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The Annals of Thoracic Surgery, Vol 40, 551-555, Copyright © 1985 by The Society of Thoracic Surgeons
JP Kelly, WR Webb, PV Moulder, C Everson, BH Burch and ES Lindsey
One hundred six consecutive patients with injuries to the tracheobronchial
tree who were admitted to the emergency room of the Tulane Medical Center
Hospital or the Charity Hospital of Louisiana at New Orleans over a period
of almost 20 years were analyzed retrospectively. Penetrating trauma of the
neck or chest was reported in 100 of the patients, and only 6 had blunt
trauma to the neck or thorax as the cause of injury. There were 18 deaths
among the 106 patients (16.98%), including 11 (13.75%) of 80 with injuries
of the cervical trachea. Seven (53.8%) of 13 with principal injuries of the
thoracic trachea died; all 13 patients with major bronchial injuries
survived. On admission to the emergency room, all patients had signs of
airway compromise such as tachypnea, dyspnea, cyanosis, subcutaneous
emphysema, or an abnormal respiratory pattern. Severe airway compromise was
evident in 46 patients; 24 (23%) were treated with oral or nasal
intubation, 19 (18%) with emergency tracheostomy, and 3 (2%) with
intubation of a tracheal injury. Hemoptysis was an unreliable signal of
serious injury, being present in only 28 of the patients. Patients who had
major vascular injuries combined with trachea involvement were generally
not salvageable. In regard to morbidity and mortality, the most common
preventable errors were delay in diagnosis and treatment of
tracheobronchial injuries, missed esophageal injuries, massive aspiration
of blood, and abdominal vascular injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Management of airway trauma. I: Tracheobronchial injuries
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