The padded dashboard syndrome refers to a pattern of airway injury that can occur during a car accident. A high index of suspicion may be necessary to make the diagnosis.
The padded dashboard syndrome occurs when an automobile is involved in a frontal impact.
Scenario 1:
(1) an unrestrained person is present in the front passenger seat
(2) the anterior aspect of the neck strikes the car dashboard
Scenario 2:
(1) the driver is usually unrestrained
(2) the driver's anterior neck strikes the steering wheel
Neck structures may be damaged:
(1) when they are crushed between the dashboard or steering wheel and the vertebral column.
(2) if the neck is hyperextended at the time of impact.
The structures that may be injured include:
(1) larynx, crichoid cartilage and/or trachea
(2) esophagus
The patient experiences severe respiratory distress when not intubated. If the patient was intubated at the scene then the respiratory distress may appear soon after extubation.
Other findings may include:
(1) crepitus over the laryngeal shield
(2) neck pain made worse by coughing or swallowing
(3) dysphonia or aphonia
(4) stridor
(5) hematoma or ecchymosis
(6) tenderness to palpation
Reasons why the diagnosis may be delayed:
(1) The injury is rare.
(2) Other injuries may be absent.
Differential diagnosis: seat belt injury to the trachea
