Managing the Transected Airway

A Summary by Georgie Harris

The management of the transected airway is frightening because it is a rare airway emergency and one that does not fit the usual plan A,B,C airway management algorithms. An approach is presented which considers two principal anatomical distinctions for injuries both above and below the cricoid cartilage.

Secondly, the mechanism of injury is classified according to whether it is either penetrating or blunt trauma. Finally the airway management urgency is described according to either an immediate or semi-urgent approach being required.

These three approaches, the location of the injury relative to the cricoid, the mechanism of the injury and thirdly, the urgency of the airway intervention required are then applied together to provide a guide to management of the transected airway.

[az_box_icon animation_loading=”no” animation_loading_effects=”fade_in” icon=”font-icon-video” title=”The Video” position=”left”][az_lightbox_video image=”17307″ animation_loading=”yes” animation_loading_effects=”scale_up” link_url=”https://vimeo.com/145366263″ title=”Managing the Transected Airway by Georgie Harris”]

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Managing the Transected Airway by Georgie Harris from Royal North Shore Hospital & UTS

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Dr Matthew Oliver

Given ED physicians aren’t familiar with trache’s and Dr Harris mentions cric is contraindicated in blunt injury, does that mean we should learn how to do trache’s as an emergency procedure in ED!? And if not what would you recommend to an ED Physician who ‘can’t intubate, can’t ventilate’ a blunt neck injury?
- ICN
  
  I’ll ask Georgie her opinion & get back to you; but if the cut is below the cricoid, a cricothyroidotomy won’t necessarily help. Georgie’s approach is aimed at the ED physician to prepare for this incredibly rare event…
- ICN
  
  From Georgie Harris:
  
  “Simple answer is yes! If you are seriously concerned about possible cricotracheal separation and can’t intubate, can’t ventilate then yes, you should do trache rather than cric. Just like peri-mortem c section or thoracotomy, there are very rare circumstances when a ed/retrieval doc just might have to do it…..and having visualised or thought about what you would do is really important.”
  - Dr Matthew Oliver
    
    Thank you for the quick response, and thanks for such a great talk!
    Perhaps I should book on the airway course for SMACC DUB and you guys can show me how!
Ioannis Dimitriadis

o hi matt,interesting topic,good questions
dominick m carella

We have used ECMO for repair
- dominick m carella
  
  VV
- ICN
  
  Nice! that would work if you could get it going fast enough….