PMC6535340_01
(
A
) Clinical appearance of the patient in the trauma bay after intubation and bilateral needle thoracostomy; (
B
) computed tomography imaging displaying rupture of the right main stem bronchus (arrow), massive soft tissue and mediastinal emphysema, and significant right pneumothorax and in spite of drainage (*thoracostomy tube).
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Still, there was no obvious difference in breath sounds on both sides, so bilateral needle thoracostomy was performed, and the patient was endotracheally intubated ( Fig. 1A ). Computed tomography (CT) scan showed a complete avulsion of the right main stem bronchus at the level of the carina, a residual pneumothorax with mediastinal shifting, atelectasis of the right lung, as well as emphysema of the mediastinum and soft tissue ( Fig. 1B ).
Intraoperative placement of traction suture at the caudal tracheal rim of the defect, allowing simultaneous occlusion of the defect and patency of the left main stem bronchus.
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Hence, intubation under visual and tactile guidance with a preloaded 5.0 tube, using bronchoscope as "guidewire," was possible ( Fig. 2 ).