IntroductionWe present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube.Case presentationA 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with no motor deficits. On his spinal CT a fracture on multiple ribs leading to right sided hemothorax was observed with air in the T6-T8 spinal canal. A chest tube was placed and as he did not have any neurological deficits surgical intervention to the pneumorrhachis was not considered. On the next day's a follow-up CT the air in the spinal canal was reduced and on the 5th day resolved completely.ConclusionTraumatic pneumorrhachis is a rare phenomenon and is not fully understood how the air from the posterior mediastinal wall can spread to the epidural or subarachnoid space. One hypothesis for subarachnoid air is that the high pressure air from a pneumothorax or pneumomediastinum pushes in a one-valve mechanism through the fascial layers of the posterior mediastinum through the neural foramina into the spinal canal. In our case, after the insertion of the chest tube the air in the subarachnoid space resolved and the patient's tingling sensation on his legs disappeared. We believe that the negative pressure of the chest tube did a somehow reverse effect of the air flow back from the spinal canal into the chest tube which has not been reported in the literature before.
Anesthesia Management in Trauma Trauma, which means wound in ancient Greek, is the leading cause of death in the 1-44 age group, and the third cause of death following cancer and cardiovascular disease in all age groups. Trauma is defined as tissue damage characterized by structural changes and physiological disorders due to mechanical, thermal, electrical and chemical energies, ionized or nuclear radiation or absence of essential elements of life such as oxygen and heat. Trauma has many reasons such as traffic accidents, work accidents and falling from height (1,2). These patients need a systematic anesthesia management in posttraumatic evaluation, airway management, resuscitation, possible preoperative and postoperative surgical process, intensive care follow-up and treatment (3). The nature of trauma, uncontrollable bleeding after trauma, coagulation anomalies, hypothermia, shock, acidosis disrupt the normal homeostatic mechanism. Acute coagulopathy caused by high blood loss in major traumas is often associated with poor clinical course in trauma patients (4,5). Another paradox is the nature of unexplained events, insufficient anamnesis information and the necessity of emergency intervention in trauma cases. Initial Assessment of Trauma Algorithms have been defined for systemic approach to trauma patients and more than fifty scoring systems have been developed. The Trauma score, which was defined in 1981 by adding respiratory rate and systolic blood pressure to the Triage index, is a widely used scoring system. It was revised in 1989 and Revised Trauma score was formed (Table 1). In order for the trauma centers to systematically engage a modern trauma approach in harmony between the other disciplines, it is necessary to establish national guidelines tailored to the needs and ensure their widespread use. Airway obstruction, severe hemorrhage and hypoxia due to tension pneumothorax may be among the causes of early death due to trauma (6-8). From the moment the trauma patient is met, the first step is to apply the
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