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  • • Blunt tracheobronchial injuries often the result of compression of the airway between the sternum and the vertebral column

    • Blunt injury usually involves distal trachea or mainstem bronchi

    • Penetrating tracheobronchial injuries may occur at any location

    • Tracheobronchial injury suspected with massive air leak or with poor reexpansion after chest tube placement

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Epidemiology

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  • • Trauma patients

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Symptoms and Signs

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  • • Most patients have pneumothorax, subcutaneous emphysema, and hemoptysis

    • Penetrating injuries usually cause massive hemoptysis

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Imaging Findings

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  • • Pneumothorax

    • Pneumomediastinum

    • Subcutaneous air

    • Pneumothorax that persists after chest tube placement

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  • • Associated abdominal injuries may dictate care

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  • • Physical exam

    • ABG measurements

    • Chest x-ray

    • Late presenting injuries may require bronchoscopy

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  • • Resuscitation and stabilization

    • Chest tube

    • Intubation and mechanical ventilation

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Surgery

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  • • Immediate primary repair is indicated for tracheobronchial laceration

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Indications

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  • • Tracheobronchial laceration

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Treatment Monitoring

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  • • Serial chest x-ray

    • Serial ABG measurements

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References

Karmy-Jones R et al: Urgent and emergent thoracotomy for penetrating chest trauma. J Trauma 2004;56:664.  [PubMed: 15128141]
Meredith JW, Hoth JJ: Thoracic trauma: when and how to intervene. Surg Clin N Am 2007;87:95.  [PubMed: 17127125]
Stassen NA et al: Reevaluation of diagnostic procedures for transmediastinal gunshot wounds. J Trauma 2002;53:635.  [PubMed: 12394859]

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