryAssociated problemsCaution: red flag signs and symptoms
MaxillofacialTraumatic brain injury and base of skull fracture
Cervical spine fracture
Ophthalmic injury
Vascular injury
Pulmonary aspiration of blood and debris
Signs of Increased intracranial pressure
Neurological deficit
Neurogenic shock
Significant bleeding from fracture displacement
Bilateral anterior mandible fractures and airway obstruction
Ventilatory failure
LaryngotrachealCervical fracture
Vascular injury
Oesophageal injury
Rib fractures and flail segment
Pulmonary contusion
Massive hemoptysis and stridor have previously been reported as cardinal features of severe laryngotracheal trauma
Massive surgical emphysema
Ventilatory failure
Cardiovascular collapse
Trachea and
Vascular injury
Oesophageal injury
Rib fractures and flail segment
Tension pneumothorax
Pulmonary contusion
Massive hemoptysis
Massive surgical emphysema
Ventilatory failure
Cardiovascular collapse


Blunt airway trauma, 100% O2, Trendelenburg, cricoid pressure, rigid laryngoscopy, postive pressure ventilation, bronchoscopy, supraglottic, laryngotracheal, trachea, bronchi, tracheostomy, RSI, cricothyroidotomy, awake fiber intubation, fibreoptic scope-assisted direct laryngoscopy, video lanryngoscopy

Keep in mind

  • Full stomach vs difficult airway vs need for double-lumen tube
  • Airway management may be difficult in the uncooperative or pediatric patient 

Suggested reading

  • Shilston J, Evans DL, Simons A, Evans DA. Initial management of blunt and penetrating neck trauma. BJA Educ. 2021;21(9):329-335.
  • Mercer SJ, Jones CP, Bridge M, Clitheroe E, Morton B, Groom P. Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma. Br J Anaesth. 2016;117 Suppl 1:i49-i59.
  • Jain U, McCunn M, Smith CE, Pittet JF. Management of the Traumatized Airway. Anesthesiology. 2016;124(1):199-206.
  • Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg. 2014;9:117.

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