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ZARIA THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES

ZARIA THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES. DR SANNI R. O 25 th - 02 - 2011. INTRODUCTION RELEVANT ANATOMY AETIOLOGY PATHOPHYSIOLOGY CLINICAL FEATURES INVESTIGATION TREATMENT COMPLICATION PROGNOSIS CONCLUSION. INTRODUCTION.

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ZARIA THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES

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  1. ZARIA THORACIC CLUB MEETINGAHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES DR SANNI R. O 25th - 02 - 2011

  2. INTRODUCTION • RELEVANT ANATOMY • AETIOLOGY • PATHOPHYSIOLOGY • CLINICAL FEATURES • INVESTIGATION • TREATMENT • COMPLICATION • PROGNOSIS • CONCLUSION

  3. INTRODUCTION • Tracheal injuries are rare, life threatening. • Seen in penetrating or blunt neck, chest injury. • Increasing incidence of iatrogenic causes. • Difficult to diagnose & treat. • Broncoscopy for evaluation of lesion. • Primary repair treatment of choice.

  4. Historical perspective • 100% Mortality through out most of history. • 1871- healed TBI in a Duck noted by Winslow. • 1873-earlier report in medical literature. • 1927- 1st documented survival. • 1945- 1st attempt at repair.

  5. epidemiology • Most common injury to the airway.0.5-2% • 2.1-5.3% blunt trauma pt reaching Hospital alive. • 30-80% die b/4 emergency care. • Noted in 2.5-3.2 autopsies post trauma. • 0.5% poly traumatised pt. • 1/20,000 pt intubated, 15% emergency intubation. • M > F.

  6. RELEVANT ANATOMY • Trachea situated btw lower larynx & middle mediastinum. • 4.5 inch length, 1inch diameter. • 15-20 cartilages . • Posteriorly covered by membrane. • Ciliated columnar epithelium.

  7. Aetiology • Blunt, penetrating trauma from RTA. • Gunshot injury. • Fall from height ,crush chest injury. • Stab wound, assault, suicide. • Explosion. • iatrogenic-intubation, bronchoscopy, tracheostomy. • Inhalational injury.

  8. Pathophysiology • Increased pressure in airway ,shearing force. • Sudden chest deceleration in RTA, Shearing force. • Rapid ant. –post. Chest compression, pressure at carina . • Perforation by styelet, ETT. • Penetrating injury.

  9. Classification • Transverse ,most common. • Longitudinal/spiral. • Complex. • Complete or incomplete.

  10. Clinical feature • Depend on location, severity • Hx of trauma, surgery. • Dyspnoea, cough, haemoptysis • hoarseness ,stridor, • Subcutenous emphysema, cyanosis. • Airway obstruction.

  11. Evidence penetrating/blunt trauma. • Air leak. • Pneumothorax. • Other injuries (50%) • Pulmonary contusion, lacerations, • # sternum, rib, clavicle, • Aortic, Spinal cord, head, facial, abdominal injury.

  12. INVESTIGATION • 30-50% not discovered at first. • 10% no sign on CXR. • CXR- sub. emphysema deformity, defect in trachea. high seated hyoid ,sub.emphysema. pneumothorax, pneumomediastinum ETT out of place. fallen lung sign.

  13. CT Scan. • Bronchoscopy -most effective, fastest reliable. • Oesophagoscopy.

  14. Treatment • Based on location severity stability of pt. • Aim- keep airway patent. • Non-operative. • Operative.

  15. Resuscitate- • ETT to bypass at Bronchoscopy. • Supplemental oxygen, mech. ventilation. • Tracheostomy. • Chest tube. • Pulmonary toileting.

  16. Fluid mgt. • Antibiotics. • Analgesia. • Monitoring of vital signs.

  17. Indication for surgical mgt • Tracheal tear affecting ventilation. • Mediastinitis. • Persistent air leak despite chest tube. • Tear >0.5 circumference airway. • Tear with loss of tissue. • Positive pressure ventilation.

  18. Surgical repair. • Rt. Post. Lateral Thoracotomy. • +/- limited debridement • Sutured, +/- butressed.

  19. Complications • Death- pneumothorax, insuffitient airway. • Infection. • Atelectasis. • Stenosis. PROGNOSIS

  20. Conclusion • Though rare, tracheal injury is potentially life threatening and difficult to diagnose therefore high index of suspicion is needed for prompt intervention.

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