Nicholson Benjamin, Dhindsa Harinder, Seay Louis
Prehosp Emerg Care. 2017 Mar-Apr;21(2):257-262. doi: 10.1080/10903127.2016.1229822. Epub 2016 Oct 4.
Blunt injuries to the cervical trachea remain rare but present unique and challenging clinical scenarios for prehospital providers. These injuries depend on prehospital providers either definitively securing the injured airway or bridging the patient to a treatment facility that can mobilize the necessary resources.
The case presented here involves a clothesline injury to a pediatric patient that resulted in complete tracheal transection and partial esophageal transection. Ground and air prehospital providers utilized a stepwise approach to this airway injury and achieved a favorable outcome. The patient was serendipitously intubated through a blind nasal approach that entered the proximal esophagus, exited through the tear and entered the distal trachea.
There is a paucity of literature describing the successful management of these devastating injuries. While some authors have advocated for early flexible fiberoptic intubation or proceeding directly to tracheostomy, these techniques are not available in the prehospital environment. This case also highlights the inherent issues with proceeding to cricothyroidotomy in patients with tracheal trauma and should give all providers pause before considering this management technique.
Ultimately, a systematic approach to all airways will ensure that prehospital providers are best prepared for even the most challenging scenarios.
钝性颈部气管损伤仍然罕见，但对院前急救人员来说，是独特且具有挑战性的临床情况。这些损伤取决于院前急救人员要么明确确保受伤气道的安全，要么将患者转运至能够调集必要资源的治疗机构。
此处呈现的病例涉及一名儿科患者因晾衣绳损伤导致气管完全横断和食管部分横断。地面和空中院前急救人员对该气道损伤采用了逐步处理方法，并取得了良好结果。患者意外地通过盲探经鼻途径插管，该途径进入近端食管，穿过撕裂处并进入远端气管。
描述成功处理这些严重损伤的文献很少。虽然一些作者主张早期进行可弯曲纤维支气管镜插管或直接行气管切开术，但这些技术在院前环境中无法应用。该病例还凸显了气管创伤患者行环甲膜切开术存在的固有问题，在考虑这种处理技术之前，应让所有急救人员有所顾虑。
最终，对所有气道采用系统方法将确保院前急救人员即使面对最具挑战性的情况也能做好最佳准备。
