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