If you coach baseball, soccer, hockey, field hockey, basketball, football, tennis or any other sport, you must know the signs to a throat injury. Having this knowledge is vital and can help you recognize the signs and allow you to help save some athletes life.
Ringside physicians have to be aware of throat trauma and the serious complicating effects of missing a quick and accurate diagnosis. Blunt throat trauma to the neck is sometimes difficult to assess and often overlooked with disastrous results.
The literature backs up to the 1960s about frank discussion of procedures, and most of that protocol is still followed today. Since the steps are established, most of the information does not make it to your coaches' forums and workshops. Many sideline physicians can easily miss the common signs and make a bad choice and cost someone their life.
- Contact with a ball to the throat.
- Contact with throat by head or other body part.
- Contact with the throat by stick or other athletic object.
- Throat compression such as in fighting or wrestling, although illegal, it is still possible. Compression of a windpipe is common in MMA (mixed martial arts) and is how 90% of all fights end. Repeated trauma or force to that area causes it to weaken.
- Contact with the ground or anything else, during a fall. (How many kids fall on a soccer ball?)
- Whiplash-type injuries can also result in trauma to the throat.
In the sport of boxing and martial arts, it is a common event for me to see this occur in 1 out of 200 fights. Most of the time, throat trauma is self-evident. The red flags for an emergency situation are:
- Bleeding, noted externally or in the mouth.
- Loss of landmarks due to swelling.
- Loss of breath, labored breathing.
- Increased breath sounds on auscultation.
- Spitting up blood.
- Hoarseness. *Most Common
- Difficulty swallowing. *2nd Most Common
- Loss of movement of the laryngeal structures during speech and/or swallowing.
What To Do!
- Remain calm and speak with authority in your voice.
- Look each person directly in their eyes whom you are asking to do something, and have them repeat it back to you if they are emotionally attached to the patient. Some of you will have to inform them that questions delay treatment.
- Isolate the person from any family or friends' interference.
- Do not excite the patient, rather have them lie down and apply any ice to the sides of their neck. The ice will help stop swelling to the area.
- Lying the patient down will stop further injury from a fall after passing out.
- Tilt the head back slightly; do not use a large pillow or device behind the neck which might result in additional pressure on the area.
- Do not give the patient anything to drink. The act of swallowing will aggravate the condition by bringing blood to the area and it is likely that you will obstruct the smaller airway with fluid.
- Begin to monitor the breaths per minute.
No matter how you deal with this type of injury, always assume that the worst is coming. It is better to be over-reactive than post-reactive and sued. Remain calm and insist on 911 or self-transport. Make sure you inform the 911 operator that throat trauma has occurred and that breathing is becoming impaired.
Note swelling and hoarseness, and begin to monitor the breaths per minute. Beginning CPR on an unconscious patient is noble, but seems almost useless, since none of your breaths will be able to enter the patient's lung until a trach is cut and inserted by EMS or the ED staff. You must attempt to do CPR.
I have seen it before: someone running around after a throat shot and displaying a pseudo-rust sign (holding their neck), while others do not hold their throat - one girl was gripping her arm - but within minutes they pass out (usually while I am on the phone to 911).
Once the patient is down, you should attempt CPR until EMS arrives; keep an eye on the chest to see if it rises as you attempt to blow into the patient's mouth. Report any lack of movement to the EMS staff.
Handling this situation in a calm, informed manner will gain the respect of EMS and your community quickly. I would rather send ten people to the ED than one person to the morgue. You do have the right as a physician to demand transport to an Emergency Department.
You do not, however, have the right to tell them which ED to go to. Nor do you have any input on the EMS's activity once they arrive. Some are trained in intubations, although the literature is somewhat unclear on the additional possibility of puncture.
Post-Traumatic follow-up instructions:
- Restricted use of voice.
- A fluid diet in some cases.
- Adherence to use of oxygen and/or antibiotics.
- Some extreme cases require steroid usage.
- Careful, daily follow up examinations of the external and internal larynx for increased swelling or signs of infection.
- Am J Public Health. 2002 Dec; 92(12):2001-9. "Chiropractic health care in health professional shortage areas in the United States." Smith M, Carber L. Palmer Center for Chiropractic Research (PCCR), Davenport, Iowa 52803, USA.
- J Manipulative Physiol Ther. 2000 Nov-Dec; 23(9):601-9. "The role of Chiropractic in Primary Care: Findings of Four Community Studies." Teitelbaum M. Abt Associates, Inc, Bethesda, Md., USA.
- Arch. Ortoloarng. 1965, 81:91-96. "Problems of Closed Laryngeal Injury." Brandenburg, J. H.
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- Can J Surg. 2003 Feb; 46(1): 57-8. "Pharyngeal perforation caused by blunt trauma to the neck." Hagr A, Kamal D, Tabah R.
- J Emerg Med. 1995 Mar-Apr; 13(2): 165-7. "Traumatic retropharyngeal hematoma--a cause of acute airway obstruction." Mitchell RO, Heniford BT