Junctional Trauma: Neck, Thorax and Upper Limb Flashcards
What is “junctional”?
A zone that spans the root of an extremity and its adjacent body cavity
Classifications of junctional trauma
- Type 1
> Wound encroaches on junctional zone but surgical control can be gained without entering body cavity - Type 2
> Wound encroaches on a junctional zone requiring surgical access to gain haemorrhage control
Types of causes of junctional trauma
- Penetrating (eg. gunshot)
- Blunt (eg. car crash)
Anatomical considerations of a junctional trauma injury
- Blood vessels
- Brachial plexus/nerves
- Bones
3 zones of the axillary artery
- Zone 1 (rib 1 to superior border pec major)
- Zone 2 (superior to inferior border pec major)
- Zone 3 (inferior border pec major to inferior border teres major)
Branches of each zone of axillary artery
- Zone 1
> Superior thoracic - Zone 2
> Thoracoacromial trunk
> Lateral thoracic - Zone 3
> Subscapular
> Posterior circumflex
> Anterior circumflex
What does the carotid sheath surround? (lateral to medial)
- Internal jugular vein
- Vagus nerve
- Common carotid artery
Steps in managing a haemorrhage
- CABC
> Catastrophic haemorrhage
> Airway
> Breathing
> Circulation
Types of haemostatic agent
- Factor concentrators
- Mucoadhesive
- Procoagulant
What is a mucoadhesive?
Pad that sticks to tissues like glue and creates a dressing that wont move
What is a procoagulant?
Gauze infused with clotting factors to physically help body form more clots
Steps in surgery managing a haemorrhage
- Gain proximal and distal control
- Repair
What spinal root levels do upper and lower brachial plexus injuries contain?
- Upper = C5-6
- Lower = C8-T1
- C7 can be either
What type of injury causes an upper brachial plexus injury?
Neck forcibly pushed away from shoulder (eg. falling onto shoulder)
What palsy occurs after an upper brachial plexus injury, and what arm position is typical of this?
- Erb’s palsy
- “Waiter’s tip” position
