A novel method of airway management in a case of penetrating
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Abstract
Direct injury to airway is a rare event and also a challenge to anaesthesiologist and surgeon. We present a case report of open tracheal injury with right pneumothorax in a young male following assault with a sharp weapon. In spite of a chest tube in situ, the patient came with collapse of one lung and tachypnoea which required surgical exploration. Lower airway was evaluated by fibre-optic bronchoscopy through the open tracheal wound while he was awake and tracheal tube was passed over the bronchoscope. There was no vascular or oesophageal injury detected. Although there was a pleural tear, there were no signs of injury to lung parenchyma. After evaluation, end to end anastomosis of the trachea was planned, for which orotracheal tube was passed with surgical assistance. Patient was shifted to post-operative high dependency unit and was electively ventilated for 7 days and was later successfully extubated under fibre-optic bronchoscope guidance.

CASE REPORT
We report a case of a 22-year-old male brought to emergency department with a history of sickle injury on the left side of the neck following which the patient developed dyspnoea and aphonia. On examination, the patient was alert, restless and unable to lie supine. Heart rate (HR) was 120/min, blood pressure (BP) 138/84 mmHg, respiratory rate 38/min and saturation (SpO2) 86% on room air. The patient was not able to vocalise, with persistent air leak from the neck wound [Figure 1a]. There was no active bleeding and his BP was stable although he had tachycardia. In view of respiratory distress and suspected airway injury, immediate chest and cervical spine X-ray was obtained. Chest X-ray showed gross right-sided pneumothorax and pneumomediastinum, causing collapse of the right lung [Figure 2c]. Computerised tomography (CT) revealed large anterior tracheal wall injury with right-sided gross pneumothorax and pneumomediastinum, with no vascular injury [Figure 2b]. A right-sided intercostal drain (ICD) was inserted with little improvement in patient's respiratory status......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966357/?report=reader
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