Patient crushed by truck on chest, successfully treated by doctors

A 17-year-old female patient, who had a traffic accident (a 1.5-ton truck crushed her left chest), was admitted to the hospital in a conscious state, with pain in her left shoulder and chest wall, severe shortness of breath, complete loss of alveolar murmur in her left lung, and soft tissue contusions in multiple locations (shoulder, chest wall, abdomen, left arm).

The patient was given a preliminary diagnosis: Closed chest trauma due to a traffic accident, left lung contusion, 5 broken ribs, and severe left pneumothorax. The patient had a left pleural drain placed, which released a lot of air.

The patient was fortunately taken to the hospital in time for treatment (photo source: 108 Central Military Hospital).

After placing the drain, the patient's respiratory condition did not improve, and the drain continued to release air. A chest CT scan showed that the left lung was still collapsed, with a hematoma in the lower lobe of the lung.

After consultation, the patient was indicated for emergency bronchoscopy. The bronchoscopy results showed a near-severe tear of the left main bronchus, and the upper and lower lobe bronchi below the site of the injury could not be examined.

The patient was quickly operated on. The bronchial injury was extremely complicated: contusion, near complete rupture of the left main bronchus near the division of the upper and lower lobe bronchi, longitudinal tear of the posterior mucosa of the left main bronchus, and crushing and nearly severing of the first two cartilage rings of the upper lobe bronchus.

In addition, the lower lobe of the lung was severely contused, and bleeding from the bronchial artery caused a large hematoma in the lower lobe of the left lung.

The surgical team aspirated the hematoma in the lower lobe of the left lung, cut and removed the complex tear of the left main bronchus and the upper lobe bronchus, the lower lobe bronchus, and created a junction of the left main bronchus - left lower lobe bronchus - left upper lobe bronchus.

According to Dr. Ngo Vi Hai - Head of the Department of Thoracic Surgery, the main surgeon of the surgery, "For this injury, reconstructing the junction of the main bronchus - upper and lower lobar bronchus is the only solution to preserve the patient's lungs, otherwise the patient will lose the entire left lung.

Because with this type of damage, both lobes of the bronchus are severely damaged, if only one lobe is cut, it cannot be connected to the main bronchus.

If the entire left lung is lost, it will be very serious, it can be life-threatening in the short term as well as greatly affect the patient's quality of life later on. This is a very young patient, so we are trying our best to do the best for him."

Three days after the emergency surgery, the patient was extubated and was breathing well on his own. The patient then received intensive treatment, using antibiotics and bronchoscopy to aspirate the bronchial blood, combined with active physical therapy to help the patient cough up all the blood and restore respiratory function.

The patient quickly recovered. After 1 week, the patient had a bronchoscopy and chest CT scan to check that the bronchial anastomosis was well healed and the lung parenchyma was almost completely recovered.

The patient was discharged 9 days after surgery in stable condition, with normal breathing and scheduled regular follow-up appointments to monitor and ensure long-term results of the surgery.

The success of this surgery demonstrates the expertise of the doctors as well as the effectiveness of the organization and coordination of specialties in diagnosing and treating emergency patients at the 108 Military Central Hospital.

Source: https://www.congluan.vn/bi-o-to-tai-de-len-nguc-benh-nhan-da-duoc-bac-si-cap-cuu-thanh-cong-post273701.html