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Tracheal injury

Damage to the thoracic trachea belongs to the competence of thoracic surgeons, while damage to the cervical trachea is within the scope of interest of both surgeons and laryngologists.

Depending on whether the trachea communicates with the external wound, its open and closed injuries are distinguished, and depending on the penetration of the wound into the lumen of the hollow organ, penetrating and non-penetrating.

Closed injuries of the trachea, like the larynx, occur more often with bruises. The most significant injuries are observed when violence acts in the anteroposterior direction, since in this case the trachea is pressed against an unstable spine (Zenger V.G. and Nasedkin A.N., 1991). Severe damage occurs when the inter-ring ligaments are torn, which leads to the separation of the tracheal rings from each other. In cases where the posterior membranous wall is preserved, the gaping edges of the inter annular gap do not exceed 1.5 cm.If, however, a complete transverse rupture of the trachea occurs, then the lower part of it separates into the depth of the chest and the distance between the separated fragments reaches 4 cm or more ( Schuster, M.A. et al., 1989).

Gunshot wounds of the cervical trachea are usually accompanied by injuries of other organs of the neck - large vessels and nerves, damage to the larynx, thyroid gland, esophagus and spine. In many cases, these injuries are incompatible with life and lead to the rapid death of the wounded.

According to the statistics of Z.A. in the Great Patriotic War Neufaha (1951) isolated tracheal wounds in relation to the total number of neck injuries accounted for 16.5%, combined trachea and larynx wounds - 2.4%, and trachea and esophagus - 3.8%.

Symptoms In most cases, shock develops immediately after an injury. The most important symptoms of tracheal damage are: respiratory failure, swallowing, coughing, hemoptysis, and emphysema.

Bleeding that occurs when the neck and trachea are injured is usually divided into internal (hemoptysis) and external through the wound (often in the form of foamy sputum). Internal bleeding causes a painful cough and is very dangerous, since the ingress of large amounts of blood, for example from an damaged thyroid gland, into the trachea and bronchi, can lead to instant death.

Shortness of breath is expressed in varying degrees. With separation of the trachea, threatening shortness of breath quickly builds up. Aphonia is the result of severe pain during phonation and the inability to pump a respiratory stream.

Emphysema can be very significant and by the nature of its distribution is divided into: 1) emphysema of the subcutaneous tissue, 2) mediastinal emphysema and 3) interstitial emphysema (spreading in the lung tissue).

The prognosis of tracheal damage is always serious. It deteriorates significantly in the presence of concomitant lesions of other organs of the neck, in particular, when there is a message between the trachea and esophagus. Injury of large vessels and nerves causes rapid death from bleeding and shock.

Treatment. Urgent and urgent measures for tracheal injury are to restore pulmonary ventilation, stop bleeding and eliminate shock. Intubation is not always feasible, and with separation of the trachea is dangerous. It is possible to insert a thin endotracheal tube through the natural pathways, as well as a tracheotomy or endotracheal tube into the lumen of the trachea through the wound channel.

Tracheostomy should be performed with closed tracheal injuries, even in the absence of suffocation.
Timely performed tracheostomy can prevent the dangerous development of mediastinal emphysema (Suprunov V.K., 1960).

If possible, a tracheostomy is performed below the site of injury to the trachea. If the tracheotomy cannula is not long enough, it must be extended with a tube made of synthetic material, or an endotracheal tube should be used.

With adverse anatomical options and pathological conditions, the introduction and change of the tracheostomy tube can be difficult. In such cases, Killian’s middle nasal mirror helps a lot.

To stop bleeding and revision of the neck wound, a vertical incision is made, which allows an examination near the larynx and paratracheal space and doping of bleeding vessels.

In cases of tracheal detachments, emergency care begins with an urgent surgical intervention - a tracheostomy from a long vertical incision made up to the hilt of the sternum. The severed distal end of the trachea is detected with the index finger inserted into the upper aperture of the chest cavity. A clamp is held on the finger to capture the edge of the trachea and pull it up. If it is impossible to stitch the trachea end to end, the wound is opened in an open way with reconstruction of the lateral and posterior walls of the trachea (M. Schuster et al., 1989). In the case of transverse rupture of the trachea, the torn area is sutured. The skin wound remains open, sutures are applied only along the edges. An adequate antibacterial antibiotic therapy is prescribed.

Persistent post-traumatic stenosis and large defects of the trachea are eliminated through plastic surgeries requiring an individual approach in each individual case and belong to one of the difficult sections of laryngology.

Separately, it is necessary to dwell on tracheal injuries during medical manipulations.

Technically improperly performed tracheostomy can cause the development of cicatricial stenosis of the trachea. Björk tracheostomy, widely used in surgical practice, during which a scapular flap is cut out in the front wall of the trachea, subsequently, as a result of the flap being lowered into the lumen of the trachea, can lead to the formation of granuloma and the development of cicatricial stenosis. That is why, we continue to recommend the most sparing version of the tracheostomy - the longitudinally-transverse tracheostomy according to V.I. Voyachek, in which a vertical incision of the soft tissues is made before the trachea, and the trachea itself is cut across between the cartilage rings.

In children with a narrow trachea, its transverse inter-ring dissection can practically lead to a separation of its upper fragment from the lower one, the connection between which will be preserved only due to the posterior membranous detachment. This leads to the inflection of the children's trachea and the development of severe, difficult to eliminate stenosis. Therefore, children tracheostomy should in principle be performed only by vertical dissection of the required number of tracheal rings.

The prolonged presence of the endotracheal tube in the lumen of the trachea, especially when there is a mutual mismatch, or when pressure on its walls by an overstretched inflatable cuff, can lead to the development of an endotracheal granuloma and cicatricial stenosis of the trachea. The emergence of such a new iatrogenic variant of the development of tracheal stenosis is especially often observed in pediatric otolaryngology - as a result of continued intubation (Soldatov I.B. et al., 1986).
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Tracheal injury

  1. Tracheal injury
    Tracheal injuries occur much less frequently than damage to the larynx, which is associated with its position, elasticity and easy displacement. According to the localization of damage, they are divided into 2 groups: 1) damage to the cervical region and 2) damage to the thoracic region. This division has a purely practical purpose, since otorhinolaryngologists treat the injuries of the cervical spine, and surgeons treat the chest. According to
  2. Injuries, foreign bodies of the esophagus, trachea and bronchus
    Injuries, foreign bodies of the esophagus, trachea and
  3. LESSON 13 First aid for injuries. Closed soft tissue damage. Traumatic brain injuries. Damage to the chest. Transport immobilization for injuries.
    Purpose: To teach students the differentiological diagnosis of various traumatic conditions, the rules of first aid to the victim. Test questions 1. Injury. Definition Classification of injuries. 2. Closed soft tissue damage. Injury. First aid. 3. Stretching. Complaints First aid. 4. The gap. Complaints First aid. 5. The syndrome of prolonged crushing. Pathogenesis. The clinical picture.
  4. Trachea features
    Trachea is a continuation of the larynx. It is wide and short, the frame of the trachea consists of 14-16 cartilaginous rings, which are connected by a fibrous membrane instead of an elastic closure plate in adults. The presence in the membrane of a large number of muscle fibers contributes to a change in its lumen. Anatomically, the trachea of ​​the newborn is at the level of the fourth cervical vertebra, and in the adult at the level of VI — VII
  5. The mechanism of injury. Classification of injury types
    A. External forces Newton’s law of inertia: “A moving body continues to move until an external force acts on it.” 1. The horizontal moment. Force = MA = MDD = V2 - V1 / t = braking V2 = final speed V1 = initial speed 2. Gravity. Force = GmM / R2 = mg g = GM / R2 = acceleration due to gravity = 9.8 m / s2 R = radius of the Earth; G = grav. Constant; M = mass
  6. Examination of the larynx and trachea.
    Carry out external and internal studies of the larynx and trachea. Outdoor research. It consists of examination, palpation and auscultation. With an external examination, you can notice the lowering of the head, stretching of the neck and shortness of breath, sometimes swelling is established in the larynx and trachea due to inflammation and swelling of the surrounding tissues. When examining the trachea determine the change in its shape,
  7. Tracheal intubation
    Anatomical causes of difficult intubation With laryngoscopy, a clear overview of the vocal cords should be clear. Difficulties may occur if: the vocal cords (1), upper teeth (2) or tongue (3) are displaced in the direction shown in Figure 41. This may be due to anatomical features and is not a pathology. {foto171} Fig. 38. Laryngoscopy Classification of the upper respiratory tract
  8. Tracheal intubation
    Equipment for tracheal intubation. Orotracheal or nasotracheal intubation - a relatively complex manipulation, limited to 20-30 s, requires special training and equipment. Typically, a tracheal intubation kit consists of: 1) nasal masks of several sizes; 2) S-shaped ducts (Safar duct); 3) a set of thermoplastic disposable endotracheal tubes with
  9. Tracheal resection anesthesia
    General information Indications for resection of the trachea include stenosis and tumors of the trachea and, less commonly, some congenital diseases. Tracheal stenosis occurs after a closed or penetrating trauma, as well as a complication of tracheal intubation and tracheotomy. Most tumors histologically represent squamous cell carcinoma and cystic adenocarcinoma. Narrowing the lumen of the trachea causes progressive dyspnea.
  10. Tracheal intubation
    Differences of the respiratory tract of a child from an adult: 1. The larynx is located higher in relation to the neck. In premature babies, it is located at the level of SZ, in full-term - between SZ - C4, in adolescence - between C4 - C5. Therefore, the angle of inclination of the laryngoscope blade should be somewhat different. This partly explains the fact that with laryngoscopy in young children, direct blades are preferable.
  11. Physiology of the trachea and bronchi
    The main function of the trachea and bronchi is respiratory. During breathing, in connection with excursions of the chest, the trachea and bronchi make a number of movements, while the bifurcation of the trachea during inspiration moves down and anterior to 2 cm (Lepnev P.G., 1956). The volume of air in the tracheobronchial tree, the so-called "harmful space" is equal to 120 - 180 ml. Due to the presence, in the annular ligaments and
  12. Clinical anatomy of the trachea and bronchi
    The respiratory throat (trachea) is a continuation of the larynx, with which it is connected through the cricotracheal ligament (lig. Cricotracheale). Trachea - a long cylindrical tube (length 11-13 cm); it begins at the body level of Suz. and at the level of ThiV — Thv is divided into two main bronchi (bronchus principalis dexter et sinister). The beginning of the septum dividing the trachea is called the spur (carina;
  13. Damage to the bronchi and trachea
    Fractures of the first two ribs, sternum and collarbone are the most characteristic bone injuries that cause airway injuries. Hemoptysis, atelectasis, subcutaneous emphysema, pneumomediastinum or pneumothorax, which cannot be corrected by pleural drainage, are signs of possible damage to the main respiratory tract. (The presence of bilateral pneumothorax after blunt injury
  14. Clinical anatomy of the trachea and bronchi
    The respiratory throat or trachea is a direct continuation of the larynx and refers to the initial section of the lower respiratory tract. The trachea is a hollow elastic tube, somewhat compressed in the anteroposterior direction. Above, through the cricoid-tracheal ligament, it connects to the larynx, below, in the bifurcation area, it is divided into two main bronchi. Distinguish in the trachea
  15. Malformations of the wall of the trachea and bronchi.
    Malformations of the structural elements of the wall of the trachea, bronchi and bronchioles are morphologically associated with the absence, deficiency or disorganization of cartilage or elastic and muscle tissue. Malformations of the wall of the bronchi can be divided into limited and common. Limited defects of tracheobronchial structures usually lead to local narrowing of a particular segment
    Definition When difficulties can be suspected when ETT was inserted into the trachea in a standard way, or when two attempts at tracheal intubation by an experienced practitioner were unsuccessful, intubation is considered difficult. Etiology Structural or mechanical obstruction to visualization of the larynx by direct laryngoscopy or insertion of ETT into the trachea. Typical cases patients with any
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