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2.
Laryngoscope ; 129(1): 45-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30194845

RESUMO

Lithium-ion batteries have been used for more than 20 years, most recently to power handheld devices including cellphones and electronic nicotine-delivery systems. They have garnered significant media attention due to thermal-related injuries occurring after spontaneous combustion. Spontaneous combustion of a lithium-ion battery occurs due to a process that is referred to as the thermal runaway effect. Here, we review the case of a 25-year-old female with severe oropharyngeal and upper aerodigestive thermal injuries after spontaneous combustion of a lithium-ion battery in a flashlight. We discuss the associated management and provide a review of the literature detailing similar injuries. Laryngoscope, 129:45-48, 2019.


Assuntos
Queimaduras/etiologia , Fontes de Energia Elétrica/efeitos adversos , Orofaringe/lesões , Sistema Respiratório/lesões , Adulto , Feminino , Humanos , Íons , Combustão Espontânea
3.
Am J Surg ; 217(6): 1047-1050, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30446160

RESUMO

BACKGROUND: Pneumomediastinum following blunt trauma is often observed on CT imaging, and concern for associated aerodigestive injury often prompts endoscopy and/or fluoroscopy. In recent years, adoption of multi-detector CT technology has resulted in high resolution images that may clearly identify aerodigestive injuries. The purpose of this study was to evaluate the utility of multi-detector CT in the identification of blunt aerodigestive injuries. METHODS: Over five years, patients with pneumomediastinum following blunt trauma were identified from the registry of a level 1 trauma center. All CT imaging of trauma patients during this time period was accomplished with 64-slice scanners. RESULTS: 127 patients with blunt traumatic pneumomediastinum were identified. Five airway injuries were identified, and all injuries were evident on CT imaging. No patient was found to have airway injury by endoscopy that was not evident on CT. No patient had an esophageal injury. CONCLUSION: Multi-detector CT imaging identifies aerodigestive injuries associated with pneumomediastinum following blunt trauma. The absence of a recognizable aerodigestive injury by CT effectively rules out the presence of such injury.


Assuntos
Sistema Digestório/lesões , Enfisema Mediastínico/etiologia , Tomografia Computadorizada Multidetectores , Sistema Respiratório/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Digestório/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Pessoa de Meia-Idade , Sistema de Registros , Sistema Respiratório/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Ferimentos não Penetrantes/complicações , Adulto Jovem
4.
Int J Pediatr Otorhinolaryngol ; 109: 133-137, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29728167

RESUMO

BACKGROUND: Foreign body aspiration (FBA) is the 4th leading cause of death in children between the ages 1-5. Although direct laryngoscopy and bronchoscopy (DL&B) is the reference standard for diagnosis of pediatric airway foreign bodies, there is a high negative bronchoscopy rate, exposing patients to unnecessary operative and anesthetic risks and costs. METHODS: A clinical care protocol entailing the selective use of low-dose non-contrast airway computed tomography (CT) for children with an intermediate risk for FBA on the basis of clinical exam and chest radiography was implemented to decrease the negative DL&B rate. A retrospective review was conducted to compare negative bronchoscopy rates before and after implementation of the new protocol and the diagnostic performance characteristics of airway CT for airway foreign bodies were analyzed. RESULTS: After implementation of the airway FB clinical care protocol entailing selective airway CT, the overall negative bronchoscopy rate decreased from an institutional historical rate of 37% (54/145) to 17% (10/56) (p = .06). The overall sensitivity, specificity, and positive and negative predictive value of airway CT for FB was 91%, 100%, 100%, and 97% respectively. CONCLUSIONS: Low-dose non-contrast airway CT is highly sensitive and specific for airway foreign bodies, and its selective use in a clinical care protocol for children with suspected foreign body aspiration could greatly reduce the negative bronchoscopy rate, thereby decreasing operative risks and costs.


Assuntos
Broncoscopia/métodos , Corpos Estranhos/diagnóstico , Laringoscopia/métodos , Sistema Respiratório/lesões , Tomografia Computadorizada por Raios X/métodos , Broncoscopia/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Laringoscopia/efeitos adversos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Laryngoscope ; 128(2): 490-495, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28815616

RESUMO

OBJECTIVES: To evaluate outcomes of foreign body aspiration (FBA) and to investigate surgeon and hospital volume as risk factors for a complicated course. STUDY DESIGN: Retrospective case series. METHODS: Children with FBA in a multihospital network were identified from January 2005 to September 2015. Demographic information, surgeon, and hospital location were reviewed. Mean operative time and hospital length of stay were recorded. Cases requiring intensive care unit admission, hospital stay greater than 24 hours, need for more than one bronchoscopy, operative time greater than 1 hour, or death were considered "complicated." RESULTS: A total of 450 cases of airway foreign body extraction were performed. Patient ages ranged from 0.6 to 18.8 years, with a median age of 1.9 years. Bronchoscopy with foreign body extraction was performed by 55 different surgeons at 11 different facilities. There were one to 24 surgeons for each facility, with an average number of 5.4 surgeons per facility. A total of 88 (19.6%) cases were considered complicated, including five (1.1%) deaths. Increased rates of complications were seen with unwitnessed aspiration (P = 0.008) and hyperlucency (P < 0.001) or infiltrates (P = 0.001) on chest radiographs. No significant association was found between surgeon type or facility as related to a complicated case. CONCLUSIONS: Unwitnessed aspiration events and abnormalities on chest radiograph may be associated with a more complicated course in children with FBA. This multihospital study identified a low number of procedures by many surgeons; however, surgeon and hospital volume did not significantly correlate with higher complication rates. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:490-495, 2018.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/efeitos adversos , Corpos Estranhos/cirurgia , Complicações Pós-Operatórias/etiologia , Sistema Respiratório/lesões , Cirurgiões/estatística & dados numéricos , Adolescente , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Broncoscopia/métodos , Criança , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Radiografia , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/cirurgia , Estudos Retrospectivos , Fatores de Risco
6.
Int J Pediatr Otorhinolaryngol ; 104: 72-75, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29287885

RESUMO

OBJECTIVES: To describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed. RESULTS: Sixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection. CONCLUSIONS: Our institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases. LEVEL OF EVIDENCE: Case Series.


Assuntos
Broncoscopia/estatística & dados numéricos , Corpos Estranhos/diagnóstico , Sistema Respiratório/lesões , Feminino , Corpos Estranhos/epidemiologia , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Laringoscopia/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
7.
Int J Pediatr Otorhinolaryngol ; 100: 232-237, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28802379

RESUMO

OBJECTIVE: Foreign body aspiration (FBA) could be a serious life-threatening condition in children. Patients usually underwent bronchoscopy with suspicious of FBA alone. In this study, we aimed to determine which patients need to go to bronchoscopy based on pre-operative findings. METHODS: Retrospective analysis of patients underwent bronchoscopy between 1999 and 2015 was performed. Clinical symptoms, witnessed aspiration event (WAE), physical examination findings (PEFs) and radiological findings (RFs) were analyzed by multivariate analysis to evaluate the indications of bronchoscopy. RESULTS: 431 patients (266M, 165F) underwent bronchoscopy with a median age of 2 years (7 months-16 years). A foreign body was detected in 68% of the patients. Univariate analysis demonstrated that wheeze was the sole distinctive clinical symptom for detection of FBA (p<0.001). The rates of positive WAE, PEFs and RFs were 83%, 71.7% and 36.9%, respectively. All of them were identified as independent predictive parameters in the detection of FBA by univariate analysis (p = 0.003&p<0.001&p = 0.015). Multivariate analysis was performed with considering the association between them. The rate of positive bronchoscopy was 91.3% in patients with positive WAE, PEFs and RFs together(84/92). In patients with a positive WAE alone who had not got PEFs and RFs, the rate of positive bronchoscopy was 34.2% (25/73). A foreign body was detected in 84% of the patients who had not got a WAE but positive PEFs and RFs together(21/25). Bronchial laceration was occurred in one patient during bronchoscopy. Pneumothorax was not seen in any of the other patients. The rate of mortality was 0.4% in the overall group (2 patients). CONCLUSION: The indications of bronchoscopy in suspected FBA are usually based on clinical suspicious. The definition of " suspicous" could be a WAE or positive PEFs and RFs. The association of these factors increase the rate of positive bronchoscopies. In the light of our study, the classical indication for suspected FBA is still valid as "suspicious requires bronchoscopy".


Assuntos
Broncoscopia/métodos , Corpos Estranhos/diagnóstico , Sistema Respiratório/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Estudos Retrospectivos
8.
Int J Pediatr Otorhinolaryngol ; 95: 109-113, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28576517

RESUMO

OBJECTIVES: Flexible endoscopy (FE) is frequently used to diagnose tracheobronchial foreign bodies (TBFB). However, it is still controversial for retrieval of TBFB in pediatric field. This study aims at reporting and evaluating our experiences of using short-length FE with a non-invasive ventilation (NIV) technique and intensive care unit (ICU) support in retrieving pediatric TBFB. METHODS: A retrospective review of the hospital database and FE videos of pediatric patients aged less than 18 year-old who were diagnosed of TBFB and managed in our hospital over a 17-year period (1999-2015). The demographic data were collected and analyzed. A NIV technique of providing nasopharyngeal oxygen with intermittent nose closure and abdominal compression was routinely performed in procedural sedated patients throughout the whole FE procedures. RESULTS: Sixty-six consecutive patients with 76 TBFB were enrolled. Among them, 72 (94.7%) TBFB in 64 patients were successfully retrieved at the first attempt of FE immediately after the diagnosis was made. There were 13 iatrogenic TBFB in patients who already had coexisting airway problems. The median age was 16 months (range 1.5 months-17 years) and the median body weight was 10.5 kg (range 3.5-48.5 kg). Seventy (70/72, 97.2%) TBFB were retrieved by short-length FE and among them, 55 procedures (55/72, 76.4%) used FE with no working channel. No significant acute or late adverse effects were noted. The mean retrieval procedural time was 23.6 ± 15.1 min. CONCLUSION: Using short-length FE with this NIV technique, appropriate sedation and ICU support is a safe, simple and effective modality for the retrieval of TBFB immediately after confirming the diagnosis in pediatric patients.


Assuntos
Broncoscopia/métodos , Corpos Estranhos/diagnóstico , Ventilação não Invasiva/métodos , Sistema Respiratório/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Corpos Estranhos/terapia , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos
9.
Pediatr Surg Int ; 33(1): 59-64, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27738825

RESUMO

BACKGROUND: Airway foreign bodies (FB) are a common medical emergency within the pediatric population. While deaths are not uncommon, the in-hospital mortality rates and correlation with anatomic location of the airway foreign body have not been previously reported. METHODS: The KID database was reviewed for 2003, 2006, 2009, and 2012 for pediatric patients with a discharge diagnosis of airway foreign body using ICD-9 codes (933.1, 934.x). RESULTS: 11,793 patients, ages 0-17, were found to have an airway FB. Of patients admitted for airway FB 21.2 % required mechanical ventilation during their hospitalization, and the overall mortality rate was 2.5 %. Location of the airway FB was dependent on age (p < 0.01). Use of mechanical ventilation was dependent on the location of the airway FB (p < 0.01) and being transferred from another hospital (OR 2.59, p < 0.01). Univariate analysis demonstrated differences in in-hospital mortality based on location (p < 0.01), use of a ventilator during hospitalization (OR 24.4, p < 0.01), and transfer from another hospital (OR 2.11, p < 0.01). CONCLUSIONS: The in-hospital mortality rate for airway foreign bodies is 2.5 %. The anatomic location of airway FB in pediatric patients varies by age, and affects the need for mechanical ventilation and in-hospital mortality.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Corpos Estranhos/diagnóstico , Sistema Respiratório/diagnóstico por imagem , Adolescente , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/epidemiologia , Broncoscopia , Criança , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Sistema Respiratório/lesões , Estudos Retrospectivos , Estados Unidos/epidemiologia
10.
Anesteziol Reanimatol ; 61: 168-172, 2017 Sep.
Artigo em Russo | MEDLINE | ID: mdl-29465199

RESUMO

THE AIM: A comparative analysis of the injuries of upper airways flexible reinforced laryngeal mask and endotracheal intubation by examining the stress response reaction of the cardiovascular system, as well as the frequency and variety of complications. Blood pressure, heart rate, glucose and cortisol, and complications of airway management in children were analyzed. METHODS: The influence of the method of airway management with surgery in nose and sinuses in children in the stress response, hemodynamics, injuries of the airway were studied. The study included 140 patients aged 3 to 17 years. RESULTS: LMA FlexibleTMhas a minimal negative impact on the hemodynamics. Stress response is less pronounced when installing laryngeal mask than with tracheal intubation, which manifests itself in less cortisol concentration of 3.7%, 11.4% glucose. After removing the flexible reinforced laryngeal mask less than after extubation occurs: cough by 21%, 10% hoarseness, and sore throat by 26%. CONCLUSION: The use of the laryngeal mask airway during surgery in the nose and paranasal sinuses safer and less trau- matic manipulation compared with tracheal intubation.


Assuntos
Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Procedimentos Cirúrgicos Nasais , Seios Paranasais/cirurgia , Sistema Respiratório/lesões , Adolescente , Criança , Pré-Escolar , Hemodinâmica/fisiologia , Humanos , Hidrocortisona/sangue , Complicações Intraoperatórias , Máscaras Laríngeas/efeitos adversos , Estresse Psicológico/sangue , Resultado do Tratamento , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
11.
Br J Anaesth ; 117 Suppl 1: i49-i59, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27566791

RESUMO

INTRODUCTION: Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the 'anticipated' difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns. METHODS: A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma. Our protocol and search strategy are registered with and published by PROSPERO (http://www.crd.york.ac.uk/PROSPERO, ID: CRD42016032763). RESULTS: A systematic literature search yielded 578 articles, of which a total of 148 full-text papers were reviewed. We present our results categorized by mechanism of injury: blunt, penetrating, blast, and burns. CONCLUSIONS: The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some time, or adequate time). Human factors, particularly the development of a shared mental model amongst the trauma team, are vital to mitigate risk and improve patient safety.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Sistema Respiratório/lesões , Queimaduras/cirurgia , Humanos , Intubação Intratraqueal/métodos , Laringe/lesões , Laringe/cirurgia , Sistema Respiratório/cirurgia , Traqueia/lesões , Traqueia/cirurgia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
12.
Zhonghua Jie He He Hu Xi Za Zhi ; 39(7): 534-8, 2016 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-27430925

RESUMO

OBJECTIVE: To explore the optimal pressure of sputum aspiration to ensure the effectiveness and safety of clinical operation. METHODS: We established a rabbit model of airway mucus hypersecretion by aerosol acrolein inhalation, and the animals were divided into 4 groups randomly with different sputum aspiration pressure as follows: group A -75 mmHg (1 mmHg=0.133 kPa), group B -150 mmHg, group C -225 mmHg, group D -300 mmHg. Sputum aspiration efficiency and tracheal mucosal damage degree were evaluated by sputum volume, oxygen saturation changes, the pathological sections of tracheal mucosa and the expressions of IL-1ß and TNF-α in airway secretion. RESULTS: The sputum suction volume of group A, B, C, D were (2.72±0.24), (4.81±0.32), (5.03±0.37) and (6.29±0.51) ml, respectively, which was significantly higher in group D, but lower in group A, as compared to other groups (P<0.05). There were no significant differences between B and C groups. The maximal SpO2 decrease of C and D groups [(18.1±5.2)% and(32.4±8.4)%]were significantly higher than those in A and B groups [(4.4±1.7)% and (6.3±2.9)%], and group D was significantly more than group C, and the difference was statistically significant (P<0.05). There were no significant differences between A and B groups. HE staining of tracheal mucosa in C and D groups showed that the inflammatory cell infiltration and mucosal damage were more serious than A and B groups, but the airway mucosal damage of group A was the least. CONCLUSION: The pressure of -150 mmHg was more effective with high oxygen saturation and less airway injury, which may be suitable for clinical sputum aspiration.


Assuntos
Biópsia por Agulha/métodos , Muco/metabolismo , Sistema Respiratório/lesões , Escarro , Animais , Modelos Animais de Doenças , Interleucina-1beta/metabolismo , Pressão , Distribuição Aleatória , Ratos , Fator de Necrose Tumoral alfa/metabolismo
13.
World J Surg ; 40(11): 2658-2666, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27255938

RESUMO

BACKGROUND: Injuries to the airway in the neck and thorax are uncommon, but may be potentially life threatening. The objective of this study is to determine the clinical characteristics and outcomes for patients with airway injury. METHODS: From 1974 to 2014, a prospectively entered trauma database at a Level 1 trauma center was accessed to identify patients with injuries to the larynx, cervical trachea, or thoracic airway. Hospital charts were reviewed to obtain data on demographics, presentation, injury management, in-hospital and long-term morbidity and in-hospital mortality. Multivariate logistic regression was used to estimate predictors of mortality and long-term vocal cord morbidity. Data are expressed as N (%). RESULTS: One hundred and twenty patients were included (median injury severity score: 19 [interquartile range: 10-27]). There were 65 (54 %) blunt and 55 (46 %) penetrating injuries, with 90 (75 %) suffering multiple injuries. Sixteen (13 %) patients died from associated injuries (7: in ER; 9: after admission). Injuries were located in the cervical airway [101 (84 %)], thoracic airway [21 (18 %)], or both [2 (2 %)]. Eighty-six (72 %) patients were managed surgically. Predictors of in-hospital mortality included hemodynamic instability (OR 6.54, 95 % CI 1.11-37.14), GCS < 8 upon presentation (OR 4.35, 95 % CI 3.24-5.41), and head trauma (OR 4.10, 95 % CI 1.91-6.30). Fracture of cricoid or thyroid cartilages was a strong predictor of long-term vocal cord injury (OR 3.93, 95 % CI 1.25-12.59). CONCLUSIONS: Airway trauma remains a major challenge for early diagnosis, airway control, and management of both acute life-threatening injury and long-term morbidity.


Assuntos
Lesões do Pescoço/epidemiologia , Sistema Respiratório/lesões , Traumatismos Torácicos/epidemiologia , Adulto , Manuseio das Vias Aéreas , Brônquios/lesões , Canadá/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Laringe/lesões , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/diagnóstico , Sistema de Registros , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico , Traqueia/lesões , Prega Vocal/lesões , Adulto Jovem
14.
Int J Pediatr Otorhinolaryngol ; 83: 84-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26968059

RESUMO

BACKGROUND: Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3. No data from the former U.S.S.R. are available in the international scientific literature. METHODS: Consecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies' inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis. RESULTS: 2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the "High-Income" countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data. CONCLUSIONS: Since Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective. LEVEL OF EVIDENCE: Level V, Epidemiological case series.


Assuntos
Asfixia/epidemiologia , Corpos Estranhos/etiologia , Sistema Respiratório/lesões , Ferimentos e Lesões/etiologia , Adolescente , Asfixia/etiologia , Criança , Pré-Escolar , Georgia/epidemiologia , Hospitalização , Humanos , Lactente , Exposição por Inalação , Sistema de Registros
17.
Eur Radiol ; 26(7): 2409-17, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26494643

RESUMO

OBJECTIVES: To determine the specific CT findings of penetrating neck wound profile predicting aerodigestive injuries, diagnostic performance of CTA and to propose a modified selective management algorithm to reduce nontherapeutic invasive procedures. METHODS: We retrospectively evaluated CTAs of 102 patients to determine the presence of various CT signs. "Trajectory"-based signs included trajectory of the wound extending into the aerodigestive tract and trajectory violating the deep neck spaces. "Conventional" signs included transcervical injury; wall defect; air or blood in the deep neck spaces; irregular or thickened aerodigestive tract; and active mucosal bleeding. RESULTS: Trajectory of the wound extending into the aerodigestive tract (sensitivity 76 %, specificity 97 %) and trajectory of the wound violating the suprahyoid deep neck spaces or the infrahyoid visceral space (sensitivity 97 %, specificity 55 %) were the best predictors of injury on regression analysis. The most specific "conventional" CT signs were "wall defect" and "active mucosal bleed", but had very low sensitivity. The sensitivity of CTA for detecting an injury ranged from 89.5 % to 92 %, specificity ranged from 62.5 % to 89 %. CONCLUSION: CTA can be a useful technique in detecting aerodigestive injury. Our proposed management algorithm can exclude an injury with high degree of confidence (sensitivity 97 %). KEY POINTS: • Trajectory-based CT signs predict aerodigestive injury after penetrating neck trauma. • Surgery should be considered when trajectory extends into the infra-arytenoid aerodigestive tract. • Endoscopy or exploration should be considered when trajectory violates deep neck spaces. • This modified approach can decrease negative explorations and invasive diagnostic procedures.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Lesões do Pescoço/diagnóstico por imagem , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
18.
B-ENT ; Suppl 26(1): 127-137, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29461738

RESUMO

Toxic exposure to caustics and respiratory irritants. Toxic emergencies for which the ENT physician is con- sulted mainly involve toxic exposure of the upper airway and digestive tract to caustics and respiratory irritants. The ENT physician may, however, also be involved as a first responder in the case of poisoned patients. This article therefore aims to provide a comprehensive general approach to patients with suspected poisoning and to present a more elaborate discussion on the diagnosis and management of patients following exposure to caustics and respiratory irritants. This survey, however, does not intend to be a substitute for the need for consultation with an emergency physician and a clinical toxicologist qualified in the diagnosis and treatment of poisoned patients.


Assuntos
Queimaduras Químicas/terapia , Cáusticos/toxicidade , Trato Gastrointestinal/lesões , Irritantes/toxicidade , Sistema Respiratório/lesões , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/etiologia , Humanos
20.
J Trauma Acute Care Surg ; 79(2): 188-92; discussion 192-3, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26218684

RESUMO

BACKGROUND: Incidental pneumomediastinum is a common radiologic finding following blunt thoracic injury; however, the clinical significance of pneumomediastinum on screening imaging is poorly defined (Curr Probl Surg. 2004;41(3):211-380; Injury. 2010;41(1):40-43). The purpose of this study was to define the incidence of aerodigestive injuries in patients with pneumomediastinum after blunt thoracic and neck injury. METHODS: After institutional review board approval was obtained, a retrospective review was performed of all patients admitted to Los Angeles County + University of Southern California Medical Center with blunt neck and/or thoracic injuries between January 2007 and December 2012. All patients with pneumomediastinum on radiologic investigation were included. Data accrued included demographics, admission clinical data, injury severity patterns, incidence of aerodigestive injuries, operative findings, morbidity, mortality, as well as intensive care unit and hospital lengths of stay. RESULTS: A total of 9,946 patients were included in the study. The predominant mechanism was motor vehicle collision (49%), disproportionately male (76%). Overall, 258 patients (2.6%) had a pneumomediastinum: 65 (25%) and 193 (75%) were diagnosed on a chest x-ray or on a computed tomography (CT) scan, respectively. A total of 21 patients (8.1%) had an aerodigestive workup with bronchoscopy, esophagram, and/or esophagoscopy. Overall, four aerodigestive lesions (1.6%) were diagnosed. Three tracheobronchial injuries were identified on CT scan, and one esophageal injury was diagnosed on an esophagram. Two tracheobronchial injuries required surgery, while the remaining cases were managed nonoperatively. The overall mortality in this cohort was 10.9%. CONCLUSION: Isolated findings of pneumomediastinum on screening chest x-ray or CT following blunt trauma is a poor predictor of an aerodigestive injury. Highly selective workup in this clinical setting is warranted. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.


Assuntos
Sistema Digestório/lesões , Enfisema Mediastínico/etiologia , Lesões do Pescoço/diagnóstico , Sistema Respiratório/lesões , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/complicações , Adulto , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Radiografia Torácica , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
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