7. Wounds that penetrate the platysma must be
further evaluated
The major vascular and aerodigestive structures
in the neck are located in the anterior triangle, and
all are deep to the platysma
Penetrating injuries to the posterior triangle should
raise concern about trauma to the cervical spine
and spinal cord
8.
9. Zone I is the thoracic inlet from the sternal notch
to the cricoid cartilage
Zone II is the midportion of the neck from the
cricoid cartilage to the angle of the mandible
Zone III extends from the angle of the mandible to
the base of the skull
10. Zone I
◦ Contains the subclavian arteries and veins, the dome
of the pleura, esophagus, great vessels of the neck,
recurrent nerve, trachea
Zone II
◦ Contains the larynx, pharynx, base of tongue, carotid
artery and jugular vein, phrenic, vagus, and
hypoglossal nerves
Zone III
◦ Contains the internal and external carotid arteries, the
vertebral artery, and several cranial nerves
11.
12.
13. Does the patient require emergent airway
protection?
What is the best approach and technique for
airway protection?
14. Airway compromise (eg, respiratory distress,
severe hemorrhage, extensive or sucking neck
wound, shock)
Definite airway should be perform such as
orotracheal tube or surgical airway
Surgical airway is recommended if significant
trauma or obstruction above the larynx or if
anatomy is sufficiently distorted and airway
cannot be identified
15. Significant bleeding or hematoma
Hemoptysis
Subcutaneous emphysema
Bruit or thrill
Neurologic deficit
Distorted neck anatomy
Stridor
Difficulty or pain when swallowing secretion
Abnormal voice especially hoarseness(hot potato
voice)
16. Method
Oral & nasal intubation with or without endoscopic
guidance or muscle relaxants
Surgical airway
18. Zone I injuries with concomitant thoracic
injuries
◦ pneumothorax
◦ hemopneumothorax
◦ tension pneumothorax
19. Bleeding should be controlled by pressure
Do not clamp blindly or probe the wound depths
The absence of visible hemorrhage does not rule
out
Two large bore IVs
20. Thorough head and neck exam using palpation
and stethoscope to search for thrills and bruits
Neuro exam: mental status, cranial nerves, and
spinal column
Examine the chest, abdomen, and extremities
21. Be sure to examine the back of the patient as
unsuspected stab or gunshot wounds have been
missed here
Don’t blindly explore wound or clamp vessel
24. Vascular injury Shock Hematoma
Hemorrhage
Pulse deficit
Neurologic deficit
Bruit or thrill in neck
Laryngotracheal injury Subcutaneous emphysema
Airway obstruction
Sucking wound
Hemoptysis
Dyspnea
Stridor
Hoarseness or dysphonia
Pharynx/esophagusinjurySubcutaneous emphysema
Hematemesis
Dysphagia or odynophagia
25. X-Rays
◦ Pneumothorax or hemothorax
◦ retropharyngeal air or pneumomediastinum,
suggests esophageal injury
26. CT neck
◦ A multidetector helical CT scan (MDCT)
is often the first study obtained because
it can detect laryngotracheal, vascular,
and esophageal injuries simultaneously
and rapidly
27. Esophagography
◦ All penetrating neck injuries due to
high incidence of occult
esophageal injuries
Endoscopy
◦ If swallow (-), enhances sensitivity
for penetrating esophageal injury
28. CT-Angiogram
◦ The sensitivity and specificity of CT-A for
detecting significant vascular wounds in the
neck approaches nearly that of standard
angiography
29. Angiography
◦ Angiography demonstrates sensitivity and
specificity of close to 100 percent and has
been considered the gold standard in stable
patients
30. Endoscopy or laryngoscopy
◦ alternatives for the diagnosis of LT trauma
