User:Delldot/tb

From Wikipedia, the free encyclopedia

This is a workpage, a collection of material and work in progress that may or may not be incorporated into an article. It should not necessarily be considered factual or authoritative.

Tracheobronchial injury Classification and external resources
ICD-10	GroupMajor.minor
ICD-9	xxx
eMedicine	radio/706

Tracheobronchial injury (TBI') is an injury caused by physical trauma to the tracheobronchial tree (trachea and/or the major bronchi ??? ). Though rare, tbt is potentially fatal.^[1] It can result from neck or chest trauma.^[2] and from blunt or penetrating trauma.^[1]

It is not usual for other other injuries to accompany tbt.^[3] <-- the hell? It is common for other injuries to accompany TBI;^[4] they do in about half of cases.^[1]

1 Classification
2 Signs and symptoms
3 Anatomical sites
4 Causes
5 Mechanism
6 Diagnosis
7 Treatment
8 Prognosis and complications
9 Epidemiology
10 History
11 References
12 Get
13 R
14 to do

[edit] Classification

Lesions can be transverse, occurring between the rings of the trachea, or longitudinal or spiral, occurring along the membranous part of the trachea, the main bronchi, or both.^[4] In 8% of ruptures, lesions are complex, occurring in more than one location or with more than one type of lesion on both main bronchi and the trachea.^[4]

[edit] Signs and symptoms

Hemoptysis (coughing up blood) and dyspnea (difficulty breathing) are typically found.^[4]

[edit] Anatomical sites

The most common tracheal injury is a tear near the carina or in the membranous wall of the trachea.^[3]

TBI is more common in the right main bronchus than the left, possibly because the aorta protects the left main bronchus and the right main bronchus is near vertebrae.^[4] TBI occurs within 2.5 cm of the carina 40–80% of the time.^[4]

[edit] Causes

High-energy impacts such as falls from height and vehicle collisions are the usual mechanism for TBI; the injury is rare in low-impact mechanisms.^[4]

Vehicle accidents are the usual cause.^[3] Other potential causes are falls from high places and injuries in which the chest crush injury|chest is crushed.^[3]

[edit] Mechanism

TBI, usually the result of violent compression of the chest^[1]

Though the mechanism is not well understood, TBI is widely thought to be caused by any combination of three possible mechanisms: an increase in pressure within the airways, shearing, and pulling apart.^[4] Crushing can cause the airways to be compressed between the sternum and spinal column.^[4] The pressure quickly and sharply rises because the glottis reflexively closes, potentially causing the airways to burst.^[4] Shearing may occur when the chest is suddenly decelerated because areas near the cricoid and carina are fixed to the thyroid cartilage and the pericardium respectively.^[4]

When the chest is compressed from front to back, it widens; this pulls apart the lungs, and can cause the the main bronchi to tear.^[4]

[edit] Diagnosis

Bronchoscopy is used to diagnose the injury.^[4]^[5]

[edit] Treatment

Image:Et tube

To treat TBI, the tear in the airway is bypassed using an endotracheal tube

Surgery is often needed to repair the tear.^[4] In severe TBIs, lobectomy (removal of a lobe of the lung) or pneumonectomy (removal of an entire lung) may be required.^[4]

[edit] Prognosis and complications

Most people who die do so within minutes of the injury, due to complications such as pneumothorax and insufficient airway and to other injuries that occurred at the same time.^[1]

Bronchial stenosis, pneumonia and bronchiectasis may occur as late complications if TBI goes untreated.^[4] Most late deaths that occur in TBI are attributed to sepsis or multi-organ dysfunction syndrome.^[4]

[edit] Epidemiology

It is difficult to determine the incidence of TBI because in many cases, death occurs before the person reaches a hospital.^[4] An autopsy study reported that TBI occurred in 2.8% of cases of blunt trauma deaths.^[4] In people with blunt trauma who do reach a hospital alive, reports have found incidences of 2.1% and 5.3%.^[4]

The mortality rate for people who reach a hospital alive is about 30%.^[4]

[edit] History

Until 1927, when a report was made of a person who survived, the mortality rate of TBI was thought to be 100%; improvements in medical care later brought the rate to under 30%.^[1]

Research directions
In other animals

[edit] References

^ ^a ^b ^c ^d ^e ^f Barmada H, Gibbons JR (July 1994). "Tracheobronchial injury in blunt and penetrating chest trauma" (pdf). Chest 106 (1): 74–8. PMID 8020323.
^ Shimizu T, Matsuzaki Y, Onitsuka T (October 2006). "Surgical treatment for traumatic tracheobronchial injuries" (in Japanese). Kyobu Geka 59 (11): 1007–11. PMID 17058663.
^ ^a ^b ^c ^d Smith M, Ball V (1998). Cardiovascular/respiratory physiotherapy. St. Louis: Mosby, 217. ISBN 0-7234-2595-7. Retrieved on 2008-06-12.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u Chu CP, Chen PP (April 2002). "Tracheobronchial injury secondary to blunt chest trauma: Diagnosis and management". Anaesth Intensive Care 30 (2): 145–52. PMID 12002920.
^ Sakurada A, Kondo T (July 2004). "Blunt tracheobronchial injury" (in Japanese). Kyobu Geka 57 (8 Suppl): 770–5. PMID 15362558.

v • d • e Chest trauma

Chest wall injuries and Fractures	Rib fracture, Flail chest, Sternal fracture, Clavicle fracture, Shoulder girdle fracture, Scapular fracture

Pulmonary and Respiratory system injuries	Pneumothorax, Hemothorax, Hemopneumothorax, Pulmonary contusion, pulmonary laceration, Tracheobronchial injury

Cardiac and Circulatory system injuries	Pericardial tamponade, Myocardial contusion, Traumatic aortic rupture, Thoracic aorta injury