The treatment of otolaryngology, head, and neck trauma in warfare varies depending on the time period after the injury, with different focus areas at each stage. The key is early, definitive treatment, which allows medical measures to be implemented as soon as possible.
In the middle and later stages, the focus shifts to preventing complications. The main emphasis in treating otolaryngology, head, and neck trauma is preventing suffocation, as fatal dangers include spinal cord transection and major blood vessel hemorrhage. Based on anatomical and physiological features, patients with otolaryngology, head, and neck trauma should be urgently treated and quickly transferred to hospitals for specialized care. Early, correct handling of these injuries is critical for improving survival rates and achieving the best treatment outcomes.
1. Early and Effective Emergency Treatment
In this phase, the focus is on clearing the airway and controlling major blood vessel bleeding. The first responders or the initial witnesses should immediately provide basic life support, such as cardiac compressions, artificial respiration, bleeding control, and maintaining an open airway.
Medical personnel should conduct a thorough examination, assess the injury, and establish the treatment and management order, aiming for rapid transfer to a definitive care facility. Critical patients must be treated quickly, accurately, and effectively.
In cases of otolaryngology, head, and neck trauma, maintaining airway patency is key to life-saving interventions. If blood clots, bone fragments, or foreign objects are present in the mouth or throat, they should be cleared promptly. For edema or airway obstruction, tracheal intubation or cricothyroidotomy should be performed. For active bleeding, hemostatic powders or gauze can be used for initial control, followed by pressure or dressing to reduce blood loss and gain time for further treatment. Detached tissues from the ears, nose, and other areas should be properly preserved for later repair.
2. Respiratory Difficulty or Airway Obstruction Rescue
Establishing an effective airway is the key to alleviating respiratory difficulty and saving lives in cases of otolaryngology, head, and neck trauma. After clearing blood clots, bone fragments, saliva, or vomit from the mouth, nose, and throat, an appropriate emergency airway should be established.
In cases of severe airway obstruction with no available tools for endotracheal intubation or tracheotomy, a cricothyroidotomy or tracheostomy may be performed. If possible, endotracheal intubation or quick tracheotomy should be done based on the condition.
3. Hemorrhage Control
The principle of hemorrhage control is to stop bleeding and maintain effective circulation. For neck vascular injuries, packing can be used to control bleeding, avoiding unnecessary ligation to preserve brain blood flow. For major bleeding in the neck, arteries such as the common carotid and internal carotid should be repaired, while other blood vessels may be ligated depending on the injury.
To prevent hematoma-induced airway obstruction, open wounds in the neck area can be left unsutured temporarily, and vessels that have stopped bleeding should be left undisturbed for later treatment. For nasal trauma, packing with gauze or 2% boric acid gauze strips can control bleeding, and if bleeding persists, vascular ligation can be performed.
4. Prevention of Shock
To prevent shock in otolaryngology, head, and neck trauma, comprehensive measures should be taken based on the overall condition. These measures include bleeding control, fluid resuscitation, maintaining adequate circulatory volume, clearing abnormal respiratory secretions and foreign objects, and establishing a clear airway. For patients experiencing severe pain or agitation, sedation and analgesia should be administered. Proper wound debridement and antibiotic therapy are crucial to prevent infection.
5. Timely Diagnosis and Treatment of Brain Injuries
Severe otolaryngology, head, and neck injuries often involve cranial trauma, which may present with symptoms like consciousness disturbance, cerebrospinal fluid leakage from the nose or ear, and nasal bleeding.
Emergency treatment should prioritize brain injuries, such as stabilizing the head trauma before treating nasal or facial injuries. If there is active nasal bleeding with brain injury, the bleeding should be managed first. The treatment focus for patients with head and neck trauma and concurrent brain injuries is to clear the airway, prevent suffocation in comatose patients, control major bleeding early, manage brain injuries, and prevent complications like cerebral edema, intracranial hypertension, and intracranial infection. Additionally, protecting and accelerating brain function recovery is crucial.
6. Preservation of Physiological Functions and Aesthetic Repair
Early and correct management is key to preserving and saving the physiological functions of the respiratory, swallowing, smell, and hearing functions, as well as reconstructing anatomical positions. Timely and accurate restoration of injured tissue anatomy and preserving viable tissues will help rebuild functions and prevent complications such as scarring, narrowing, and functional impairments after wound healing.
7. Infection Prevention
For otolaryngology, head, and neck trauma, timely and adequate use of broad-spectrum antibiotics is essential to prevent infection. This prevents tissue necrosis due to infection, helps restore tissue vitality and organ function, and mitigates the severe consequences of potential infection spread.