Ch. 44 Gunshot Wound to the L Neck Flashcards
What are the hard signs of vascular injury?
- Active arterial bleeding
- Pulsatile or expanding hematoma
- Presence of shock
- Palpable thrill or audible bruit
Presence of one or more of these findings = indication for immediate surgical exploration
What is the significance of the following signs/symptoms in a gunshot wound to the neck patient?
- Stridor
- Odynophagia
- Horner’s Syndrome
- Thrill/bruit
- Crepitus
- Hoarse voice
What is the dx in this patient?
Penetrating neck injury in Zone 2 of neck, w/o hard signs of injury
Despite lack of hard signs, injury to critical structures needs to be r/o if injury penetrates platysma
What is the significance of whether or not the injury has penetrated the platysma (superficial neck muscle)?
Injuries that do not penetrate the platysma are by definition nonpenetrating neck injuries.
These injuries do not place the vital structures of the neck in harm’s way –> do not require any further diagnostic workup or surgical exploration
Differential dx of a pulsating mass (3)
AV fistula
Aneurysm
Pseudoaneurysm
What nerve would be injured if this patient presented with vocal cord paralysis?
What happens with damage to the phrenic nerve?
Recurrent laryngeal nerves (branches of vagus nerve) - innervate all intrinsic muscles of the larynx except cricothyroid (innervated by the external branch of the superior laryngeal nerve)
Damage to phrenic nerve: ipsilateral hemidiaphragm paralysis –> seen on CXR as elevation of diaphragm on affected side
What do you do if there are no hard signs of injury?
Obtain helical CTA to r/o injuries to the carotid, jugular vein, esophagus, and cervical spine
IF CT is negative, no surgical intervention is needed
What are the zone borders and which zones are surgically accessible?
- Zone 1: clavicles/sternal notch to cricoid cartilage
- Zone 2: cricoid cartilage to angle of mandible
- Zone 3: angle of mandible to base of skull
Zone 2 injuries = surgically accessible via standard neck incision
