Juvekar Nilesh M, Deshpande Sharmila S, Nadkarni Anand, Kanitkar Shreedhar
Department of Cardiac Anesthesia, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India.
Ann Card Anaesth. 2013 Apr-Jun;16(2):140-3. doi: 10.4103/0971-9784.109772.
We describe tracheobronchial injury (TBI) in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB) was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR) for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.
我们描述了一名17岁青少年在道路交通事故导致钝性创伤后发生的气管支气管损伤（TBI）。患者因颈部和面部肿胀并伴有双侧气胸被送至一家基层医院，在该医院插入了双侧肋间引流管，随后患者被转至我院。进行了纤维光学视频支气管镜检查（FOB），观察了气管和支气管情况，并评估了损伤的部位和程度。在评估气道之前一直维持自主呼吸。然后用丙泊酚麻醉患者，使用琥珀酰胆碱使其肌肉松弛，并插入双腔支气管导管；此后，评估了控制手法通气的充分性以及通过肋间引流管的漏气情况，患者被转至手术室（OR）进行气道损伤修复。在进行FOB期间，手术室随时准备应对任何突发情况。本病例描述了医疗团队成员之间进行适当准备和沟通以应对创伤性TBI所有可能情况的必要性。
