1 / 29

NECK TRAUMA

NECK TRAUMA. Neck Trauma. 5-6% as isolated injury Fatality rates: stab wounds 1-2% gunshot wounds 5-12% rifle/shotgun 50% preventable deaths 50%. Blunt Trauma Diving injuries Assault Vehicular crashing into windshield /steering wheel seat belt whiplash “clothesline”. Penetrating

duc
Download Presentation

NECK TRAUMA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NECK TRAUMA

  2. Neck Trauma • 5-6% as isolated injury • Fatality rates: • stab wounds 1-2% • gunshot wounds 5-12% • rifle/shotgun 50% • preventable deaths 50%

  3. Blunt Trauma Diving injuries Assault Vehicular crashing into windshield /steering wheel seat belt whiplash “clothesline” Penetrating Assault stab wounds gunshot wounds Vehicular broken glass Causes of Neck Trauma

  4. Triangles of the Neck

  5. Anatomy of the Neck

  6. ZONES OF THE NECK[MONZON]

  7. Zones of the Neck

  8. Zones of the Neck • Zone I • highest mortality • Zone II • most frequent site of injury • lower mortality • Zone III • neurological • distal carotids • pharyngeal injuries

  9. Blunt Neck Trauma • Frequently involves C5-C6 • Rescue/ transport • neck immobilization • avoid intubation in symptomatic/ high risk • Neurologic injury

  10. Penetrating Neck Trauma • 70 - 80% of injuries • vascular/aerodigestive tract injury • Hemorrhage • 20-30% • Mortality • 5-6 %

  11. Signs of Significant Injury in Penetrating Neck Trauma • VASCULAR INJURY • Shock • Active bleeding • Large/expanding hematoma • Pulse deficit

  12. AIRWAY INJURY • Dyspnea • Stridor • Hoarseness • Dysphonia or voice change • Subcutaneous emphysema

  13. DIGESTIVE TRACT INJURY • Hemoptysis • Dysphagia/odynophagia • Hematemesis • Subcutaneous emphysema

  14. Injured Structures from Penetrating Neck Wounds • SYSTEM INJURED PATIENTS(%) • Arterial 516 (12.3) • Venous 769 (18.3) • Digestive 354 ( 8.4) • Respiratory 331 ( 7.8) • Source: Adapted from JA Asensio, et al. Management of Penetrating Neck Injuries: The Controversy Surrounding Zone II Injuries In JA Asensio and JA Weigelt (eds.), The Surgical Clinics of North America Contemporary Problems in Trauma Surgery. 71:2, 1991;

  15. Initial Care • ABCs of Trauma Resuscitation • ventilation • treatment of shock • baseline neurologic exam

  16. Spontaneous respiration conscious stridor tachypnea dyspnea frothing No respiration intubate airway obstruction shock Airway Assessment

  17. Hemorrhage/ Shock • Control bleeding • direct digital pressure • occult bleeding • hemothorax - CTT • Venous access • fluid replacement/ blood • central line

  18. Time factor Manner of injury Pre-existing disease Vital signs location/ extent of injury neurologic deficit ? probing History/ Physical Exam

  19. Penetrating Neck Trauma Algorithm

  20. Presentation • - GSW, POE: L supraclavicular, No POX, Hemorrhagic shock • - hacking wound to the neck with external bleeding; shock • - punctured wound to the neck, stable vital signs • - punctured wound to the neck. stable VS, suddenly develops dyspnea

  21. Presentation • - 1.5 cm stab wound zone II, stable vital signs with subcutaneous emphysema • - punctured wound,nape, in hypovolemic shock, unable to move or feel LLE

  22. Mandatory Exploration • negligible m/m for (-) exploration • comparative cost of work-up • 17-25% (+) exploration in asymptomatic patients • 83% significant injury in transcervical gunshot wounds • high mortality for delayed operations: • 67% for vascular injury • 44% for esophageal injury

  23. Selective Exploration • 40-60% incidence of negative exploration • medical cost of unnecessary surgery • availability of accurate, non-invasive diagnostic facilities • mandatory exploration based on high velocity military injuries

  24. Rules on Exploration • All symptomatic patients are explored • Work-up is irrelevant in the presence of clinical signs of injury • Zone I injuries liberally explored • difficult vascular control • disastrous consequences with delay

  25. Diagnostic work-up • Angiography • gold standard for vascular injury • more in Zones I and III • Esophagography • water soluble/ barium contrast • 50-90% sensitivity • Esophagoscopy • 50-90% sensitivity • rigid / flexible

  26. Surgical Management • Vascular injuries • Carotid Artery • blunt injury - 20-40% mortality • permanent neurologic impairment in 40-60% • repair or ligation of penetrating lacerations • comatose patients • acute stroke after revascularization

  27. Vascular injuries • Vertebral artery • hyperextension/rotation • chiropractic manipulation • soccer/volleyball injury • heavy metal rock music • Usually diagnosed angiographically • thrombosis/hemorrhage

  28. Esophagus • Difficult diagnosis • clinically evident in 20-30% • exponential increase in MR with late diagnosis, 100% if undiagnosed • Primary repair when feasible • cutaneous pharyngostomy/ esophagostomy

  29. Subcutaneous emphysema, hoarseness,respiratory distress debridement reduction of fractures coverage of exposed cartilage closure of tracheal defects tracheostomy Larynx and Trachea

More Related