Penetrating neck trauma: Difference between revisions
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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 | ||
== | ===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 | ||
==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
- Blood vessels
- 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
- CT and CTA
Treatment
- Airway
- Consider intubation in:
- Stridor
- Hemoptysis
- Subq emphysema
- Expanding hematoma
- Stridor
- Consider intubation in:
- Breathing
- Minimize BVM (positive pressure > air into soft tissue plains)
- Circulation
- Place IV on contralateral side of injury