Difference between revisions of "Penetrating neck trauma"

(Management)
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*Missed esophageal injury is leading cause of delayed death
 
*Missed esophageal injury is leading cause of delayed death
  
==Zones==  
+
==Diagnosis==
 +
===Zones===
  
 
*Zone 1: Clavicles to inf aspect of cricoid cartilage
 
*Zone 1: Clavicles to inf aspect of cricoid cartilage
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*CN 9-12
 
*CN 9-12
  
==Management==
+
===Imaging===
 +
*Imaging
 +
**CT and CTA
 +
***Useful for evaluating esophageal injury
 +
**Angiography
 +
***Useful if embolization or stent placement are anticipated
 +
 
 +
==Treatment==
 
*Airway  
 
*Airway  
 
**Consider intubation in:
 
**Consider intubation in:
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*Circulation
 
*Circulation
 
**Place IV on contralateral side of injury
 
**Place IV on contralateral side of injury
 
*Imaging
 
**CT and CTA
 
***Useful for evaluating esophageal injury
 
**Angiography
 
***Useful if embolization or stent placement are anticipated
 
  
 
==See Also==
 
==See Also==
  
 
[[Category:Trauma]]
 
[[Category:Trauma]]

Revision as of 21:19, 16 July 2011

Background

  • Defined by platysma violation
  • Multiple structures are injured in 30%
    • Stab wound can enter in one zone and damage another
  • Surgery required in 15-20%
  • Missed esophageal injury is leading cause of delayed death

Diagnosis

Zones

  • Zone 1: Clavicles to inf aspect of cricoid cartilage
    • Highest mortality (usually due to exsanguination)
  • Zone 2: Inf cricoid cartilage to angle of mandible
    • Most commonly injuried
  • Zone 3: Angle of mandible to base of skull
  • Anatomical Structures at Risk:
    • Blood vessels
      • Carotid and vertebral arteries
      • Brachiocephalic and subclavian vessels
      • Jugular vein
  • Lung apices
  • Spinal cord
  • Thoracic duct
  • Brachial plexus
  • Phrenic and vagus nerves
  • Esophagus
    • Dysphagia, hematemesis, blood in saliva
  • Trachea
  • CN 9-12

Imaging

  • Imaging
    • CT and CTA
      • Useful for evaluating esophageal injury
    • Angiography
      • Useful if embolization or stent placement are anticipated

Treatment

  • Airway
    • Consider intubation in:
      • Stridor
      • Hemoptysis
      • Subq emphysema
      • Expanding hematoma
      • Stridor
  • Breathing
    • Minimize BVM (positive pressure > air into soft tissue plains)
  • Circulation
    • Place IV on contralateral side of injury

See Also