Throat Trauma - Soccer

Abstract

HISTORY: A 21-year-old female college soccer player sustained a throat injury. During the last eight minutes of a late season game, the soccer player jumped vertically to head the ball. At the same time, two opposing players from the front and back of the player were positioning themselves to also advance the ball. As all three players jumped simultaneously to head the ball, this soccer player was caught between the two opposing players. She suffered an anterior and posterior head-to-neck collision. There was no observed loss of consciousness. She complained of anterior neck pain that radiated to her posterior neck. No initial shortness of breath or hemoptysis but player complained of throat pain and hoarseness. The player denied any numbness or parasthesias in her upper or lower extremities. PHYSICAL EXAMINATION: Initial On-field examination; General: supine, alert and anxious Neck: (+) Anterior neck pain in Zone II. Trachea was midline and tender, no crepitus, no bleeding in the oropharynx or nasal mucosa, no visible obstruction, dentition intact. Cervical spine examination showed paraspinal muscle tenderness but no bony midline tenderness. Lungs: symmetric respiration, transmitted upper airway sounds, otherwise clear to auscultation bilaterally, no wheezing. Musculoskeletal: strength intact bilaterally in upper and lower extremities. Neurological: intact to tactile stimuli bilaterally in upper and lower extremities. Vital Signs per EMS: BP 110/70 HR 100 RR 28. DIFFERENTIAL DIAGNOSIS: Laryngeal edema Laryngeal spasm Vocal Cord paralysis Vocal Cord hematoma Foreign Body obstruction Bronchospasm TEST AND RESULTS: Pulse Oximetry: 99% RA FINAL WORKING DIAGNOSIS: Trauma induced Laryngeal injury with possible spinal column injury TREATMENT AND OUTCOMES: Cervical spine immobilized with rigid cervical collar and spinal board. Player was given supplemental oxygen via mask and transferred to outside Trauma Center. During EMS transport, hoarseness progressed into stridor with increased respiratory rate and increased shortness of breath. Upon arrival to the Trauma Center, player taken for emergent tracheotomy and further airway management. Cervical spine management per outside hospital protocol.