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Anesthetic management of a rare presentation of pediatric blunt chest trauma.

Baldwa NM, Padvi AV, Dave NM, Garasia M - J Anaesthesiol Clin Pharmacol (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Seth G. S. Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.

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Dear Editor, Blunt chest trauma can have varied presentations in pediatric patients... Symptoms and signs can be delayed and can present from 10 days to 2 months after the history of trauma... Patient can present at a later date, in the phase of mediastinitis with fever, dyspnea, air leak and desaturation as in our case... We proceeded with the case suspecting an esophageal tear and peripheral airway injury... There was disappearance of end-tidal carbon dioxide with desaturation during thoracotomy, which could have been addressed either using jet ventilation, or plugging of the defect, or maybe creating a bypass to such a defect... The essence of airway management in these cases is to bypass the lesion by means of endobronchial intubation with a single-lumen or double-lumen endotracheal tube or endobronchial blockers... We could not do that as the patient was in lateral decubitus, was desaturating and the tear had friable edges and there was lung contusion... Jet ventilation was considered but was not immediately available... Although rare, delayed signs like persistent air leak, worsening oxygenation and signs of mediastinitis should raise suspicion of combined tracheo-esophageal injury in pediatric patients with blunt chest trauma... Team-work and good communication with surgeons, physicians is necessary for successful outcome of such patients who need multiple surgeries and have a prolonged stay in the intensive-care unit.

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Related in: MedlinePlus

Contrast dye study showing dye in the stomach with pneumothorax
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Figure 3: Contrast dye study showing dye in the stomach with pneumothorax

Mentions: Patient was stable on conservative management but, on day 12, she started desaturating and required ventilatory support. There was a suspicion of saliva draining into the ICD on day 14. A dye study showed dye in the stomach with no obvious leak and relatively normal chest [Figure 3]. However, on clinical suspicion of esophageal tear, patient was posted for diagnostic thoracoscopy on the same day.


Anesthetic management of a rare presentation of pediatric blunt chest trauma.

Baldwa NM, Padvi AV, Dave NM, Garasia M - J Anaesthesiol Clin Pharmacol (2013)

Contrast dye study showing dye in the stomach with pneumothorax
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713693&req=5

Figure 3: Contrast dye study showing dye in the stomach with pneumothorax
Mentions: Patient was stable on conservative management but, on day 12, she started desaturating and required ventilatory support. There was a suspicion of saliva draining into the ICD on day 14. A dye study showed dye in the stomach with no obvious leak and relatively normal chest [Figure 3]. However, on clinical suspicion of esophageal tear, patient was posted for diagnostic thoracoscopy on the same day.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Seth G. S. Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, Blunt chest trauma can have varied presentations in pediatric patients... Symptoms and signs can be delayed and can present from 10 days to 2 months after the history of trauma... Patient can present at a later date, in the phase of mediastinitis with fever, dyspnea, air leak and desaturation as in our case... We proceeded with the case suspecting an esophageal tear and peripheral airway injury... There was disappearance of end-tidal carbon dioxide with desaturation during thoracotomy, which could have been addressed either using jet ventilation, or plugging of the defect, or maybe creating a bypass to such a defect... The essence of airway management in these cases is to bypass the lesion by means of endobronchial intubation with a single-lumen or double-lumen endotracheal tube or endobronchial blockers... We could not do that as the patient was in lateral decubitus, was desaturating and the tear had friable edges and there was lung contusion... Jet ventilation was considered but was not immediately available... Although rare, delayed signs like persistent air leak, worsening oxygenation and signs of mediastinitis should raise suspicion of combined tracheo-esophageal injury in pediatric patients with blunt chest trauma... Team-work and good communication with surgeons, physicians is necessary for successful outcome of such patients who need multiple surgeries and have a prolonged stay in the intensive-care unit.

No MeSH data available.


Related in: MedlinePlus