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Airway, fracture

Xiao Zhu, Kelly N Evans, Areeg El-Gharbawy, Jonathan Y Lee, Jack E Brooker, Noel Jabbour, Elizabeth C Tyler-Kabara, Suneeta Madan-Khertarpal, Joseph E Losee, Jesse A Goldstein
Pierre Robin Sequence (PRS) can be associated with skeletal dysplasias, presenting with craniocervical instability and devastating spinal injury if unrecognized. The authors present the case of an infant with PRS and a type II collagenopathy who underwent multiple airway-securing procedures requiring spinal manipulation before craniocervical instability was identified. This resulted in severe cervical cord compression due to odontoid fracture and occipitoatlantoaxial instability. This case highlights the importance of early cervical spine imaging and cautious manipulation in infants with PRS and suspected skeletal dysplasia...
January 1, 2018: Cleft Palate-craniofacial Journal
Willian Ricardo Pires, Gabriel Mulinari Santos, Erik Neiva Ribeiro de Carvalho Reis, André Hergesel de Oliva, Ricardo Garcia Mureb Jacob, Leonardo Perez Faverani, Francisley Ávila Souza, Idelmo Rangel Garcia Júnior
Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection...
February 23, 2018: Journal of Craniofacial Surgery
Joseph J Ruzbarsky, Elizabeth B Gausden, Elan M Goldwyn, Isaac P Lowenwirt, Vitaly Kotlyar
Background: Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. Questions/Purposes: The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Carlos Almeida, Maria João Freitas, Diogo Brandão, José Pedro Assunção
Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage...
January 13, 2018: Revista Brasileira de Anestesiologia
John Breeze, R Blanch, J Baden, A M Monaghan, D Evriviades, S E Harrisson, S Roberts, A Gibson, N MacKenzie, D Baxter, A J Gibbons, S Heppell, J G Combes, R F Rickard
INTRODUCTION: The evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons. METHOD: A systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma...
January 10, 2018: Journal of the Royal Army Medical Corps
Eric W Glissmeyer, Ryan R Metzger, Robert Bolte
OBJECTIVE: The objective of this study was to compare demographic injury and treatment characteristics of hospitalized pediatric cases of falls from chair lifts to cases of other ski and snowboarding injuries and identify potential interventions for preventing falls from chair lifts. METHODS: Retrospective query of the trauma registry of Utah's only pediatric trauma center for children younger than 18 years requiring hospitalization for a ski or snowboarding injury from November 2004 to February 2014...
February 2018: Pediatric Emergency Care
Ryan Blumenthal, Brigitte Hänert-van der Zee
We present the case of an adult white man found dead in a psychiatric institution with fine white powder (monoammonium phosphate) deposited over the entire face after he insufflated the contents of a dry chemical fire extinguisher. Fine white powder was present within the mouth and sinuses and lined the upper airways. On opening the thoracic cavity, approximately 500 g of fine white powder was present within the right thoracic cavity. The esophagus was ruptured. Traumatic emphysema of the posterior sternum wall was present (pneumomediastinum)...
December 22, 2017: American Journal of Forensic Medicine and Pathology
M D Mira, M I Valldeperas, A Socias, H Sarasíbar, J L Aguilar Sánchez
Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation...
December 11, 2017: Revista Española de Anestesiología y Reanimación
Zhengfei Yang, Qingyu Liu, Guanghui Zheng, Zhifeng Liu, Longyuan Jiang, Qing Lin, Rui Chen, Wanchun Tang
Background: A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Methods: Sixteen male domestic pigs weighing 39±2 kg were utilized...
September 2017: Journal of Thoracic Disease
Donnacha J McGrath, Anja Lena Thiebes, Christian G Cornelissen, Barry O'Brien, Stefan Jockenhoevel, Mark Bruzzi, Peter E McHugh
Tracheobronchial stents are used to restore patency to stenosed airways. However, these devices are associated with many complications such as stent migration, granulation tissue formation, mucous plugging and stent strut fracture. Of these, granulation tissue formation is the complication that most frequently requires costly secondary interventions. In this study a biomechanical lung modelling framework recently developed by the authors to capture the lung in-vivo stress state under physiological loading is employed in conjunction with ovine pre-clinical stenting results and device experimental data to evaluate the effect of stent interaction on granulation tissue formation...
November 24, 2017: Biomechanics and Modeling in Mechanobiology
Chun-Hao Tsai, Lin-Yu Liao, Cheng-Li Lin, Wei-Sheng Chung
BACKGROUND AND AIMS: Inhaled corticosteroids (ICSs) are crucial anti-inflammatory medications for chronic airway diseases. Studies investigating the relationship between ICSs and fractures in Asian populations are scant. We investigated whether ICSs increased the risk of low-energy fractures in patients with chronic airway diseases. METHODS: We used the Longitudinal Health Insurance Database to select patients aged 20 years and older with chronic airway diseases (asthma and COPD) between 2000 and 2011 as the base cohort...
November 17, 2017: Clinical Respiratory Journal
Nitin Bhola, Anendd Jadhav, Atul Kala, Rahul Deshmukh, Umesh Bhutekar, G S V Prasad
Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years...
December 2017: Craniomaxillofacial Trauma & Reconstruction
Hyunwoo Kyung, Jae-Ik Choi, Seung-Han Song, Sang-Ha Oh, Nakheon Kang
Fracture of nasal bone is among the most common facial bone fractures. Reduction of nasal bone fracture is able to be performed under local or general anesthesia. The aim of this study is to compare monitored anesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures.The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture between January 1, 2016 and December 31, 2016...
October 27, 2017: Journal of Craniofacial Surgery
Nitin Mehdiratta, Michael Archer, Melissa Stewart, Bradley Dennis, Eric Grogan
Tracheobronchial injuries can be difficult to diagnose and manage, especially in the presence of polytrauma. A 50-year-old woman presented as a Level I trauma activation after being struck by a motor vehicle. Initial evaluation demonstrated intracranial hemorrhage and multiple chest injuries, including multilevel bilateral rib fractures, pneumomediastinum, and concern for tracheobronchial injury. After initial stabilization, bronchoscopy was performed and demonstrated an injury to the carina. We report a novel airway and ventilation strategy in the setting of concomitant tracheobronchial injury after severe blunt chest trauma in which extracorporeal support is contraindicated...
November 2017: Annals of Thoracic Surgery
Ceferina Suarez, Jesús Maxide, Demian Szyld, Jose M Maestre
We used simulation as a job-specific functional capacity evaluation method after a distal radius fracture in an anesthesiologist. Treatment included open reduction followed by an internal fixation with an arthrodesis plate. The patient performed simulated anesthesia inductions to assess her response to endotracheal intubation, bag-mask ventilation, and the manual opening of the airway. Data collected helped to guide the rehabilitation protocol, and to assess pain and the time to safely return to work. The patient began her clinical duties after 7 weeks of therapy and was able to fully perform her daily tasks with confidence, and full functional capacity...
October 5, 2017: A & A Case Reports
Venkata S P B Durvasula, Sara C Shalin, Ozlem E Tulunay-Ugur, James Y Suen, Gresham T Richter
OBJECTIVES/HYPOTHESIS: Cricoid fracture is a serious concern for balloon dilatation in airway stenosis. Furthermore, there are no studies examining tracheal rupture in balloon dilatation of stenotic segments. The aim of this study was to evaluate the effect of supramaximal pressures of balloons on the cricoid and tracheal rings. STUDY DESIGN: Prospective cadaveric study. METHODS: Seven cadaveric laryngotracheal complexes of normal adults with intact cricothyroid membranes were acquired...
October 8, 2017: Laryngoscope
Nicole M Elsey, Joseph D Tobias, Kevin E Klingele, Ralph J Beltran, Tarun Bhalla, David Martin, Giorgio Veneziano, Julie Rice, Dmitry Tumin
BACKGROUND: Traumatic injury of the femur resulting in femoral fracture may result in significant postoperative pain. As with other causes of acute pain, regional anesthesia may offer a benefit over conventional therapy with intravenous opioids. This study prospectively assesses the effects of femoral nerve blockade with a lateral femoral cutaneous nerve block (FN-LFCN) on intraoperative anesthetic requirements, postoperative pain scores, and opioid requirements. MATERIALS AND METHODS: Seventeen pediatric patients (age 2-18 years) undergoing surgical repair of a traumatic femur fracture fulfilled the study criteria and were randomly assigned to general anesthesia with either an FN-LFCN block (n = 10) or intravenous opioids (n = 7)...
2017: Journal of Pain Research
I Papadiochos, L Goutzanis, K-I Karydi, E Kalfarentzos, N Papadogeorgakis
A mandibular fracture alone rarely causes a life-threatening injury. The aim of this paper was to emphasise the importance of prompt identification of the radiological signs of a flail mandible in a patient with maxillofacial trauma who eventually needed definitive management of her airway.
November 2017: British Journal of Oral & Maxillofacial Surgery
So Young Ji, Seung Soo Kim, Ki Sung Park, Bong Soo Baik
BACKGROUND: Packing after closed reduction of nasal fracture causes uncomfortable nasal obstruction in patients. We packed the superior meatus with synthetic polyurethane foam (SPF) to support the nasal bone, and packed the middle nasal meatus with a nasal airway splint (NAS) and SPF. The aim of this article is prospectively to compare the subjective patient discomfort of SPF (Nasopore Forte plus) packing alone and SPF with NAS. METHODS: We compared the prospectively subjective patient discomfort of SPF packing alone (group A) and SPF with NAS (group B) via visual analog scale (VAS; 0, no symptom; 100, most severe symptom)...
December 2016: Archives of Craniofacial Surgery
Parmod Kumar, Tripat Kaur, Gurpreet Kaur Atwal, Jatinderpaul Singh Bhupal, Ajay Kumar Basra
INTRODUCTION: Awake nasal or oral flexible fiberoptic intubation is the airway management technique of choice in known or anticipated difficult airway, unstable cervical fracture, limited mouth opening (as in temporomandibular joint disease), mandibular-maxillary fixation and severe facial burns. Both optimal intubating condition and patient comfort are important for fiberoptic intubation. Optimal intubating conditions provided by an ideal sedation regimen would ensure haemodynamic stability, patient comfort, attenuation of airway reflexes and amnesia...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
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