Pediatric emergency medicine trisk 3281 3281

FIGURE 106.4 Loss of thyroid cartilage prominence and associated acute airway obstruction secondary to laryngeal fracture SG, narrowed subglottic space; TC, fracture of thyroid cartilage Initial Assessment History of a mechanism concerning for laryngeal trauma should be elicited This may include a “clothes line” injury or blunt force from an object across the neck Emergency clinicians should determine if there has been any change in the quality of voice, hemoptysis, or significant neck pain On physical examination, anterior neck tenderness, crepitus, or presence of abnormal laryngeal/tracheal cartilage contours are concerning for injury (see Fig 106.4 ) Stable patients may be evaluated by an otolaryngologist with an awake fiberoptic nasopharyngoscope Unstable patients in respiratory distress may require direct laryngoscopy, intubation, rigid bronchoscopy, or emergent tracheostomy An otolaryngologist or general surgeon should be prepared to intervene with any of these procedures For children without distress, plain radiographs may help assess the thyroid cartilage