The ABCs of pediatric trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
One must keep in mind that pneumothorax may be associated with more severe injuries of the tracheobronchial tree. A large continuous air leak after chest tube placement or continued respiratory distress may signal a larger tracheobronchial injury. Bronchoscopy in the OR should be performed soon after the primary survey to diagnose the injury in those who fail to resolve their air leak, or who remain difficult to ventilate and oxygenate. If the air leak is on the left side, passing the endotracheal tube into the right main stem bronchus may temporarily allow adequate ventilation and oxygenation until it can be addressed operatively. Tidal volumes must be decreased and rate increased to avoid a pneumothorax on the right side as well. Blood loss from a massive hemothorax should continuously be monitored to avoid hypotension and determine the need for thoracotomy. In general, loss of more than 20 mL/kg of blood from the chest with continued bleeding should be addressed surgically.
Surgical Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Transfer patients with the following injuries immediately to the operating theatre for an urgent thoracotomy: Penetrating cardiac injury.Massive haemothorax with >1500 mL initial drainage or >200 mL/h for 2–4 h.Persistent large air leak suggesting tracheobronchial injury.Cardiac tamponade following trauma.
Chest injuries
Ian Greaves, Keith Porter, Chris Wright in Trauma Care Pre-Hospital Manual, 2018
Definitive treatment of tracheobronchial injury is to secure the airway, usually in hospital. A very high threshold should be maintained for attempting this pre-hospital and if the decision to proceed is made, the need for a surgical airway must be expected and planned for. If intubation is successful, the tip of the tube must be below the injury and therefore may need to be inserted further than normal.
Primary repair of a completely ruptured intermediate bronchus after blunt chest trauma. Case report
Published in Acta Chirurgica Belgica, 2022
Tracheobronchial injury is rare but considered the most severe form of chest trauma. It has a fatal course; pre-hospital mortality rate is reported up to 81% [1]. The incidence is estimated from 0.8% to 5% in the scenario of blunt or penetrating chest trauma [2]. However, diagnosis of tracheobronchial injury is difficult and often delayed. We report a case of a completely ruptured intermediate bronchus with delayed diagnosis.
Related Knowledge Centers
- Bronchus
- Exsanguination
- Pulmonary Aspiration
- Respiratory Failure
- Respiratory Tract
- Trachea
- Blunt Trauma
- Penetrating Trauma
- Chest Injury
- Smoke Inhalation