Penetrating neck trauma: Difference between revisions

Revision as of 02:28, 4 April 2011

Airway
- Consider early airway stabilization esp in those with respiratory distress, subq emphysema, expanding hematoma, AMS, or in those with direct laryngotracheal trauma

- RSI has been proven safe and effective

- minimize BVM as positive pressure generated can cause air to dissect into the neck and worsen injuries

- Orotracheal intubation usually successful but always have backup plan (fiberoptic, nasal intubation, surgical airway)

Surgical Management

Immediate Exploration if:

- hard signs of vascular injury (expanding hematoma, severe active/pulsatile bleeding, bruit, palpable thrill)

- HD unstable

- airway compromise

Can delay surgical management for further evaluation/imaging if not

Imaging/Other studies

Plain Films

- not helpful in visualizing soft tissues/vacular structures

- can show foreign bodies, fractures, tracheal displacement, hemo/penumothorax, widened mediastinum, apical hematoma, etc

Angiography

- gold standard for evaluating vasculature

- more important for Zone 1 and 3 injuries, especially for surgical planning

CT Angio

- shows soft tissue, bone, and vascular injury

- similar results as traditional angiography

- if normal, may consider eliminating surgical exploration in zone 2 PNI in a HD stable patient

Bronchoscopy

Esophagraphy/Esophagoscopy

Authors:

@@ Line 8: / Line 8: @@
 *Zone 3: Angle of mandible to base of skull
+*Anatomical Structures at Risk:
+*carotid (common, internal external)
+*vertebral arteries
+*subclavian vessels
+*jugular vein
+*brachiocephalic vein
+*aortic arch
+*lung apices
+*cervical spine/cord
+*thoracic duct
+*brachial plexus
+*phrenic nerve
+*vagus nerve
+*recurrent laryngeal nerve
+*esophagus
+*trachea
+*larynx
+*partoid/salivary glands
+*cranial nerves 9-12
+*floor of mouth/skull
-Anatomical Structures at Risk:
+==Management==
-- carotid (common, internal external)
+*Airway
+**Consider early airway stabilization esp in those with respiratory distress, subq emphysema, expanding hematoma, AMS, or in those with direct laryngotracheal trauma
-- vertebral arteries
-- subclavian vessels
-- jugular vein
-- brachiocephalic vein
-- aortic arch
-- lung apices
-- cervical spine/cord
-- thoracic duct
-- brachial plexus
-- phrenic nerve
-- vagus nerve
-- recurrent laryngeal nerve
-- esophagus
-- trachea
-- larynx
-- partoid/salivary glands
-- cranial nerves 9-12
-- floor of mouth/skull
-Management
-Airway
-- consider early airway stabilization especially in those with respiratory distress, subq emphysema, expanding hematoma, AMS, or in those with direct laryngotracheal trauma
 - RSI  has been proven safe and effective