Neck Trauma Flashcards
See picture 1 and identify the anatomical zones of the neck
Zone 1: superior border clavicle to cricoid cartilage
Zone 2: cricoid to inferior border angle mandible
Zone 3: inf border mandible to base of skull
What is at risk of being injured in zone 1 of neck? (2)
Vascular injury to aortic arch and its branches; airway injury
What is at risk of being injured in zone 2 of neck?
Vascular and aero-digestive organ injury
What is at risk of being injured in zone 3 of neck?
Vascular: internal carotid and vertebrals
Gold standard in managing penetrating neck trauma affecting any anatomical zone?
Snom: selective non- operative management
Name 9 hard signs demanding surgical exploration in neck trauma.
• Airway obstruction • shock • active pulsatile bleeding • expanding haematoma • neurological deficit in carotid or vertebral artery territory (low gcs, hemiplegia ) • air bubbling via wound • food particles leaking via wound • impaled object • delayed presentation with mediastinal sepsis (Thrill or bruit)
Name 10 soft signs of neck injury requiring investigation with ct/ct angiography
• Penetrating injury breaching platysma • history significant bleeding on scene . History hypotension • non-expanding haematoma • bruit/thrill • voice changes (hoarseness ) • haematemesis/haemoptysis • bleeding controlled with balloon tamponade • significant sub-cutaneous emphysema • proximity injury (penetration near blood vessel or injury to adjacent nerve structure)
Name 9 high risk signs in patients for blunt cerebro-vascular injuries
(To carotid and vertebral.)
• unexplained neurological deficit
• arterial epistaxis following blunt head trauma
• gcs < 8
• evidence petrous bone fracture
• dai (diffuse axonal injury ) and gcs <6
• fractures c spine, especially involving for amen transversarium
• fractures c spine with subluxation or rotational components
• le fort 2-3 facial fractures or bilateral mandibular fracture
• near hanging or strangulation
Name 4 indications for vascular investigation of the neck and which investigation should be done
• Zone 1 injury • zone 3 injury • all gunshots • suspicion post Doppler of zone 2 Require Ct angiogram
Treatment of most clavicle fractures?
Conservative- rest
According to the Canadian C spine rules, which patients require radiography? (9)
High risk factors:
• Age ≥ 65
• Dangerous mechanism
•Paraesthesia’s in extremities
Low risk factors absent which do not allow safe assessment range of motion
• dangerous motor vehicle collisions: pushed into on coming traffic, hit by bus or large truck, rollover, hit by high speed vehicle >100 km /h
• not ambulatory
• not sitting in ED
• immediate onset neck pain
• midline c-spine tenderness
Unable to actively rotate neck 45 degrees left and right
According to the Canadian C spine rules, which patients do not require radiography? (7)
No high risk factors that mandate radiography
Any low risk factor which allows safe assessment range of motion AND able to actively rotate neck 45 degrees left and right
. Simple near ended motor vehicle collision
• sitting position in ED
. Ambulatory at any time
• delayed onset neck pain
• absence midline c-spine tenderness
According to the Canadian C spine rules, which mechanisms of injury are considered dangerous and need radiography? (5)
- Fall from elevation ≥ 3 feet or 5 stairs
- axial load to head eg diving
- MVC high speed >100 km/h, rollover, ejection
- motorised recreational vehicles
- bicycle struck or collision
To which groups of people does the Canadian C spine rule not apply? (8)
• Non - trauma cases . GCS <15 • unstable vitals . Age <16 . Acute paralysis • known vertebral disease • previous c-spine surgery • pregnant
How manage injury to zone 1 neck?
Diagnostic investigations
