Tracheobronchial Injuries

Tracheobronchial tree injuries may occur all the way from the larynx down to the subsegmental bronchus. Generally, segmental and subsegmental bronchial injuries do not require treatment but laryngeal, tracheal, mainstem bronchial or lobar injuries do require treatment. If injury to the larynx results in hoarseness, subcutaneous emphysema with crepitus and noisy breathing, the patient should undergo emergency flexible bronchoscopy with an endotracheal tube inserted over the bronchoscope. Thus, when the injury is identified and the bronchoscope is placed passed the injury, the endotracheal tube can be positioned under direct

Fig 19.4a. Upright CXR of a trauma patient who was the unrestrained driver in an motor vehicle accident. The mediastinum is widened and aortic knob blunted.

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