Monday, May 28, 2018

Penetrating Neck Injuries

R.E.B.E.L.EM - May 28, 2018
"Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is necessary for proper evaluation and management...
Take Home Points
  1. Penetrating injuries to the neck can damage a host of structures. Understanding the zones of the neck and the structures within them can help predict injuries
  2. If the platysma is violated, it should be assumed that deeper structures have been injured until proven otherwise
  3. Early airway management is crucial as injuries can lead to dynamic airway obstruction. Always be prepared for a surgical airway
  4. The presence of any hard signs of aerodigestive/neurovascular injuries (expanding/pulsatile hematoma, active brisk bleeding, hemorrhagic shock, massive subcutaneous emphysema, air bubbling through the wound, neurologic deficit) or violation of platysma, mandates an immediate OR trip. Do not delay the patient getting to the OR for additional studies
  5. Attempt to control vascular injuries with direct pressure and consider balloon tamponade with a foley catheter"