Difference between revisions of "Penetrating neck trauma"
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*Zone 3: Angle of mandible to base of skull | *Zone 3: Angle of mandible to base of skull | ||
| + | *Anatomical Structures at Risk: | ||
| + | *carotid (common, internal external) | ||
| + | *vertebral arteries | ||
| + | *subclavian vessels | ||
| + | *jugular vein | ||
| + | *brachiocephalic vein | ||
| + | *aortic arch | ||
| + | *lung apices | ||
| + | *cervical spine/cord | ||
| + | *thoracic duct | ||
| + | *brachial plexus | ||
| + | *phrenic nerve | ||
| + | *vagus nerve | ||
| + | *recurrent laryngeal nerve | ||
| + | *esophagus | ||
| + | *trachea | ||
| + | *larynx | ||
| + | *partoid/salivary glands | ||
| + | *cranial nerves 9-12 | ||
| + | *floor of mouth/skull | ||
| − | + | ==Management== | |
| − | + | *Airway | |
| − | + | **Consider early airway stabilization esp in those with respiratory distress, subq emphysema, expanding hematoma, AMS, or in those with direct laryngotracheal trauma | |
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| − | Airway | ||
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- RSI has been proven safe and effective | - RSI has been proven safe and effective | ||
Revision as of 02:28, 4 April 2011
Background
- Accounts for 5-10% of traumatic injuries in adults
- Multiple structures are injured in 30% (especially if breach in platysma)
Zones
- Zone 1: Between clavicles and inf aspect of cricoid cartilage
- Zone 2: From cricoid cartilage superiorly to the angle of the mandible
- Zone 3: Angle of mandible to base of skull
- Anatomical Structures at Risk:
- carotid (common, internal external)
- vertebral arteries
- subclavian vessels
- jugular vein
- brachiocephalic vein
- aortic arch
- lung apices
- cervical spine/cord
- thoracic duct
- brachial plexus
- phrenic nerve
- vagus nerve
- recurrent laryngeal nerve
- esophagus
- trachea
- larynx
- partoid/salivary glands
- cranial nerves 9-12
- floor of mouth/skull
Management
- Airway
- Consider early airway stabilization esp in those with respiratory distress, subq emphysema, expanding hematoma, AMS, or in those with direct laryngotracheal trauma
- RSI has been proven safe and effective
- minimize BVM as positive pressure generated can cause air to dissect into the neck and worsen injuries
- Orotracheal intubation usually successful but always have backup plan (fiberoptic, nasal intubation, surgical airway)
Surgical Management
Immediate Exploration if:
- hard signs of vascular injury (expanding hematoma, severe active/pulsatile bleeding, bruit, palpable thrill)
- HD unstable
- airway compromise
Can delay surgical management for further evaluation/imaging if not
Imaging/Other studies
Plain Films
- not helpful in visualizing soft tissues/vacular structures
- can show foreign bodies, fractures, tracheal displacement, hemo/penumothorax, widened mediastinum, apical hematoma, etc
Angiography
- gold standard for evaluating vasculature
- more important for Zone 1 and 3 injuries, especially for surgical planning
CT Angio
- shows soft tissue, bone, and vascular injury
- similar results as traditional angiography
- if normal, may consider eliminating surgical exploration in zone 2 PNI in a HD stable patient
Bronchoscopy
Esophagraphy/Esophagoscopy