1. ZARIA THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES DR SANNI R. O 25 th - 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- 1 st documented survival. 1945- 1 st 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.