INTEGRATED TRAUMA TEAM APPROACH TO COMPLEX AIRWAY INJURY WITH CONCOMITANT ESOPHAGEAL LESION camtreath@yahoo.com.mx

PE118

INTEGRATED TRAUMA TEAM APPROACH TO COMPLEX AIRWAY INJURY WITH CONCOMITANT ESOPHAGEAL LESION

6

Mexico

Video

A 20-year-old male sustained severe blunt neck trauma after a head-on collision with a flatbed tow truck. Prehospital assessment revealed respiratory distress, hoarseness, neck deformity from subcutaneous emphysema, and air leakage from a small anterior neck wound. An occlusive patch was applied, and the patient was airlifted to the hospital. On arrival, ATLS protocol assessment showed compromised airway, shallow breathing, and hemodynamic stability. A cervical spine injury was excluded. Due to the high risk of losing airway patency with rapid sequence intubation, the team opted for oxygen via reservoir mask while awaiting anesthesiology and pulmonology for awake intubation. Imaging revealed a 90% circumferential tracheal rupture, subcutaneous emphysema, blunt pulmonary trauma, and a left clavicle fracture.

Awake flexible videofibrolaryngoscopy demonstrated a complete rupture in the lower third of the trachea with distal displacement. Intubation was achieved on the third attempt, and the patient was taken to the operating room. Surgical repair included end-to-end tracheal anastomosis, primary repair of a grade II anterior esophageal injury with muscle interposition, and neck drainage.

The patient was discharged on day 13, with only five days in ICU. Follow-up bronchoscopy at 3 and 12 months showed normal vocal cord mobility and no stenosis.

Tracheal injuries from blunt trauma are rare and have high prehospital mortality (30–80%). This case highlights how rapid diagnosis, effective prehospital-hospital communication, adherence to ATLS principles, and coordinated multidisciplinary management can significantly improve survival and long-term outcomes in complex airway trauma cases.

https://vimeo.com/1115867127