OnlineMedEd: Surgery: Trauma - "Neck" Flashcards
The older way of categorizing neck injuries was by zones. Give each zone and the relevant points.
•Zone I:
- proximal 1/3
- arteries, trachea, esophagus
- close to chest – anything that leads down from zone I requires a thoracic surgery
• Zone II:
- middle 1/3
- arteries, trachea, esophagus
- easy access to things on either side
•Zone III:
- distal 1/3
- arteries
- close to brain
What should you do to assess neck injury in a stable patient by zone?
- I: bronchoscopy, arteriogram, esophogram
- II: surgery
- III: arteriogram
Review the newer schematic for assessing penetrating neck trauma.
1) Is the patient stable?
- If no, OR
2) Does the stable patient have any symptoms of neck trauma?
- If yes, CTA
- If no, observe
What are signs/symptoms that make a patient unstable? What are “soft” symptoms that require CTA but so not make the patient unstable?
• Hard signs:
- Stridor
- Gurgling
- Expanding hematoma
- Pulsatile bleeding
- Shock
• Soft signs:
- Dysphagia
- Dysphonia
- Non-pulsatile bleeding
- Subcutaneous emphysema
Review the pattern of signs associated with a hemisection of the spinal cord.
AT THE LEVEL OF THE LESION:
•LMN: ipsilateral flaccid paralysis with hypotonia, fasciculations, and hyporeflexia
BELOW THE LEVEL OF THE LESION
•UMN: ipsilateral spastic paralysis with hypertonia and hyperreflexia
•DCML: ipsilateral loss of vibration and proprioception
•ACS: contralateral loss of pain and temperature sensation
Trauma can cause cord compression due to edema. How can you treat this?
IV dexamethasone
Anterior cord infarctions cause what pattern of loss?
Everything but the DCML is lost.
Anterior cord lesions (such as a mass on the anterior portion of the cord) have what presentation?
Loss of LMN function and pain/temperature at the level of the lesion that worsens with extension of the spine.
