Tracheal injury


  • Usually occurs at junction of trachea and cricoid cartilage
  • Direct trauma to airway is rare due to protection by sternum and mandible
  • Associated with cervical spine injury, head injury, multisystem trauma

Common causes

  • Motor vehicle accident: extended neck impacts on steering wheel or dashboard
  • "Clothes line injury", assaults/strangulation
  • Penetrating trauma (usually stabbings or gunshot wounds)

Clinical Features

Differential Diagnosis

Thoracic Trauma


Investigate only once airway secure

  • Plain films, CT
    • Air in soft tissues
    • Pneumomediastinum, pneumothorax
    • Cervical spine fractures
    • Hematomas, cartilage fractures
    • Evaluate for other injuries


While preparing to secure airway


Avoid cricoid pressure!

  • Awake fiberoptic intubation
  • Awake direct laryngoscopy/intubation
  • Inhalational induction/intubation (keep patient breathing spontaneously)
  • Awake tracheostomy
  • Consider intubating through open wound if transected trachea visible


  • Admit

See Also

  • Thoracic Trauma


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