Presentation
We report a patient who presented after a road traffic accident with an apparently persistent pneumothorax which failed to respond to emergency treatment. This was later discovered to be due to a traumatic bronchial rupture. [ncbi.nlm.nih.gov]
In the present clinical report, rigid bronchoscopy was not available at admission and the patient was intubated. [link.springer.com]
Elsevier Health Sciences, ٣١/٠١/٢٠١٤ - 992 من الصفحات Acclaimed for its unsurpassed readability and manageable scope, Ashcraft’s Pediatric Surgery presents authoritative, practical guidance on treating the entire range of general surgical and urological [books.google.com]
Funding and Disclosures * Presented at the annual meeting of the New England Surgical Society, Portsmouth, New Hampshire, October 4, 1957. [nejm.org]
Entire Body System
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Atrial Septal Defect
The syndrome is rarely seen and is usually associated with a patent foramen ovale or atrial septal defect. The syndrome has not been described previously in association with traumatic bronchial rupture. [ncbi.nlm.nih.gov]
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Splenectomy
Hone and expand your surgical skills by watching videos of minimally invasive procedures for recto urethral fistula, biliary atresia, laparoscopic splenectomy, uterine horn, and more. [books.google.com]
Respiratoric
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Cough
Symptoms Pain – Chest Pain, Neck Pain, Throat Pain Hoarseness, Stridor, Cough Globus Pharyngeus – persistent or intermittent, non-painful sensation of swelling or foreign body in throat. [emdocs.net]
Clinical assessment of tracheobronchial rupture is followed by conservative measures [10] before bronchoscopy and include antibiotic administration, symptoms relief with subcutaneous needle or chest tube to release pneumothorax and avoiding vigorous cough [annals.in]
Symptoms may include: Coughing up blood Bubbles of air that can be felt underneath the skin of the chest, neck, arms, and trunk ( subcutaneous emphysema ) Difficulty breathing People who have had a trauma will need to have their injuries treated. [medlineplus.gov]
Signs and symptoms include difficulty breathing, hoarseness, coughing, and abnormal breath sounds ; however they vary based on the location and severity of the injury. [wikidoc.org]
Symptoms may include: Coughing up blood Bubbles of air that can be felt underneath the skin of the chest, neck, arms, and trunk ( subcutaneous emphysema ) Difficulty breathing Exams and Tests The health care provider will perform a physical exam. [leehealth.org]
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Platypnea
A patient with blunt trauma and traumatic bronchial rupture and lung collapse had prominent symptoms of platypnea-orthodeoxia syndrome. These symptoms were relieved by bronchial repair. [ncbi.nlm.nih.gov]
Psychiatrical
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Withdrawn
After pneumonectomy, the ET was withdrawn above the carina under FOB guidance. Adequacy of left bronchial stump repair was confirmed by FOB. [annals.in]
The sheath of the bronchoscope was introduced into the left main bronchus under vision and the telescope was withdrawn. A lubricated stiff stilette (tube exchanger) was passed through the sheath into the left bronchus. [jiaps.com]
Face, Head & Neck
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Subcutaneous Emphysema of the Neck
She was alert and physical examinations revealed right shoulder laceration, right knee abrasion, right parietal scalp deep laceration with bony exposure, and subcutaneous emphysema of the neck, arms, thoracic wall and abdominal wall. [saudija.org]
Workup
Written by one of the most eminent pediatric radiologists, this popular textbook is a practical, concise, and easy-to-read guide to the radiologic workup of acute illnesses and injuries in children. [books.google.com]
Loss of the aortic knob contour, shift of the esophagus (nasogastric tube) to the right and an apical cap in addition to mediastinal widening indicate need for further workup.[4, 5] Aortic Injury 80-90% of patients with thoracic aortic rupture die in [trauma.org]
Post-traumatic epilepsy may be classified into tidamax types. 37 Indications for surgery depend on the flagyl tindamax of the diagnostic workup. B. [artem-kuzmin.ru]
Microbiology
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Pseudomonas
A second ventilator-associated pneumonia caused by Pseudomonas aeruginosa delayed withdrawal of the patient from mechanical ventilation, which was successfully achieved on day 18. [link.springer.com]
Treatment
Abstract Traumatic injury to the tracheobronchial tree requires prompt, accurate diagnosis for optimum surgical treatment. [ncbi.nlm.nih.gov]
Focus on evidence-based treatments and outcomes to apply today’s best practices. [books.google.com]
[…] to administer a treatment. [kjccm.org]
Treatment of tracheal injury Conservative treatment The simple airway mucosal tearing is always self-limited without any special treatment. [jtd.amegroups.com]
Prognosis
Outlook (Prognosis) Outlook of injury due to trauma depends on the severity of other injuries. Operations to repair these injuries often have good results. [leehealth.org]
[…] common in children than in adults and there are two peaks of incidence: 5-6 years old children tend to be pedestrians involved in traffic accidents and falls at home and 12-14 years old children tend to be involved in motorbike accidents. [5], [6] The prognosis [saudija.org]
The prognosis depends more on the associated injuries, nevertheless it seems that left-sided lesions have a more favorable outcome [ 4 ]. [omicsonline.org]
Prognosis resolution of wall motion abnormalities in 25% only (NB based on only 14 patients) Ruptured aorta traumatic aortic injuries are the second most frequent causes of death in patients with chest injuries Mechanism and types of injury Deceleration [aic.cuhk.edu.hk]
[…] tissue) may be removed in order to get clean edges that can be surgically repaired. [10] When lung tissue is destroyed as a result of TBI complications, pneumonectomy or lobectomy (removal of a lung or of one lobe, respectively) may be required. [17] Prognosis [wikidoc.org]
Etiology
Of cases of pneumomediastinum one study found 50% were Spontaneous Primary Pneumomediastinum. ( Wong, 2013 ) Secondary Pneumomediastinum Pneumomediastinum is present due to a defined etiology: Spontaneous ( Wong, 2013 ) Asthma Exacerbation – 17% Pneumonia [emdocs.net]
Minor Injury Management Sometimes the bronchial injury is minor or has a different etiology, or cause, other than trauma. Here are a few examples and how to treat them. [study.com]
Wintermark M, Schnyder P: The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001, 120: 543-547. 10.1378/chest.120.2.543. CrossRef PubMed Google Scholar 20. [link.springer.com]
Classification From etiology the tracheobronchial injury can be classified as traumatic and iatrogenic sources, in which the traumatic etiology includes crush injury, firearm injury and sharp instrument injury, which can be combined with the injury of [jtd.amegroups.com]
Epidemiology
Review Epidemiology The true incidence of TBI is still unknown as 30–80% of these trauma victims still die at the scene of the accident[ 3 ]. [cardiothoracicsurgery.biomedcentral.com]
[…] people who have tracheobronchial tears surgically repaired early in treatment. [9] Even when surgery is performed years after the injury, the outlook is good, with low rates of death and disability and good chances of preserving lung function. [17] Epidemiology [wikidoc.org]
ARDS Myocardial contusion Definition and epidemiology direct traumatic myocardial damage without traumatic involvement of coronary arteries common in blunt trauma but difficult to diagnose tends to occur in acceleration/deceleration and crush/compression [aic.cuhk.edu.hk]
[…] good for over 90% of people who have TBI surgically repaired early in treatment. [10] Even when surgery is performed years after the injury, the outlook is good, with low rates of death and disability and good chances of preserving lung function. [29] Epidemiology [en.wikipedia.org]
Pathophysiology
[…] in 76% of patients, whereas 43% patients had injuries within first 2 cm of the right main bronchus. [1], [4] Injuries on the right side were detected and treated sooner but were associated with a higher mortality than the left side injuries. [1] The pathophysiology [ijccm.org]
"Thoracic malignancy and pathophysiology". In Atluri P, Karakousis GC, Porrett PM, Kaiser LR (eds.). The Surgical Review: An Integrated Basic and Clinical Science Study Guide. Hagerstown, MD: Lippincott Williams & Wilkins. p. 376. [en.wikipedia.org]
View Article PubMed Google Scholar Chhabra A, Rudigwa P, Panneer Selvam SR: Pathophysiology and management of airway trauma. Trends Anaesth Crit Care. 2013, 3: 216-219. [cardiothoracicsurgery.biomedcentral.com]
Prevention
Thus, early surgical intervention is essential to prevent long-term complications of this injury. Ninety percent of these injuries if primarily repaired heal without any sequelae [2-5]. [ctsnet.org]
It is better to avoid the positive pressure ventilation to prevent further expansion of tear as far as possible. [jtd.amegroups.com]
Early surgical repair prevents infection and bronchial stenosis and decreases the need for lung resection. [8] In chronic bronchial rupture, fibrosis following atelectasis might prevent reexpansion and may even require pneumonectomy, [9] though, successful [jiaps.com]
"Posterior tracheal wall perforation during percutaneous dilational tracheostomy: An investigation into its mechanism and prevention". Chest. 115 (5): 1383–9. doi : 10.1378/chest.115.5.1383. PMID 10334157. [en.wikipedia.org]
Main benefit is to prevent deformity. weaning should not wait till paradoxical movement improves, rather should be initiated when gas exchange is adequate. in absence of systemic hypotension control administration of IV fluids to prevent overhydration [aic.cuhk.edu.hk]