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Penetrating Neck Trauma: Simulation Case Debriefing

Penetrating Neck Trauma: Simulation Case Debriefing. Cullen B. Hegarty, M.D. Regions Hospital Department of Emergency Medicine. Debriefing:. How did the case feel? What went well? What would you change/do differently? Crisis Resource Management review

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Penetrating Neck Trauma: Simulation Case Debriefing

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  1. Penetrating Neck Trauma:Simulation Case Debriefing Cullen B. Hegarty, M.D. Regions Hospital Department of Emergency Medicine

  2. Debriefing: • How did the case feel? • What went well? • What would you change/do differently? • Crisis Resource Management review • Review of objectives and optimal management of the case

  3. Case checklist: • Address IV access, fluids • Order appropriate labs/blood products • Complete primary and secondary survey with full exposure/skin exam and vascular exam noted • Pain management • Early airway management with rescue technique(s) if needed • Coordinate final disposition for patient

  4. Penetrating Neck Trauma: • Penetrating Neck InjuryKarim Brohi, trauma.org 7:6, June 2002

  5. Injuries: • Stab wounds to the neck can result in: • -Vascular • -Neurologic • -Laryngotracheal and/or • -GI injuries

  6. ED Management: • Basic stabilization techniques • -ATLS Primary/Secondary surveys • -emphasis on exposure for other injuries • -screening x-rays (ex: CXR) • -early airway management • Diagnostic workup of injury

  7. Diagnostic work-up • Zone III: angiography if stable • Zone I: CXR, angiography, GI study (esophagoscopy vs contrast study) if stable • Zone II: OR for exploration versus (if stable) • -studies of potential injuries: angiogram, bronchoscopy, and GI study • -CT soft tissue neck • -clinical observation for signs/symptoms • All ‘Zones’ if unstable may need OR

  8. Summary: • Review of case, performance of clinical management and team • Review of penetrating neck injury • -Zones of neck • -Basic trauma stabilization techniques • -Management of injuries based on location of wound/zone

  9. References: • Penetrating Neck InjuryKarim Brohi, trauma.org 7:6, June 2002 • http://www.trauma.org/vascular/neckneur.html • Hamilton et al: Chapter 48 ‘Head and Neck Trauma’, pp 843-869. ‘Emergency Medicine- An Approach to Clinical Problem-Solving, 2nd Edition’,Philladelphia, W.B. Saunders Company, 2003.

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