Tracheobronchial Tree Injuries Management
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Questions and Answers

What is the treatment for a patient with a tracheobronchial injury and an unstable airway?

  • Surgical repair (correct)
  • Lung resection
  • Bronchoscopy
  • Conservative management

    • A patient presents with a foreign body in the airway. What is the management of this condition?

  • Urgent bronchoscopy
  • Urgent bronchoscopy with bronchotomy (correct)
  • Bronchoscopy with precaution and lung resection
  • Surgical repair of the airway

    • What is the most common site of esophageal injuries?

  • Thoracic esophagus
  • Abdominal esophagus
  • Lower esophagus
  • Cervical esophagus (correct)

    • What is the investigation of choice for esophageal injuries?

    <p>Water soluble contrast swallow and oesophagram</p> Signup and view all the answers

    What is the management of esophageal injuries?

    <p>Debridement and drainage within 24 hours</p> Signup and view all the answers

    What is the common complication of esophageal injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the management of a foreign body in the esophagus?

    <p>Oesophagoscopy with mediastinal drainage and repair</p> Signup and view all the answers

    What is the marker of severe thoracoabdominal trauma?

    <p>Diaphragmatic injury</p> Signup and view all the answers

    What is the investigation of choice for diaphragmatic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the management of cardiac injuries?

    <p>Surgical repair</p> Signup and view all the answers

    What percentage of thoracic deaths are attributed to thoracic injury worldwide?

    <p>20-25%</p> Signup and view all the answers

    What is a characteristic of pediatric thorax in relation to thoracic trauma?

    <p>More cartilage = absorbs forces</p> Signup and view all the answers

    What type of force is responsible for injuries in acceleration-deceleration injuries?

    <p>Shearing</p> Signup and view all the answers

    What is a clinical feature of flail chest?

    <p>Paradoxical motion</p> Signup and view all the answers

    What is a common associated injury with haemothorax?

    <p>Lung contusion</p> Signup and view all the answers

    What is the primary goal of initial evaluation in thoracic trauma?

    <p>Provide prompt identification of life-threatening injuries</p> Signup and view all the answers

    What type of injury is characterized by a tear in the tracheobronchial tree?

    <p>Tracheobronchial injury</p> Signup and view all the answers

    What is a common complication of sternal fractures?

    <p>Myocardial injury</p> Signup and view all the answers

    What is the reported percentage of myocardial contusion in autopsy series of patients with BCI?

    <p>60-100%</p> Signup and view all the answers

    What is the most common site of blunt aortic injuries?

    <p>Isthmus, near ligamentum arteriosum</p> Signup and view all the answers

    What is the radiographic feature associated with thoracic aortic injury?

    <p>Loss of aortic knuckle contour</p> Signup and view all the answers

    What is the mortality rate of patients with aortic injuries within 1 week?

    <p>70%</p> Signup and view all the answers

    What is the management of blunt aortic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the most common mechanism of blunt aortic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the clinical presentation of patients with aortic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the treatment of myocardial rupture?

    <p>Simple cardiorrhaphy</p> Signup and view all the answers

    Study Notes

    Tracheobronchial Tree Injuries

    • Conservative treatment for tracheobronchial tree injuries
    • Surgical approach based on location and extension of injury
      • Cervical collar incision for proximal trachea
      • Right postero-lateral thoracotomy for lower trachea, carina, right main bronchus (RMB), and proximal left main bronchus (LMB)
      • Left postero-lateral thoracotomy for distal LMB
    • Management options: primary repair, sleeve resection, lung resection

    Foreign Body in the Airway

    • Management of foreign body in the airway:
      • Acute: urgent bronchoscopy with or without bronchotomy
      • Chronic: bronchoscopy with precaution, with or without lung resection

    Esophagus Injuries

    • Esophagus injuries are rare, often caused by blunt trauma or penetrating injuries (stab or trans-mediastinal gunshot)
    • Cervical esophageal injuries are most common
    • Clinical features:
      • Pneumothorax (left)
      • Haemothorax without rib fractures
      • Lower sternum or epigastric pain (severe blunt trauma)
      • Particulate matter in the ICD
      • Penetrating injury that has crossed mediastinum
      • Odynophagia
      • Dysphagia
      • Surgical emphysema
      • Mediastinitis
    • Investigations: combination of clinical suspicion, CXR, water-soluble contrast swallow, and oesophagoscopy
    • Management:
      • Timing: 24 hours, debride and drainage, surgical repair or resection with delayed reconstruction
      • Approach: via right posterolateral thoracotomy (RPLT) for upper esophagus, or left posterolateral thoracotomy (LPLT) for lower esophagus
    • Complications: mediastinal contamination, abscess formation, empyema thoracis

    Foreign Body in the Esophagus

    • Types of foreign bodies: bone, meat, battery, coin
    • Clinical presentation:
      • Acute: dysphagia, choking, hematemesis
      • Chronic: hemoptysis, coughing when feeding
    • Management: oesophagoscopy with or without mediastinal drainage and repair

    Diaphragmatic Injuries

    • Often occult, easily missed, and commonly detected on the left side
    • Marker of severe thoracoabdominal trauma
    • Causes: blunt, penetrating (stab or iatrogenic-ICD)
    • Clinical features:
      • With or without signs of bowel obstruction, drainage of peritoneal content via chest drain
      • NGT in the chest (CXR)
      • Herniation of GIT
      • Acute, delayed, and common on the left side
    • Investigations: CXR (elevated hemidiaphragm, haemo-pneumo), swallow and follow-through, contrast-enhanced CT scan
    • Management: surgical repair via thoracotomy, thoraco-abdominal incision, or laparotomy, laparoscopy

    Cardiac Injuries

    • Penetrating and blunt cardiac injuries
    • Blunt cardiac injuries (BCI):
      • Pathology: patchy areas of muscle necrosis, hemorrhagic infiltrate, rupture of small vessels, hemorrhage into interstitium and around muscle fibers
      • R.Madansein, Department of Cardiothoracic Surgery, UKZN
    • Frequency of Injury: 20-25% of thoracic deaths worldwide
    • Male vs female, age, blunt, penetrating, and transfixing mechanisms

    Thoracic Trauma

    • Thoracic injury accounts for 20-25% of thoracic deaths worldwide
    • Mechanism of injury:
      • Penetrating: high velocity (gunshots), low velocity (stab wounds)
      • Blunt: direct (assault and blast), indirect (falls, MVA - acceleration-deceleration injuries, crush injuries, and shearing forces)
      • Transfixing
    • Special factors: pediatric thorax (more cartilage, absorbs forces), geriatric thorax (calcification and osteoporosis, more fractures)

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    Thoracic Trauma-.pptx

    Description

    This quiz covers the management of tracheobronchial tree injuries, including conservative and surgical approaches. It discusses the different techniques used to repair injuries based on location and extension.

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