Pathology of tracheal trauma

2021-02-01 12:00 AM

Endoscopy is necessary to determine the location and nature of the injury, but extreme caution may be required as it can aggravate trauma and cause severe breathing difficulty.

Often very serious due to lack of oxygen, accompanied by gas spills, blood in the chest, easily causing serious complications.

Reason

Neck: common in open neck trauma, but can also be seen in closed trauma due to a hit or a strangled stranglehold.

Chest area: in addition to open trauma, there are also injuries caused by the sternum pressing strongly against the spine or by a bounce.

Symptom

Clinical

An overflow is a sign that needs to be detected as soon as there is an injury. The spill can be obvious, spread quickly, but it can also be small, discreet, sometimes only when the anesthetic is applied.

The gas can be under the skin, feel flat, if obvious causing deformation of the neck, chin, face, chest.

Pneumothorax in thoracic tracheal tear may only see air bubbles in the mediastinum, around the heart, the top of the lungs and may deflate part or all of the pulmonary lobe.

Difficulty breathing: both have difficulty breathing, more clearly, exhale if there is chest injury or then breathe in if there is laryngeal injury. Shortness of breath can be mild to moderate or severe and gradually progresses.

Cough: increased pain when coughing, coughing into bouts, possible coughing, difficulty breathing clear purple.

X-ray: showing a chest or chest gas spillage, the level of gas spillage, but often difficult to identify the trauma area. CT Scan can show a more complete image of the lesion.

Laparoscopy: is necessary to determine the location and nature of the injury, but extreme caution may be exercised as it may exacerbate the injury and cause severe shortness of breath.

To solve

Emergency

When there is perforation, tearing, rupture of tracheal cartilage or when there is difficulty breathing, threatening to bleed into the airways, clear air spillage.

Need to:

Open the emergency trachea, if allowed to open the trachea low, far from the wound to maintain ventilation.

Anti-shock, anti-bleeding.

Medical

Lie high head, limit changes in head position.

Early corticosteroids to reduce edema, avoid sticky scarring.

Antibiotic.

Reduce respiratory secretion to prevent inflammation of the lower respiratory tract.

SAT injection (against tetanus).

Surgery

Depending on the condition of the wound, ensure principles:

Sew tight or broken stitches.

Savings in cutting torn, broken parts.

Sew each layer in accordance with the anatomical position and the tie is always on the outside.

Staple fixed with balance, muscle, mucosa and if lacking can be moved from other places to.

Place the stent with Aboulker or Montgomery tubes and leave it on.

If cut off or crushed cartilage ring, cut off and perform tracheostomy stitching.

Fixed neck movements for at least a week.

Follow

After withdrawing the breathing tube, it is necessary to follow up periodically in the next few months to detect early signs of scarring, scarring and narrowing.