03 Dec

Fiberoptic Bronchoscopy in the Evaluation of Acute Chest and Upper Airway Trauma

Fiberoptic Bronchoscopy in the Evaluation of Acute Chest and Upper Airway TraumaBronchoscopy has been recommended for all cases of major trauma to the chest. This has been recommended mainly to evaluate for injury to the airway. In part, this is due to the often occult presentation and serious nature of these injuries. However, bronchoscopy may also be useful in the assessment and management of other problems encountered in acute trauma. Bronchoscopy for hemoptysis may reveal hemorrhage associated with pulmonary contusion and prompt the placement of a doublelumen endotracheal tube or balloon catheter for tamponade. Bronchoscopy for lung, lobar, or segmental collapse may reveal aspirated material or thick secretions and mucous plugging. Despite the frequency of this procedure in the initial assessment of trauma, there are very few data on the findings obtained from bronchoscopy. In order to determine the utility of FFB in the short-term evaluation of patients with trauma we retrospectively reviewed the patients seen at the Mayo Clinic who had FFB performed during an evaluation of trauma. this

Materials and Methods

We retrospectively identified all of the patients who were seen at the Mayo Clinic between 1977 and 1987 who had FFB performed during an admission for trauma. Ninety-six patients were identified, and 53 of these patients had bronchoscopy performed within three days of the traumatic event. Thirty patients had FFB performed on day 0, five patients on day 1, ten patients on day 2, and eight patients on day 3. This report will be limited to the findings encountered in these 53 patients. Forty-five patients were male patients, and eight were female patients. The mean age was 36 years (range, 10 to 84 years). Forty-five patients survived and eight patients died during the admission.
Results
Fifty patients had blunt trauma to the chest. Most of these were due to motor vehicle accidents, which involved 38 patients (72 percent). Three patients (6 percent) each were injured by falls or a crushing injury. One patient (2 percent) each was involved in the following: an airplane crash; bicycle accident; pedestrian accident; thrown and stepped on by a horse; trampled by cows; and repeatedly butted by a bull. Three patients had cervical trauma; one (2 percent) was from a gunshot wound, one (2 percent) was from a clothesline injury, and one (2 percent) was from an attempt at suicide by hanging.

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