Lesions of the larynx: causes, symptoms, diagnosis, treatment

Lesions of the larynx are among the most life-threatening injuries, which, if not lead to death, are most often doomed to permanent cannulation, disability and a significant deterioration in the quality of life.

Lesions of the larynx, especially when it comes to penetrating wounds, are aggravated by the proximity of large blood vessels, the violation of integrity of which in most cases leads to rapid death of the victim. The presence of large neural trunks in the neighborhood is also a factor sharply weighting the clinical course of lesions of the larynx, since their trauma leads to severe shock conditions with pronounced impairment of the functions of vital nerve centers. Combined damage to the larynx, laryngopharynx and cervical esophagus causes the occurrence of a power disturbance in a natural way, which requires a number of complex measures to ensure this vital function. Thus, traumas of the larynx can lead to either incompatible with life changes in the whole body (asphyxia, bleeding, shock), or conditions requiring immediate medical care for life indications, which is not always and not always possible to undertake. If the victim can be saved, then other problems arise, namely, ensuring full breathing, an acceptable way of feeding, preventing infection and posttraumatic stenosis of the larynx, and then a number of long rehabilitation measures aimed at restoring the natural functions of the injured organs (larynx, esophagus, nerve trunks).

Lesions of the larynx are divided into external and internal. External injuries include trauma and injuries, internal - thermal and chemical burns, internal injuries of the larynx by stabbing and cutting foreign bodies, and foreign bodies themselves, which, in addition to obstruction, bedsores, necrosis, secondary infection. Internal injuries also include the effects of prolonged intubation of the trachea (intubation granulomas, cysts, pressure ulcers) and iatrogenic lesions (forced or occurring accidentally during an endolaryngeal surgical intervention).

[1], [2], [3], [4]

Pathogenesis and pathological anatomy of laryngeal injuries

With blunt external injuries of the larynx, bruises, contusions, soft tissue tears, fractures and various severity of crushing of the larynx cartilage, dislocations in the joints, as well as associated injuries of the larynx surrounding anatomical formations can occur. Contusions cause a shock state, while contusions, fractures, dislocations, fractures disrupt the morphological and anatomical structure and integrity of the larynx, causing bleeding and damage to her nervous system. Dislocations in the joints and ruptures of their bags, hemorrhages disrupt mobility of the epiglottis, arytenoid cartilages, as a result of which the blocking, respiratory and vocal functions suffer, and the presence of bleeding leads to blood aspiration and, depending on its intensity, to various complications, from aspiration pneumonia to asphyxia . In the immediate period after trauma, there is interstitial edema of the larynx, especially pronounced in the area of cherpalodnagortan folds and arytenoid cartilages. As a rule, dislocations in the joints of the larynx are combined with fractures of its cartilage, and in isolated form are extremely rare. In children and young people, when the process of calcification of cartilage has not yet begun, due to their elasticity and mobility of the larynx relative to the spine, these lesions occur less frequently than in individuals older than 40-50 years old.

Most often, the fracture undergoes a thyroid cartilage, with the destruction passing along the median line connecting the lateral plates; also fractures and horns of the thyroid cartilage often occur. Hanging most often there are fractures of the upper horns and hyoid bone. Fracture of the cricoid cartilage occurs in the area of its arch or closer to the plate in front of the percutaneous punctate joint, as a rule, combined with a fracture of the lower horns of the thyroid cartilage and rupture of the upper and lower perstnerogovyh ligaments. Simultaneously with these injuries, dislocations of the arytenoid cartilages in the percutaneous punctate joints also occur.

The nature of cartilage fractures depends on the point of application, the direction and magnitude of the traumatic force. They can be open (with violation of the integrity of the mucous membrane) and closed - without the latter. Displaced fragments of cartilage injure the mucosa, perforate it, causing internal bleeding (threat of aspiration asphyxia) and emphysema surrounding the larynx of interstitial spaces (threat of compression asphyxia). The most massive emphysema occurs when the damage to the cartilaginous framework and mucous membrane is localized in the backing space due to the fact that in this case a kind of valve is formed, the mechanism of which is that the exhaled air, encountering an obstacle at the level of the glottis closed as a result of the violation mobility of the arytenoid cartilages, rushes under pressure through ruptures of the mucous membrane into the surrounding tissues, with no reverse movement due to the valve mechanism forming the floating parts of the ruptured mucosa. With such traumatic lesions of the larynx, emphysema can reach the mediastinum, interfering with the diastole of the heart. Of secondary complications should be noted abscesses and phlegmon, perichondritis, cicatricial deformation of the larynx, mediastinitis, sepsis.

With penetrating wounds of the larynx (punctured, cut, gunshot wounds), the laryngeal cavity can be opened in various directions, communicating it with the esophagus, mediastinum, pre-invertebrate space, and in especially severe cases - with large veins and arteries of the neck. Cut wounds, the origin of which is due to an attempted murder or suicide, have a transverse direction, are located above the anterior margin of the thyroid cartilage, seize the medial thyroid and sublingual-epiglottis ligament, and also the epiglottis. When cutting the muscles that fix the larynx to the hyoid bone, in particular the thyroid-lingual muscle, the larynx under the action of the sternum-like muscles descends and moves forward, which makes its cavity visible through the wound hole. This wound configuration provides the victim relatively free breathing through the wound and emergency assistance at the scene by diluting the edges for free air access. If the cutting object (knife, razor) falls on the dense thyroid cartilage, it slides down and cuts the pericarpoid-shaped ligament (membrane), starting on the arch of the cricoid cartilage and attached to the lower edge of the thyroid cartilage. In this case, the larynx cavity becomes visible from below, and the initial sections of the trachea - from above. This circumstance also allows for emergency respiratory measures, for example, by inserting a tracheotomy cannula into the trachea through the wound channel.

With wounds located between the cricoid cartilage and the trachea, completely disconnecting them, the trachea falls into the mediastinum; at the same time there is a strong bleeding from the damaged thyroid gland. Due to the fact that the large vessels cover the powerful sternocleidomastoid muscles and to the fact that the head is reflexively deflected posteriorly when the injury is caused, and the large vessels of the neck are displaced posteriorly along the neck, the latter are rarely injured, which, as a rule, saves life of the victim.

Gunshot wounds of the larynx are the heaviest and often because of the defeat of neighboring vital organs (carotids, spinal cord, large nerves) are incompatible with life. Damaging objects in these wounds are fragments (grenades, mines, shells, etc.), bullets and secondary damaging objects (stones, glass, etc.). The most extensive destruction of the larynx is caused by shrapnel wounds, as the zone of destruction extends far beyond the larynx itself.

In external injuries, the nerves of the larynx can also be damaged, either directly from the injuring gun, or, again, from swelling, a hematoma, a fragment of cartilage. Thus, the defeat of the recurrent nerve by these factors leads to its paralysis and reduction of the vocal fold to the medial line, which significantly aggravates the respiratory function of the larynx, taking into account the rapidly developing interstitial edema.

External injuries of the larynx

The larynx, thanks to its topographic and anatomical position, can be recognized as an organ well protected from external mechanical stress. Above and in the front it is protected by the lower jaw and thyroid gland, from below and from the front - the sternum handle, from the sides - strong sternocleidomastoid muscles, and behind - the bodies of the cervical vertebrae. In addition, the larynx is a movable organ that, when subjected to mechanical action (shock, pressure), is easily amortized, displaced both en masse and parts by its articular apparatus. However, with excessive force of mechanical influence (blunt trauma) or with piercing-cutting in gunshot wounds, the degree of damage to the larynx can be variated from mild to severe and even incompatible with life.

The most common causes of external injuries of the larynx are:

1. hitting the front surface of the neck on protruding solid objects (steering wheel or steering wheel of a motorcycle, bicycle, stair rail, chair back, table edge, strung cable or wire, etc.);
2. direct impacts on the larynx (palm, fist, foot, horse's hoof, sports equipment, abandoned or torn off by rotating the unit, etc.);
3. suicide attempts by hanging;
4. knife piercing-cutting, bullet and shrapnel wounds.

External injuries of the larynx can be classified according to criteria that have a certain practical significance both for setting the appropriate morphological and anatomical diagnosis, and for determining the severity of the lesion and making an adequate decision but rendering assistance to the victim.

[5], [6], [7], [8], [9], [10]

Classification of external lesions of the larynx

Situational criteria

1. household:
   1. as a result of an accident;
   2. for murder;
   3. for suicide.
2. production:
   1. as a result of an accident;
   2. as a result of non-compliance with safety regulations.
   3. wartime injury.

By severity

1. Lungs (non-penetrating) - injuries in the form of bruises or tangential wounds without breaking the integrity of the walls of the larynx and its anatomical structure, not causing immediate disruption of all functions.
2. Moderate (penetrating) - lesions in the form of fractures of the larynx cartilage or penetrating wounds of a tangential character without significant destruction and detachment of the individual anatomical formations of the larynx with immediate non-severe disruption of its functions that do not require emergency care for vital indications.
3. Severe and extremely severe - extensive fractures and crushing of the cartilages of the larynx, cut-chopped or gunshot wounds, completely blocking the respiratory and lumbar functions, incongruous (heavy) and combined (extremely difficult and incompatible with life) with the injury of the main arteries of the neck.

By anatomical and topographic-anatomical criteria

Isolated lesions of the larynx.

• With blunt trauma:
  • rupture of the mucosa, internal submucosal hemorrhage without damage to the cartilage and dislocations in the joints;
  • fracture of one or more cartilages of the larynx without their dislocation and violation of the integrity of the joints;
  • fractures and detachments (disconnection) of one or more cartilages of the larynx with ruptures of articular bags and dislocations of joints.
• At gunshot wounds:
  • the tangential wounding of one or more cartilages of the larynx in the absence of penetration into its cavity or into one of its anatomical divisions (vestibule, vocal cicle, lining space) without significant disturbance of respiratory function;
  • penetrating blind or through injury of the larynx with violation of different degrees of respiratory and vocal functions without combined damage to surrounding anatomical formations;
  • penetrating blind or through injury of the larynx with violation of different degrees of respiratory and vocal functions with the presence of lesions of surrounding anatomical formations (esophagus, neurovascular bundle, spine, etc.).

[11], [12], [13], [14], [15], [16]

Internal trauma of the larynx

Internal injuries of the larynx refer to less traumatic lesions of the larynx as compared to its external injuries. They can be limited only by damage to the mucosa, but may be deeper, damaging the submucosal layer and even the perichondrium, depending on the cause of the lesion. An important cause complicating internal injuries of the larynx is a secondary infection that can provoke the onset of abscesses, phlegmon and chondroperichondritis followed by a more or less severe cicatricial stenosis of the larynx.

Classification of internal injuries of the larynx

Acute trauma of the larynx:

• iatrogenic: intubation; as a result of invasive interventions (galvanocautasis, diathermocoagulation, endolaryngeal traditional and laser surgical interventions);
• damage by foreign bodies (stitching, cutting);
• burns of the larynx (thermal, chemical).

Chronic injuries of the larynx:

• bedsores that result from prolonged intubation of the trachea or the presence of a foreign body;
• intubation granulomas.

To a certain extent, the classification criteria for external injuries of the larynx may be applicable to this classification.

Chronic laryngeal trauma most often occurs in persons weakened by long-term illnesses or acute infections (abdominal, typhus, etc.), in which overall immunity decreases and saprophyte microbiota is activated. Acute traumas of the larynx can occur with esophagoscopy, and chronic - with prolonged stay of the probe in the esophagus (with probe feeding of the patient). With intubation anesthesia, laryngeal edema often occurs, especially in the sublobar space of children. In some cases, acute internal injuries of the larynx occur with forced crying, singing, coughing, sneezing, and chronic - with prolonged professional voice loading (nodules of singers, prolapse of the ventricles of the larynx, contact granuloma).

[17], [18], [19], [20]

Symptoms of larynx injury

Symptoms of laryngeal injuries depend on many factors: the type of injury (bruise, compression, injury) and its severity. The main and first symptoms of external mechanical trauma are shock, respiratory obstruction and asphyxia, as well as bleeding - external or internal, depending on the damaged vessels. With internal bleeding, aspiration asphyxia is added to the mechanical obstruction of the airways.

Lacrimal concussion

With concussion of the larynx, even if there are no external signs of its damage, there is a pronounced shock state, which can lead to rapid reflex death of the victim from stopping breathing and disturbing cardiac activity. The starting points of this fatal reflex are the sensory nerve endings of the laryngeal nerves, the carotid sinus and the perivascular plexuses of the vagus nerve. The shock state is usually accompanied by loss of consciousness, upon exiting this state the patient feels pain in the larynx, intensifying when swallowing and talking, radiating into the ear (ears) and the occipital region.

Hanging

A special clinical case is hanging, which is the compression of the neck by loops under the weight of its own body, resulting in mechanical asphyxia and, as a rule, death. The immediate cause of death can be actually asphyxia, cerebral circulation disorders due to clamping of the jugular veins and carotid arteries, cardiac arrest as a result of clenching of the wandering and overturned nerves due to their compression, damage to the medulla by the 2nd cervical vertebra tooth during its dislocation. When hanging can occur injuries of the larynx of a different kind and localization, depending on the position of the strangulation tool. Most often, fractures of the larynx cartilage and dislocations in the joints, the clinical manifestations of which are revealed only with the timely rescue of the victim, even in cases of clinical death, but without the subsequent decortication syndrome.

Injuries to the larynx

The injuries of the larynx, as already noted above, are divided into cut, chopped and gunshot. More often than others, cut wounds of the anterior surface of the neck occur, among which wounds are marked with damage to the thyroid membrane, thyroid cartilage, wounds localized above and below the cricoid cartilage, wounds perianthiform and larynotracheal. In addition, wounds in the front surface of the neck are divided into wounds without damage to the larynx cartilage, with their damage (penetrating and non-penetrating) and associated injuries of the larynx and pharynx, larynx and vascular nerve bundle, larynx and cervical vertebrae. According to AI Yunina (1972), injuries of the larynx, in accordance with clinical and anatomical expediency, should be divided:

• on injuries to the sub- and sub-speaking areas;
• pre-vocal and vocal folds;
• lining space and trachea with or without damage to the esophagus.

When the first group is injured, the pharynx and the laryngopharynx are inevitably damaged, which considerably increases the trauma, complicates the surgical intervention and greatly prolongs the postoperative period. The wound of the thyroid cartilage invariably leads to injuries to the area of vocal folds, pear-shaped sinuses and, often, an arytenoid cartilage. This type of injury often leads to obstruction of the larynx and the occurrence of choking. The same phenomena occur in the case of injuries of the lining space.

Damage to the larynx with cut wounds

Damage to the larynx with cut wounds can be of varying severity - from the larynx that barely penetrates to the complete cut, with damage to the esophagus and even the spine. The wound of the thyroid leads to hard-to-stop parenchymal hemorrhage, and the wounding of large vessels, which occur for the reasons noted above, is much less frequent, often leads to profuse bleeding, which, if not immediately terminated by the death of the victim from hemorrhage and hypoxia of the brain, sick from asphyxia, caused by the flow of blood in the respiratory tract and the formation of clots in the trachea and bronchi.

The severity and scale of the wound of the larynx does not always correspond to the magnitude of the external wound, especially this refers to stab wounds and bullet wounds. Relatively small skin lesions can hide deeply penetrating wounds of the larynx, combined with wounds of the esophagus, neurovascular bundle, vertebral bodies.

Penetrating cut, punctured or gunshot wound has a characteristic appearance: on exhalation, bubbling bloody foam comes out of it, and on inhaling air is sucked into the wound with a characteristic hissing sound. There are aphonia, attacks of cough, which increases the "on the eyes" beginning with the emphysema of the neck, extending to the chest and face. Disturbances of breathing can be caused both by the flow of blood into the trachea and bronchi, and by destructive phenomena in the larynx itself.

The victim with trauma of the larynx may be in a state of traumatic shock in the twilight state or with complete loss of consciousness. At the same time, the dynamics of the general condition may acquire a tendency to move to the terminal state with a violation of the rhythm of the respiratory cycles and cardiac contractions. Pathological breathing is manifested by a change in its depth, frequency and rhythm.

[21], [22], [23]

Respiratory failure

Increases in the rhythm of respiration (tachypnea) and uregia (bradypnoea) occur when the excitability of the respiratory center is disturbed. After forced breathing due to the weakening of the excitation of the respiratory center, caused by a decrease in the carbon dioxide content in the alveolar air and blood, apnea may occur, or a prolonged absence of respiratory movements. With a sharp depression of the respiratory center, with severe obstructive or restrictive respiratory failure, oligopnea - rare surface breathing is observed. The periodic types of pathological respiration that result from a disturbance of the equilibrium between excitation and inhibition in the central nervous system include periodic Cheyne-Stokes respiration, respiration of the Biota and Kussmaul. With superficial Cheyne-Stokes breathing, superficial and rare respiratory movements become more frequent and deeper, and after reaching a certain maximum again weaken and thin, then there comes a pause of 10-30 seconds, and respiration resumes in the same sequence. Such breathing is observed in severe pathological processes: violation of cerebral blood flow, TBI, various brain diseases with the defeat of the respiratory center, various intoxications, etc. Breath breathing occurs when the sensitivity of the respiratory center decreases - alternating deep breaths with deep pauses up to 2 min. It is characteristic for terminal states, often precedes the arrest of respiration and cardiac activity. It occurs with meningitis, brain tumors and hemorrhages in it, as well as with uremia and diabetic coma. The great breath of Kussmaul (a symptom of Kussmaul) - gusts of convulsive, deep breaths audible at a distance, - occurs with coma, in particular with diabetic coma, kidney failure.

Shock

Shock is a severe generalized syndrome that develops sharply as a result of the action on the body of extremely strong pathogenic factors (severe mechanical trauma, extensive burn, anaphylaxis, etc.).

The main pathogenetic mechanism is a sharp disorder of blood circulation and hypoxia of the organs and tissues of the body and primarily the central nervous system, as well as secondary metabolic disorders as a result of disorders of nervous and humoral regulation of vital centers. Among the many types of shock caused by various pathogenic factors (burn, myocardial infarction, transfusion of incompatible blood, infection, poisoning, etc.), the most common is traumatic shock that occurs with extensive injuries, fractures with damage to the nerves and brain tissue. The most typical shock in the clinical picture is the trauma of the larynx, in which four major shock factors can be combined: pain in the trauma of sensitive laryngeal nerves, discoordination of vegetative regulation due to damage to the vagus nerve and its branches, airway obstruction and blood loss. The combination of these factors many times increases the threat of a severe traumatic shock, often leading to death at the scene.

The main regularities and manifestations of traumatic shock are the initial generalized excitation of the nervous system caused by the release into the bloodstream as a result of the stress response of catecholamines and corticosteroids, which leads to a certain increase in cardiac output, vasospasm, tissue hypoxia, and the occurrence of so-called oxygen debt. This period is called the erectile phase. It is short-lived and can not always be traced to the victim. It is characterized by excitement, sometimes screaming, motor anxiety, increased blood pressure, increased heart rate and respiration. Following the erectile, the torpid phase is due to the aggravation of hypoxia, the emergence of foci of inhibition in the central nervous system, especially in the subcortical areas of the brain. Disorders of blood circulation and metabolic disorders are observed; part of the blood is deposited in venous vessels, the blood supply of most organs and tissues decreases, characteristic changes in microcirculation develop, the oxygen capacity of the blood decreases, acidosis and other changes in the body develop. The clinical signs of the torpid phase are manifested by the inhibition of the affected person, the limitation of mobility, the weakening of the reaction to external and internal stimuli or the absence of these reactions, a significant decrease in blood pressure, a frequent pulse and superficial breathing of the Cheyne-Stokes type, pallor or blueness of the skin and mucous membrane, oliguria, hypothermia. These disorders as the shock develops, especially in the absence of therapeutic measures, gradually, and with a severe shock, rather quickly, are aggravated and lead to the death of the body.

There are three degrees of traumatic shock: I degree (light shock), II degree (shock of medium severity) and III degree (severe shock). At the first degree (in the torpid phase) consciousness is preserved, but clouded, the victim monosyllabically answers questions in a muffled voice (with a larynx injury that leads even to a mild shock, voice communication with the patient is excluded), pulse 90-100 beats / min, blood pressure (100-90) / 60 mm Hg. Art. At a shock of II degree the consciousness confused, retardation, a skin cold, pale, pulse PO-130 beats / min, arterial pressure (85-75) / 50 mm Hg. , breathing is frequent, there is a decrease in urination, pupils are moderately dilated and react weakly to light. With the shock of the third degree - the blackout of consciousness, the lack of response to stimuli, the pupils are dilated and do not respond to light, pale and cyanotic skin covered with cold sticky sweat, frequent superficial unstable breathing, threadlike pulse 120-150 beats / min, arterial pressure 70/30 mm Hg. Art. And lower, a sharp decrease in urination, up to anuria.

With an easy shock wave under the influence of adaptive-adaptive reactions of the body, and with shock of moderate severity - additionally and under the influence of medical measures, gradual normalization of functions and the subsequent exit from shock are observed. Severe shock often even during the most intensive treatment takes an irreversible course and ends with death.

Diagnosis of larynx injury

Diagnosis of external injuries of the larynx is not simple, as it may seem at first glance: it is easy to establish the fact of the larynx injury and its appearance, but it is very difficult at first to assess the severity and establish the nature of internal injuries both in wounds and in blunt injuries. First of all, on the scene of the accident the health worker assesses the consistency of the respiratory function of the larynx and excludes the presence of bleeding. In the first case, attention is paid to the frequency, rhythm and depth of the respiratory movements and chest excursions, as well as to the signs, if present, of expiratory or inspiratory dyspnoea, manifested respectively by swelling or drawing in the supple surfaces of the chest, cyanosis, impaired cardiac activity and anxiety, as well as increasing emphysema, indicating a rupture of the mucous membrane and the formation of obstruction of the larynx, which prevents expiration. In the second case, the definition of the presence of external bleeding is established easily, in contrast to intra-irtane bleeding, which can occur secretly, but give out its cough and splashes of scarlet blood, which are released with an air stream through the mouth. The penetrating wound of the larynx is manifested by a noisy exhalation through the wound opening and a bloody foam emerging through it with air. In all cases of laryngeal trauma, there are symptoms such as breathing disorder, dis- or aphonia, and very often dysphagia, especially if the upper larynx and the larynx are affected. Cartilage fractures are determined by palpation of the anterior surface of the larynx (crepitation, dislocation).

At the scene, the "urgent" diagnosis of the larynx injury is intended to establish indications for emergency medical care based on vital indications, such as providing breathing, stopping bleeding, and fighting shock (see below). In a hospital, the victim is subjected to an in-depth examination to assess the general condition and determine the nature of the injury. As a rule, victims with severe trauma of the larynx are placed in the intensive care unit or directly to the operating room for urgent surgical assistance (final stopping of bleeding by vascular bandaging, tracheostomy and, if possible, specialized or qualified surgical care). If the victim's condition allows, he undergoes a radiological examination of the larynx, which allows to reveal fragments of cartilage, dislocation of parts of the larynx, dislocations in the joints and other signs of violation of its integrity, the presence of hematomas and emphysema. X-ray examination should also touch the hyoid bone, trachea, lungs and chest. If suspicion of a lesion of the esophagus is carried out and its examination using fibroscopy and radiography with contrasting. .

Endoscopic examination of the larynx is expedient to be carried out immediately after radiography, which gives an idea of the nature of the trauma of the larynx. Mainly direct microlaringoscopy is performed, which allows in detail to examine the damaged parts of the larynx and determine their localization and prevalence.

[24], [25], [26], [27], [28], [29], [30]

Treatment of laryngeal injuries

In case of external injuries of the larynx, the nature and volume of first aid and subsequent treatment, as well as indications for transportation of the victim, are determined by the general condition of the patient (no shock, the presence of compensated or decompensated shock), the nature of the injury (bruise, cartilage fractures, cut, chopped or gunshot wound, injury, etc.), the presence of life-threatening conditions (respiratory obstruction, bleeding), etc.

First aid for all types of external injuries of the larynx consists in emergency provision of adequate volume of breathing, either by intubation of the trachea, or by using a wound channel communicating with the lumen of the trachea, or by means of conicotomy or tracheotomy. A specialized surgical emergency team usually performs these procedures at the scene of the accident. To insert a sufficient diameter in the wound of a tracheotomy or rubber tube, you can use the Killian nose mirror (with long branches), since the length of the jaw in the tracheotomy set of the Tissot expander may not be sufficient to penetrate the larynx or trachea lumen. In this case, to suppress the cough reflex and pain syndrome, the patient is administered promedol with atropine and diphenhydramine. The list of urgent measures to provide emergency care to the victim also includes the fight against shock, and treatment should be comprehensive and carried out in the intensive care unit or intensive care unit after providing emergency care to prevent asphyxia or bleeding, or at the same time. In case of traumatic shock hypertensive drugs (dopamine, adrenaline), glucocorticoids (Betamethasone, Hydrocortisone, Dexamethasone, etc.), metabolites, plasma substitutes and other blood substitutes, fibrinolysis inhibitors (Aprotinin, Gordoks), neuroleptics (droperidol), agents for parenteral and enteral nutrition (albumin), enzymes and antiferment (Aprotinin). Each of these drugs is prescribed according to the appropriate indications when coordinated with the physician-resuscitator.

Transportation of the patient from the scene is carried out only after a temporary stoppage of bleeding (dressing the vessel in the wound, pressing a large vessel with a finger, etc.) and establishing breathing (intubation of the trachea, conicotomy). The injured person is transported in a semi-sitting position, simultaneously giving him oxygen or carbogen. During transportation of the victim who is in an unconscious state, measures should be taken to prevent the tongue from becoming tongue by fixing it outside the mouth.

In the surgical department, traumatic damage to the larynx and other respiratory organs is carefully examined to determine the priority measures for the care and treatment of the victim. When the trachea ruptures, its lower end is displaced into the thoracic cavity. In these cases, enter the bronchoscope in the distal part of the trachea, through it suck the blood that has entered into it and conduct the ventilation.

The methods of mechanical ventilation, at least the simplest, should be owned by every practicing physician of any medical specialty. IVL - a therapeutic device aimed at maintaining gas exchange in the absence or sharp suppression of their own breathing. Ventilation is included in a complex of resuscitation measures when blood circulation and respiratory arrest stop, respiratory depression due to various diseases, poisoning, blood loss, trauma, etc. When providing first aid, the most commonly used is the so-called expiratory ventilation by mouth-to-mouth or mouth-to-nose . Before the onset of ventilation, it is necessary to restore airway patency. To do this, the tongue is pulled with the help of a tongue and fixed by stitching outside the mouth, or the victim is laid on his back, his head thrown back, put one hand under his neck, and put the other on the forehead. In this position, the root of the tongue moves away from the back wall of the pharynx, and free air is provided to the larynx and trachea. To restore airway patency, you can use an S-shaped duct or an intubation tube. If it is impossible to restore the external patency of the airways, a tracheotomy is produced.

The technique of ventilation with airway patency is as follows. In the aforementioned position of the victim, the assisting person grasps his nose with his fingers, takes a deep breath and, tightly covering the mouth of the victim with his lips, makes an energetic exhalation, blowing air into his lungs; then the lower jaw of the victim is taken down, the mouth opens and spontaneous exhalation is carried out due to the elasticity of the chest. In the first and second stage, the ventilator helps to follow the excursion of the chest - its ascent by blowing in air and lowering with its passive expiration. If the injection of air through the nose of the victim, then to facilitate exhalation should open his mouth. In order not to touch the mouth or nose of the patient with the mouth, you can put a gauze or handkerchief on them. It is more convenient to insert a nasopharyngeal cannula or a rubber tube through the nostril to a depth of 6-8 cm and blow air through it, clutching the mouth and other nostril of the victim.

The frequency of injection depends on the rate of passive exhalation of air and in an adult should be within 10-20 per 1 minute, and the volume of air blown each time is within 0.5-1 liter.

Intensive ventilation is continued until the disappearance of cyanosis and the appearance of the patient's own adequate breathing. When the heart is stopped, the ventilator is alternated with an indirect heart massage.

After the victim leaves the shock state, the thoracic surgeon provides the patient with a surgical manual aimed at restoring the integrity of the trachea.

With closed fractures of the cartilages of the larynx with their displacement, the position is restored using a tracheoscopic tube and fixed with a tamponade around the intubation tube inserted into the larynx. With open fractures of the larynx, laryngotomy and reposition of its viable fragments with a rubber tube are shown. Free fragments of cartilage, which can not be used for plastic restoration of the larynx lumen, are removed.

To prevent posttraumatic stenosis of the larynx, resort to the early bougie of its lumen.

What prognosis are injuries of the larynx?

Traumas of the larynx have a very serious prognosis, because the life of the victim is threatened with shock, choking, bleeding, secondary purulent complications.