This week, we discuss penetrating neck trauma and some pearls and pitfalls in management.
Episode 152.0 – Penetrating Neck Trauma
Show Notes
REBEL EM: Penetrating Neck Injuries
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Zone 1 |
Zone 2 |
Zone 3 |
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Anatomic Landmarks |
Clavicle/Sternum to Cricoid Cartilage |
Cricoid Cartilage to the Angle of the Mandible |
Superior to the Angle of the Mandible |
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Anatomic Structures in Zone |
Proximal Common Carotid Artery |
Carotid Artery |
Vertebral Artery |
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Subclavian Artery |
Vertebral Artery |
Distal Carotid Artery |
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Vertebral Artery |
Jugular Vein |
Distal Jugular Vein |
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Lung Apices |
Pharynx |
Salivary and Parotid Glands |
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Trachea |
Trachea |
Cranial Nerves IX – XII |
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Thyroid |
Esophagus |
Spinal Cord |
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Esophagus |
Larynx |
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Thoracic Duct |
Vagus Nerve |
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Spinal Cord |
Recurrent Laryngeal Nerve |
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Spinal Cord |
Hard + Soft Signs of Major Aerodigestive or Neurovascular Injury
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Hard Signs |
Soft Signs |
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Airway Compromise |
Hemoptysis |
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Expanding or Pulsatile Hematoma |
Oropharyngeal Blood |
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Active, Brisk Bleeding |
Dyspnea |
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Hemorrhagic Shock |
Dysphagia |
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Hematemesis |
Dysphonia |
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Neurologic Deficit |
Nonexpanding Hematoma |
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Massive Subcutaneous Emphysema |
Chest Tube Air Leak |
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Air Bubbling Through Wound |
Subcutaneous or Mediastinal Air |
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Vascular Bruit or Thrill |
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Crepitus |
WTA Management Algorithm for Penetrating Neck Injury (Sperry 2013)
Thrill or bruit is listed as a hard sign of neck injury in Tintinalli 9 ed.