chest trauma in spite of seat belts - It happens!
I received an online consultation on a lazy Sunday afternoon during the Lockdown of April 2020. When I called up the hospital to provide and estimate for surgery for the Child who needed heart surgery, they asked me whether I operated on Tracheal injuries as well.
As Young parents, we are so happy when we get our first car, that a joy ride is mandatory for the family. One such dad took his son on a drive around the empty street that morning. The Boy was on the lap of the father and the dad was not wearing the seat belt.
Ramming into the concrete divider, the car was totalled. The dad was unscathed.
Unable to breathe and unconscious the 4 year old boy was brought to the emergency where on Intubation he deteriorated further. The Emergency CT scan showed air in both pleura collapsing the lungs. Chest tubes were inserted to drain the air which was copious enough to prevent lung expansion.
That is when I was speaking to the Hospitalist.
It was sheer luck for the boy that my training had included thoracic surgery. CT scan showed complete division and separation of the trachea. midway down its length. Out of the purview of the ENT, Trauma and paediatric surgeons.
The Emergency surgery involved taking the child onto Cardiopulmonary Bypass(#CPB), retracting the endotracheal tube within it, and repairing the delicate trachea over it. The heart and lungs being normal, these functions recovered rapidly. Though his brain showed diffuse neuronal injury due to hypoxia, he was able to function adequately enough to come of the ventilator machine. 17 days in the ICU and a toiletting tracheostomy later, he went home! (Pic)
Steering wheel injury involves the liver, heart, lung, spleen or aorta. As most of them occur in adults. In a child, the wheel hits relatively higher on the torso. The flexible sternum and ribs had pinched the boy's trachea against the vertebra posteriorly resulting in a clean through and through cut.
The Boy survived, it was a miracle.
Moral:
children do not belong in the front seats, especially on your lap.
and please wear your seat belts!
Pediatric and Neonatal cardiac surgeon.
4 年venkata ashok chowdary kunla
Staff Specialist at The Sydney Children's Hospital Network
4 年Nice work
Physician Assistant ( Freelance)
4 年Grt sir
Fetal/Pediatric Echocardiographer
4 年Very nice work. These deceleration injuries also can result in a Transecetion of the Aorta. I have seen a few cases that were flown in for aortic dissection diagnosed by CT. When the surgeon opened the chest there was food in the thoracic cavity due esophageal rupture, not the aorta. I am glad your training and experience paid off in this case. Congrats.