Summary

In study session V you have learnt

• Direct airway damage can occur anywhere between the nasopharynx and the bronchi.
• Partial or complete airway obstruction in the acute stage of air way trauma may be caused by soft tissue edema of the pharynx and peripharyngeal hematoma, blood or debris in the oropharyngeal cavity and aspirated teeth or foreign bodies in the pharynx. Prophylactic intubation of the trachea or close and repeated examination of the upper airway may avert airway compromise before it occurs.
• Trauma to the chest may severely compromise the function of the heart or lungs, leading to cardiogenic shock and hypoxia. Of the several causes that may alter respiration after trauma, tension pneumothorax, flail chest, and open pneumothorax are immediate threats to the patient's life and therefore require rapid diagnosis and treatment.
• Tension pneumothorax develops when air enters the pleural space from the lung or through the chest wall via a one-way valve like opening, which allows entry of air but no exit. Clinically, tension pneumothorax is characterized by chest pain, dyspnea, tachycardia, hypotension, contralateral tracheal deviation, and ipsilateral lung hyperresonance to percussion with the absence of breath sounds by auscultation.
• Open pneumothorax results from a large defect of the chest wall usually caused by a wound that creates a communication between the pleural space and external environment.
• When rib fractures occur at multiple sites in more than three ribs on the same side, the chest wall in the injured area moves paradoxically, that is, it moves inward during inspiration and outward during expiration.
• Hemothorax is accumulation of blood in the pleural space. Massive hemothorax is defined as a rapid accumulation of more than 1,500 cc of blood in the pleural space.
• Nonpenetrating or blunt cardiac trauma is an injury ranging from minor bruises of the myocardium to cardiac rupture. Most patients with myocardial contusion have external signs of thoracic trauma (e.g., contusion, abrasions, sternum fractures, visible flail segments), absence of visible thoracic lesions decreases the suspicion but does not exclude cardiac injury.
• Penetrating cardiac trauma is the most common cause of significant cardiac injury seen in hospital settings, with the predominant injury being from guns and knives. Cardiac tamponade and exsanguination are immediately life-threatening complications of penetrating cardiac trauma. Prompt recognition and treatment is required to avoid poor outcomes.
• Massive and rapid accumulation of blood within the pericardium usually results in severe tamponade, cardiac arrest, and sudden death. As little as 60-100 mL of blood in the pericardial sac can produce the clinical picture of tamponade.
• The classic findings of pericardial tamponade are tachycardia, hypotension, distant heart sounds, distended neck veins, pulsus paradoxus or pulsus
• These patients are benefited if they are managed with specialist in the field of anesthesia, cardiothoracic surgeon and with resourceful hospital having intensive care unit.
• Resuscitation and anesthetic care are directed toward airway control, maintenance of adequate pulmonary ventilation, and management of blood loss
• In the setting of airway injury blind intubation techniques are contraindicated. Over sedation and neuromuscular relaxants are also best avoided as these may result in loss of the airway. Emergency cricothyroidotomy or surgical tracheostomy may be required.
• Chest tube placement should be strongly considered in any patient with pneumothorax if general anesthesia with tracheal intubation and positive pressure ventilation is required.
• In patients with airway or breathing difficulty, early intubation and initiation of positive pressure ventilation should be considered.
• The anesthetic consideration to emergency and trauma patient should be considered here.