Tracheobronchial Injury

Question 1

General Considerations:

• Injury to the trachea or bronchus as a result of blunt trauma relatively uncommon is severe.
• Approximately 80% of patients die before reaching hospital
• Are usually result of motor vehicle accidents and crush injuries
• Right-sided injuries more common and typically more severe, while almost 80% occur within 2 cm of the carina
• Injury is missed in at least 25% of patients during the initial trauma evaluation

Answer 1

Tracheobronchial Injury

Question 2

Physical Findings:

Failure to recognize during the initial trauma evaluation common.

Patients may be comfortable on room air or may present in acute respiratory distress

Most common symptoms and signs:
* Dyspnea
* *Subcutaneous emphysema of the neck or upper thoracic region
* Hoarseness
* Hemoptysis
* Hypoxia
* Persistent pneumothorax despite appropriate tube thoracostomy.

Answer 2

Tracheobronchial Injury

Question 3

Lab/Imaging:

CXR findings indicative of tracheobronchial injury:
* Subcutaneous emphysema
* Pneumomediastinum: rotation inspiration swollen and shifted
* Pneumothorax
* Peri-bronchial air

Answer 3

Tracheobronchial Injury

Question 4

Treatment:

All patient in respiratory distress with suspected injury should be endotracheal intubated.
* Preferable over a bronchoscope if time allows.
* Blind intubation is discouraged as it may result in the complete disruption of small tracheal lacerations.

Stable patients with suspected trauma to the trachea or bronchi should undergo immediate bronchoscopy.
* Definitive evaluation and localization of the injury.
* Operative repair

Cricothyroidotomy if needed.

Disposition:
MEDEVAC

Answer 4

Tracheobronchial Injury