Laryngeal cannula injury
Introduction
Introduction to laryngeal cannula injury Laryngeal intubation injury (intubationtraumaoflarynx) occurs in general anesthesia, rescue of critically ill patients, etc., requiring oral or nasal laryngotracheal intubation (laryngotrachealintubation). Therefore, in recent years, such laryngeal injuries have been increasing, and long-term indwelling of the nasogastric tube may also cause mucosal damage in the posterior region of the ring. Its incidence rate is reported between 10% and 60% at home and abroad. Tracheal intubation was unskilled, the operation was rude, the glottis was not seen, and blind insertion was forcibly inserted. Due to insufficient surface anesthesia during awake intubation, the patient has a severe cough, and a laryngeal spasm occurs, and the laryngoscope or the front end of the cannula damages the throat. Patients with ulcers and pseudomembranes must be treated with antibiotics and steroids. The paralyzed patient speaks less and does not act as a breath holding force. If the pseudomembrane does not fall off, it can be removed under the laryngoscope. basic knowledge The proportion of illness: the prevalence rate in the throat cannula population is 9% Susceptible people: no specific population Mode of infection: non-infectious Complications: purulent granuloma
Cause
Causes of laryngeal cannula injury
Abnormal operation (30%):
Tracheal intubation was unskilled, the operation was rude, the glottis was not seen, and blind insertion was forcibly inserted. Due to insufficient surface anesthesia during awake intubation, the patient has a severe cough, and a laryngeal spasm occurs, and the laryngoscope or the front end of the cannula damages the throat.
Improper use (25%):
The intubation is too thick, the outer balloon of the cannula is inflated too much, or the patient's head is moved too much during the intubation process, and the mucosa in the laryngeal cavity is damaged by friction. The intubation time is too long and the throat mucosa is pressed for too long.
Quality reasons (25%):
The quality of the cannula is not good, the diameter of the cannula is too thick and too hard, and the diaphragm and mucous membrane of the larynx are stimulated.
Prevention
Laryngeal cannula injury prevention
The throat is the necessary passage for breathing. Blockage of blood clots caused by trauma, tissue displacement, swelling of the tongue to the neck, and retention of foreign bodies, etc., may cause obstruction of the airway and even suffocation. Therefore, in first aid, care must be taken to keep the airway open. If the wound is wide and deep, the tracheotomy should be performed first to maintain the breathing. After the breathing is guaranteed, the wound is treated. When the neck is small and swollen, the secretion of the throat should be sucked out at any time to move the mandible forward. Pull out the tongue to prevent blockage of the respiratory tract; if available, oxygen can be given to compensate for the lack of respiratory airflow. If the dyspnea after the above treatment is still very serious, it is necessary to consider whether a pneumothorax or mediastinal emphysema has occurred, and the thoracic surgeon should be treated further. Secondly, there are many large blood vessels in the throat, and it is prone to major bleeding after injury. Therefore, proper hemostasis is a very important first aid. For bleeding and bleeding of wounds, gauze can be used to fill or compress to stop bleeding. If there is a large blood vessel injury, it can be ligated and hemostasis. However, for the internal carotid artery and common carotid artery that supply blood in the brain, you can only pay attention to suture, throat injury, etc., transfer and other treatments to stop bleeding, otherwise it will affect the blood of the brain. supply. In addition, when the throat is injured, the esophagus is easily damaged, and the swallowing function is impaired. In severe cases, the stomach tube should be placed early so as to maintain nutrition after nasal feeding. When foreign matter remains in the damaged esophagus, it is necessary to carefully check (including X-ray examination), what should be paid attention to in the throat injury, and identify the exact part of the foreign body, and then take it out. If the foreign body is close to the large blood vessels in the neck or accompanied by blood vessels, do not rush to remove it to prevent major bleeding and cause serious consequences. After surgical treatment of throat trauma, adequate antibiotics should be given to prevent wound infection and pulmonary complications.
Complication
Laryngeal cannula injury complications Complications of purulent granuloma
Secondary bleeding, local infections, lung and intracranial infections, etc., late symptoms are mostly traumatic sequelae, such as scarring, resulting in respiratory and swallowing dysfunction or neurological dysfunction, and affect the face. The early prominent symptom is bleeding. Although it does not necessarily damage the main aorta in the neck, it can also cause suffocation due to blood inflow into the airway, or shock due to excessive blood loss, followed by tissue edema, hematoma and dyspnea caused by aneurysm. Subcutaneous emphysema, mediastinal emphysema, difficulty swallowing, and dysphonia may also occur. After laryngeal cartilage fracture, it is easy to have subcutaneous emphysema in the neck; airway obstruction, palpation with fracture signs such as thyroid cartilage larynx or annular cartilage arched process disappear; there is mucosal tear in the laryngeal cavity.
Symptom
Throat cannula injury symptoms Common symptoms Throat pain Throat itch Cough hoarse throat edema vocal palsy granuloma
1, ulcer
The laryngeal mucosa is ulcerated, torn and edematous, and the epithelial exfoliation is followed by infection to form an ulcer, which is more common in the posterior part of the vocal cords. It is located in the vocal folds of the sacral cartilage, often with fibrin and leukocyte deposition, forming a pseudomembrane. The symptoms are hoarseness, sore throat, cough and blood in the sputum. Laryngoscopy revealed ulcers and pseudomembranes.
2, granuloma
Based on the above ulcers and pseudomembranes, inflammatory cell infiltration occurs, and a large number of fibroblasts and vascular endothelial cells proliferate. Under the laryngoscope, gray or white, granuloma with smooth surface and touched polyps can be seen. The patient felt discomfort in the throat, hoarseness, and blood in the cough; if the granuloma increased, blocking the glottis, breathing difficulties may occur.
3, ring ankle dislocation
Under the laryngoscope, one side of the sacral cartilage is red and swollen, and the scorpion-like epiglottis protrudes above the glottis. The vocal cord movement is limited, and the patient has hoarseness and long-term unhealed.
4, vocal cord paralysis
As a result of injury to the recurrent laryngeal nerve, hoarseness occurs after surgery.
Examine
Laryngeal cannula injury examination
Laryngoscopy.
1. Ulcer: Laryngoscopy can be seen in the posterior part of the throat with ulceration, edema, congestion, and formation of white film.
2, granulation: laryngoscopy to see granules reddish or grayish white, the surface is still smooth, easy to contact with bleeding. Direct laryngoscopy is not easy for patients with acute heaviness because it can accelerate the occurrence of airway obstruction. Indirect laryngoscopy and fiberoptic laryngoscopy are common laryngeal mucosal edema, hematoma, hemorrhage, tear, laryngeal cartilage exposure and pseudo-channel. The glottic stenosis is limited, and the vocal cord activity is limited or fixed. The lateral lateral slice and the body slice can show the location of the laryngeal fracture and tracheal injury. Chest X-rays can show whether there is pneumothorax and emphysema. CT scan of the neck is extremely valuable for the diagnosis of fracture, displacement and laryngeal structural deformation of the hyoid bone, thyroid cartilage and annular cartilage. MRI of the neck is of great value in judging the damage of the throat, neck soft tissue and blood vessels.
Diagnosis
Diagnosis and identification of laryngeal cannula injury
1, tracheal intubation is not skilled, the operation is rude, did not see the glottis, blindly forcibly inserted. Due to insufficient surface anesthesia during awake intubation, the patient has a severe cough, and a laryngeal spasm occurs, and the laryngoscope or the front end of the cannula damages the throat.
2. The intubation is too thick, and the outer balloon of the intubation is inflated too much, or the patient's head is moved too much during the intubation process, and the mucosa in the laryngeal cavity is damaged by friction.
3, intubation time is too long, the throat mucosa compression time is too long.
4, the quality of the intubation is not good, the diameter of the tube is too thick and hard, oppressing and stimulating the mucous membrane of the larynx.
