Neck Injuries Flashcards
(26 cards)
Mx of neck injuries - penetrating and blunt
Penetrating injuries
- Alert and haemodynamically normal individuals should be allowed to sit up to
at least 45º
- To control bleeding, direct digital compression is preferred to bulky dressings.
Blunt injuries
* Bruising or soft tissue haematomas that might indicate underlying injuries
* Significant structural injury is commonly repaired surgically.
what are some mechanisms of injury for the neck
- Steering wheel
- Assault
- Strangulation/Hanging
- “Clothes line” injuries
- Other (sports, industrial,
etc.)
Examples of penetrating mechanisms of injury
- Missile injury (bullet, knife,
or other) - Stabbing or lacerations
- Impalement
- Animal bites
Zones of the neck (Zone I)
Anatomical landmarks / structures
Anatomical landmarks:
Clavicle/sternum to cricoid cartilage
Boundaries:
Cricoid process to sternoclavicular notch
Anatomical structures in zone:
- Proximal common carotid artery
- subclavian artery
- Vertebral artery
-Lung apices
- trachea
- thyroid
-esophagus
-thoracic duct
-spinal cord
Zones of the neck (Zone II)
Anatomical landmarks / structures
Anatomical landmarks:
Cricoid cartilage to the mandible
Boundaries:
The angle of mandible to the cricoid process
Anatomical structures in zone:
- Carotid artery
- Vertebral artery
- Jugular vein
- Pharynx
- Trachea
- Esophagus
- Larynx
- Vagus nerve
- Recurrent laryngeal nerve
- Spinal cord
Zones of the neck (Zone III)
Anatomical landmarks / structures
Anatomical landmarks:
Superior angle of the mandible
Boundaries: Base of skull to angle of mandible
Anatomic structures in zone:
- Vertebral artery
- Distal carotid artery
- Distal jugular vein
- Salivary and Parotid glands
- Cranial nerves IX-XII
- Spinal cord
Blood supply to the head and neck
- Common carotid artery
- Subclavian artery
- Vertebral artery
- Carotid sinus
- External carotid artery
- Internal carotid artery
- Occupital artery
- Superficial temporal artery
- Maxillary artery
- Facial artery
- Lingual artery
- Superior thyroid artery
Pt Ax - what to ax
- Gun
– Caliper, distance - Knife
– Length, angle - Amount of blood loss
- Baseline mental status
- Baseline motor status
- Drug or alcohol use
What are the key findings
- Hard signs
- Soft signs
Hard signs
* Airway obstruction
* Pulsatile bleeding
* Expanding hematoma
* Unresponsive to resuscitation
* Extensive subcutaneous
emphysema
Soft signs
* Voice change
* Wide mediastinum
* Hemoptysis
* Hematemesis
* Dysphonia/dysphagia
Mx of patient - primary survey
- ABCs
- Ensure airway is patent
- Ensure patient is adequately oxygenating
- Control any obvious hemorrhaging
- IV access
- Local pressure only
- No tourniquets
- No pressure dressings
- No probing or blind clamp
placement
Physical exam of a neck injury
*Contusions, lacerations, abrasions to
the neck, etc.
*Expanding hematomas, obvious
bleeding
*Hoarseness, stridor,
*Subcutaneous emphysema
*Hemoptysis, drooling
*Dyspnea
*Distortion of the normal anatomic
landmarks
*Mandibular/midface instability
What are some vascular injuries in the neck
Physical Exam
* External marks
* Decreased LOC
* Hemiparesis
* Hematoma
* Hypotension
* Dyspnea
* Thrill, bruit, pulse not present
Associated injuries of the neck
- Le Fort II or III fractures
- Basilar skull fracture involving the
carotid canal - Diffuse Axonal Injury with GCS < 6
- Cervical vertebral body fracture
- Near hanging with anoxic brain
injury - Seatbelt abrasion of anterior neck
with significant swelling/altered
mental status
what are some signs of a tracheal and largygeal injury
Signs of injury
* Hoarseness and dysphonia
* Hemoptysis
* Subcutaneous emphysema in
the neck and trunk
* Tenderness over the trachea
How to mx a laryngotracheal injury
- Secure the airway
- Early repair
- Laryngeal fractures
– Thyroid fracture most common
– Delay of reduction makes it more
difficult and return of normal
function unlikely
What are some indications to do a horizontal cricothyrotomy (look up SJAWA CPG)
- To provide an airway when all other methods have failed or the airway or ventilation cannot be achieved by any other intervention.
- Complete airway obstruction in patients older than 6y of age where all other clearing methods have failed, including attempts to push obstruction to the R) bronchus
- Failed intubation, as a last resort to secure an airway in a severely compromised patient, who cannot be ventilated or oxygenated by any other means
Patient factors and considerations for horizontal cricothyrotomy (look up SJAWA CPG)
- aspiration of blood or stomach contents
- incorrect placement
- Oesophageal perforation or laceration
- where possible, store the tracheal dilator in packaging to minimise infection risk
- all equipment involved in this procedure is single use only
Cricothyrotomy (Vertical) indications (SJAWA CPG)
- Can’t intubate, can’t oxygenate (CICO) situation with decreasing SPO2
- Primary airway attempt if ETT, supraglottic airway or BVM is not feasible (massive facial trauma or burns)
Contraindications for Cricothyrotomy (Vertical) (SJAWA CPG)
- Children <6 years of age
- Open tracheal injury
Patient factors and considerations for Cricothyrotomy (Vertical) SJAWA CPG
- This is a tactile procedure. Surgical field may become obscured due to haemorrhage following incision
- Incorrect pre-tracheal insertion of ETT (surgical emphysema developing in neck on ventilation of patient)
- Placement of ETT into R) main bronchus (asymmetrical chest wall movement)
Esophageal Injury - penetrating and blunt examples
Penetrating
– Sharp weapon (knife)
– High speed projectile (bullet)
– Iatrogenic laceration
– Lumen outward injury
Blunt
*Barotrauma
*Blast injuries
*Crush injuries
*Blow to the neck
Esophageal injury signs
- Hematemesis
- Odynophagia
- Dysphagia
- Drooling, hypersalivation
- Tracheal deviation
- Sucking neck wound
- Subcutaneous emphysema
- Pain with turning neck
How to position a patient with neck trauma
- Position patient in manner that
is most comfortable - Patients with anterior neck
trauma may want to lean
forward or sit upright - Patients with copious secretions
can be rolled on their side
Complications of neck injuries
- Loss of airway
- Swallowing problems with aspiration
- Stroke in unrecognized vascular injuries
- Soft tissue necrotizing infections, including mediastinitis due
to delayed diagnosis of esophageal injuries - Air embolism
- Pneumothorax, tension pneumothorax
