Penetrating neck trauma - Revision history

Rossdonaldson1: /* Injuries Patterns by Zone */

2024-10-09T21:02:56Z

Injuries Patterns by Zone

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	===Injuries Patterns by Zone===		===Injuries Patterns by Zone===
			*These patterns are neither sensitive nor specific
			**Neck zones were classically used to determine workup. However, evaluation has moved primarily to a "zoneless" approach in part due to easy access to neck CTA.
	{\| {{table}}		{\| {{table}}
	!Zone!!class="unsortable"\|Anatomic Landmarks!!class="unsortable"\|Potential Injuries		!Zone!!class="unsortable"\|Anatomic Landmarks!!class="unsortable"\|Potential Injuries

2024-10-09T20:59:31Z

Background

← Older revision		Revision as of 20:59, 9 October 2024
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	[[File:Neck zones.png\|thumb\|Zones of Neck]]		[[File:Neck zones.png\|thumb\|Zones of Neck]]
	[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]		[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
			[[File:Infrahyoid deep neck spaces.png\|thumb\|]]
	*Defined by platysma violation		*Defined by platysma violation
	**Assume significant injury has occurred until proven otherwise		**Assume significant injury has occurred until proven otherwise

2024-02-07T22:35:53Z

Background

← Older revision		Revision as of 22:35, 7 February 2024
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	==Background==		==Background==
	[[File:Neck zones.png\|thumb\|Zones of Neck]]		[[File:Neck zones.png\|thumb\|Zones of Neck]]
			[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
	*Defined by platysma violation		*Defined by platysma violation
	**Assume significant injury has occurred until proven otherwise		**Assume significant injury has occurred until proven otherwise

2022-04-24T14:56:46Z

Zone II

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	====Zone II====		====Zone II====
	*Optimal management is controversial		*Optimal management is controversial
	**Platysma		**Platysma penetration
	***~~Not penetrated: obs and~~ discharge		***No penetration → Observe, possible discharge
	***~~Penetrated and vitals~~/~~airway~~ stable~~: CT angio~~ of neck		***Penetration + Vitals/Airway stable → CTA of neck
	***~~Penetrated and~~ unstable, ~~expanding hematoma:~~ OR		***Penetration + Vitals/Airway unstable, or other hard signs → OR for surgical exploration
	*All bleeding should be controlled with pressure, not with clamps		*All bleeding should be controlled with pressure, not with clamps

2021-01-30T20:19:46Z

General

← Older revision		Revision as of 20:19, 30 January 2021
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	*Breathing		*Breathing
	**Minimize BVM (positive pressure --> air into soft tissue plains)		**Minimize BVM (positive pressure --> air into soft tissue plains)
	**Consider CXR to eval for [[pneumothorax\|PTX]], especially if Zone I injury		**Consider ultrasound or CXR to eval for [[pneumothorax\|PTX]], especially if Zone I injury
	*Circulation		*Circulation
	**Place IV on contralateral side of injury		**Place IV on contralateral side of injury

2021-01-30T20:19:26Z

General

← Older revision		Revision as of 20:19, 30 January 2021
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	***Expanding hematoma		***Expanding hematoma
	*Breathing		*Breathing
	**Minimize BVM (positive pressure --> air into soft tissue plains)		**Minimize BVM (positive pressure --> air into soft tissue plains)
			**Consider CXR to eval for [[pneumothorax\|PTX]], especially if Zone I injury
	*Circulation		*Circulation
	**Place IV on contralateral side of injury		**Place IV on contralateral side of injury

2020-02-23T17:25:53Z

Clinical Features

← Older revision		Revision as of 17:25, 23 February 2020
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	\|-		\|-
	\| [[focal neuro deficits\|Neuro Deficit]]/[[weakness\|Paralysis]]/[[CVA\|Cerebral ischemia]] \|\|[[Paresthesias]]		\| [[focal neuro deficits\|Neuro Deficit]]/[[weakness\|Paralysis]]/[[CVA\|Cerebral ischemia]] \|\|[[Paresthesias]]
			\|-
			\| Absent or unequal radial pulse
	\|}		\|}

2020-02-22T12:09:02Z

General

← Older revision		Revision as of 12:09, 22 February 2020
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	*Disability		*Disability
	**Neuro deficits may be secondary to direct cord injury or cerebral ischemia secondary to carotid injury		**Neuro deficits may be secondary to direct cord injury or cerebral ischemia secondary to carotid injury
	**Place in C-collar if:		**Place in C-collar only if:
	***ALOC, [[focal neuro deficits\|neuro deficits]], or significant blunt injury		***ALOC, [[focal neuro deficits\|neuro deficits]], or significant blunt injury

2020-02-22T12:08:07Z

General

← Older revision		Revision as of 12:08, 22 February 2020
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	***Expanding hematoma		***Expanding hematoma
	*Breathing		*Breathing
	**Minimize BVM (positive pressure > air into soft tissue plains)		**Minimize BVM (positive pressure --> air into soft tissue plains)
	*Circulation		*Circulation
	**Place IV on contralateral side of injury		**Place IV on contralateral side of injury

2020-02-22T12:07:35Z

Evaluation

← Older revision		Revision as of 12:07, 22 February 2020
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	==Evaluation==		==Evaluation==
	[[File:Cta-neck-trauma-algorithm.png\|thumb\|Algorithm for CTA Neck after penetrating trauma]<ref>Sperry JL, Moore EE, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936–940. [http://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsPenetratingNeckTrauma.pdf\|fulltext] </ref>]]		[[File:Cta-neck-trauma-algorithm.png\|thumb\|Algorithm for CTA Neck after penetrating trauma]<ref>Sperry JL, Moore EE, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936–940. [http://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsPenetratingNeckTrauma.pdf\|fulltext] </ref>]]
	===~~Evaluation~~ (WTA Algorithm)===		===Workup (WTA Algorithm)===
	*If hard signs or HD instability, attempt tamponade, secure airway, then OR.		*If hard signs or hemodynamic instability, attempt tamponade, secure airway, then directly to OR for surgical exploration
	*If no hard signs and yet suspect injury, CTA.		*If no hard signs and yet suspect injury, CTA neck with IV contrast

	~~===Imaging Options===~~
	*[[CXR]]
	**Pneumo/hemothorax, pneumomediastinum
	*CTA
	**1st line
	*Angiography
	**Gold-standard
	**Useful if embolization or stent placement are anticipated or CT inconclusive

	==Management==		==Management==