New GSW case

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The patient may have an esophageal injury considering an anteroposterior
trajectory.

Jose Luis J. Danguilan, MD

On Mon, Mar 16, 2009 at 11:45 PM, D. R. Gill <d_gill911 at yahoo.com> wrote:

> You should also try Hyaluronic acid (HA). It has shown successful in
> treating tracheal injuries and in post-op. HA is essential in preventing
> tracheal stenosis.
>
> Just a thought,
> D. R. Gill
> Mercer University
>
>
> --- On Mon, 3/16/09, kmattox at aol.com <kmattox at aol.com> wrote:
>
> From: kmattox at aol.com <kmattox at aol.com>
> Subject: Re: New GSW case
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Date: Monday, March 16, 2009, 10:42 AM
>
> Concerned that there IS an esophageal injury still.  Did you use
> gastrograffin
> or Barium. Barium is preferred.  A negative esophageal swallow does not
> rule out
> an injury.   This patient will need a permanent tracheostomy.
> ------Original Message------
> From: William Bromberg
> Sender:
> To: trauma-list at trauma.org
> ReplyTo: Trauma & Critical Care mailing list
> Sent: Mar 16, 2009 9:32 AM
> Subject: New GSW case
>
> Hello all — I have a case I'd like your opinions on:
>
> 11 y.o female, 60kg. Sustained a GSW ( .380 handgun) directly through
> and through the trachea and spinal cord. Spinal injury is complete at T3
> — fairly straightforward.
>
> The tracheal injury consists of two very clean holes directly anterior
> and posterior (I will admit to having perc. trachs less perfectly
> placed) at 4-5 cm above the carina. There was minimal mediastinal air on
> the CT, no esophageal or great vessel injury (Ba swallow and CT angio
> respectively). The patient is temporarily intubated past the injury (via
> bronchoscopy) and sedated in the PICU.
>
> Does it have to be fixed or can it be managed non-operatively with
> temporary intubation?
>
>
> Thanks,
> Bill
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>
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