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Podcast 885: Penetrating Neck Injuries
Manage episode 393987668 series 1397179
Contributor: Ricky Dhaliwal MD
Educational Pearls:
Three zones of the neck with different structures and risks for injuries:
Zone 1 is the most caudal region from the clavicle to the cricoid cartilage
Zone 2 is from the cricoid cartilage to the angle of the mandible
Zone 3 is superior to the angle of the mandible
Zone 1 contains the thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins), carotid arteries, vertebral artery, apices of the lungs, trachea, esophagus, spinal cord, thoracic duct, thyroid gland, jugular veins, and the vagus nerve.
Zone 2 contains the common carotid arteries, internal and external branches of carotid arteries, vertebral arteries, jugular veins, trachea, esophagus, larynx, pharynx, spinal cord, and vagus and recurrent laryngeal nerves
Lower risk than Zone 1 or Zone 3
Zone 3 contains the distal carotid arteries, vertebral arteries, jugular veins, pharynx, spinal cord, cranial nerves IX, X, XI, XII, the sympathetic chain, and the salivary and parotid glands
Hard signs that indicate direct transfer to OR:
Airway compromise
Active, brisk bleeding
Pulsatile hematomas
Hematemesis
Massive subcutaneous emphysema
Soft signs that may obtain imaging to determine further interventions:
Hemoptysis
Oropharyngeal bleeding
Dysphagia
Dysphonia
Expanding hematomas
Soft sign management includes ABCs, type & screen, and airway interventions followed by imaging of the head & neck area
Patients with dysphonia or dysphagia with subsequent negative CTAs may get further work-up via swallow studies
References
Asensio JA, Chahwan S, Forno W, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma. 2001;50(2):289-296. doi:10.1097/00005373-200102000-00015
Azuaje RE, Jacobson LE, Glover J, et al. Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma. Am Surg. 2003;69(9):804-807.
Ibraheem K, Wong S, Smith A, et al. Computed tomography angiography in the "no-zone" approach era for penetrating neck trauma: A systematic review. J Trauma Acute Care Surg. 2020;89(6):1233-1238. doi:10.1097/TA.0000000000002919
Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: A guide to evaluation and managementx. Ann R Coll Surg Engl. 2018;100(1):6-11. doi:10.1308/rcsann.2017.0191
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
1067 episodes
Manage episode 393987668 series 1397179
Contributor: Ricky Dhaliwal MD
Educational Pearls:
Three zones of the neck with different structures and risks for injuries:
Zone 1 is the most caudal region from the clavicle to the cricoid cartilage
Zone 2 is from the cricoid cartilage to the angle of the mandible
Zone 3 is superior to the angle of the mandible
Zone 1 contains the thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins), carotid arteries, vertebral artery, apices of the lungs, trachea, esophagus, spinal cord, thoracic duct, thyroid gland, jugular veins, and the vagus nerve.
Zone 2 contains the common carotid arteries, internal and external branches of carotid arteries, vertebral arteries, jugular veins, trachea, esophagus, larynx, pharynx, spinal cord, and vagus and recurrent laryngeal nerves
Lower risk than Zone 1 or Zone 3
Zone 3 contains the distal carotid arteries, vertebral arteries, jugular veins, pharynx, spinal cord, cranial nerves IX, X, XI, XII, the sympathetic chain, and the salivary and parotid glands
Hard signs that indicate direct transfer to OR:
Airway compromise
Active, brisk bleeding
Pulsatile hematomas
Hematemesis
Massive subcutaneous emphysema
Soft signs that may obtain imaging to determine further interventions:
Hemoptysis
Oropharyngeal bleeding
Dysphagia
Dysphonia
Expanding hematomas
Soft sign management includes ABCs, type & screen, and airway interventions followed by imaging of the head & neck area
Patients with dysphonia or dysphagia with subsequent negative CTAs may get further work-up via swallow studies
References
Asensio JA, Chahwan S, Forno W, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma. 2001;50(2):289-296. doi:10.1097/00005373-200102000-00015
Azuaje RE, Jacobson LE, Glover J, et al. Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma. Am Surg. 2003;69(9):804-807.
Ibraheem K, Wong S, Smith A, et al. Computed tomography angiography in the "no-zone" approach era for penetrating neck trauma: A systematic review. J Trauma Acute Care Surg. 2020;89(6):1233-1238. doi:10.1097/TA.0000000000002919
Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: A guide to evaluation and managementx. Ann R Coll Surg Engl. 2018;100(1):6-11. doi:10.1308/rcsann.2017.0191
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
1067 episodes
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