Difference between revisions of "Penetrating neck trauma"

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==Background==
 
==Background==
 
*Defined by platysma violation
 
*Defined by platysma violation

Revision as of 23:27, 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