Station 4 Flashcards by Georgia Tindle

What are the boundaries of the posterior triangle?

Anterior: posterior border of SCM
Posterior: anterior border of trapezius muscle
Inferior: middle 1/3 of clavicle

How well did you know this?

Not at all

Perfectly

What two subdivisions/triangles does the posterior triangle split into? What divides these two triangles?

Occipital triangle and subclavian triangle - split by the inferior belly of the omohyoid muscle

How well did you know this?

Not at all

Perfectly

Which main vein sits in the posterior triangle?

External jugular vein

How well did you know this?

Not at all

Perfectly

Which cranial nerve traverses the posterior (occipital) triangle?

Accessory nerve (CNXI)

How well did you know this?

Not at all

Perfectly

Which muscles do the accessory nerve (CNXI) innervate?

SCM and trapezius

How well did you know this?

Not at all

Perfectly

Which two plexuses form the floor of the posterior triangle?

Cervical plexus (incl phrenic nerve therefore must be v careful when doing cervical plexus nerve block)
Brachial plexus

How well did you know this?

Not at all

Perfectly

Which vein does the external jugular vein drain into?

Subclavian vein

How well did you know this?

Not at all

Perfectly

Where does the scalenus anterior muscle attach inferiorly?

1st rib

How well did you know this?

Not at all

Perfectly

What are the four divisions/triangles of the anterior triangle?

Carotid triangle
Submental triangle
Submandibular triangle
Muscular triangle

How well did you know this?

Not at all

Perfectly

What are the boundaries of the anterior triangle?

Superiorly: inferior border of the mandible
Laterally: medial border of sternocleidomastoid
Medially: sagittal line down midline of body

How well did you know this?

Not at all

Perfectly

What are the boundaries of the carotid triangle?

Superior: posterior belly of digastric muscle
Lateral: medial border of SCM\
Inferior: superior belly of omohyoid muscle

How well did you know this?

Not at all

Perfectly

What are the contents of the carotid triangle?

Carotid sheath:
Common carotid artery
Internal jugular vein
Vagus (CNX) nerve

Hypoglossal (CNXII) nerve

Carotid sinus (IX) baroreceptors

How well did you know this?

Not at all

Perfectly

What is the carotid sinus?

A dilated portion of the common carotid and internal carotid arteries. It contains baroreceptors that detect stretch as a measure of BP. CNIX (glossopharyngeal) feeds this info to the brain and uses it to regulate BP.
Some people have hypersensitive baroreceptors - external pressure on the carotid sinus can cause bradycardia and hypotension. Therefore checking the pulse at the carotid triangle is not advised.

How well did you know this?

Not at all

Perfectly

What structures does the carotid sheath contain?

Common carotid artery (bifurcates within the sheath into ext/int CA)
Internal jugular vein
Vagus nerve (CNX)
Cervical lymph nods

How well did you know this?

Not at all

Perfectly

At what level does the common carotid artery bifurcate?

Superior margin of the thyroid cartilage (C4)

How well did you know this?

Not at all

Perfectly

What are the boundaries of the submental triangle?

Inferior: hyoid bone
Medial: midline
Lateral: anterior belly of digastric muscle
Base: mylohyoid muscle

Where does the mylohyoid bone run?

Mandible to the hyoid bone

What does the submental triangle contain?

Mainly submental LNs

What are the boundaries of the submandibular triangle?

Superior: body of mandible
Anterior: anterior belly of digastric muscle
Posterior: posterior belly of digastric muscle

What the submandibular triangle contain?

Submandibular (salivary) gland, LNs, facial artery and vein

What are the four boundaries of the muscular triangle?

Superior: hyoid bone
Medial: midline of neck
Supero-laterally: superior belly of omohyoid muscle
Infero-laterally: inferior portion of SCM

What are the contents of the muscular triangle?

NO VESSELS
Infrahyoid muscles (sterno-hyoid, thyro-hyoid and sternothyroid)
Pharynx
Thyroid glands
Parathyroid glands

What are the surface landmarks of the IJV and the carotid artery?

Between clavicular and sternal heads of SCM, lateral to carotid artery.

What is the inferior border of zone III of penetrating neck trauma?

Angles of the mandible

What is contained with zone III of penetrating neck trauma?

Salivary glands, oral and nasal cavity

What are the borders of the zone II of penetrating neck trauma?

Superior: level of angles of the mandible Inferior: cricoid cartilage

What is contained within zone II of penetrating neck trauma?

``` Larynx Carotid arteries IJV Oesophagus Cervical region of vertebral column ```

What are the borders of zone I of penetrating neck trauma?

Root of neck, extends from clavicles and manubrium to level of inferior border of cricoid cartilage

What is contained within zone I of penetrating neck trauma?

``` Cervical pleurae Apices of lungs Thyroid Trachea Oesophagus Common carotid IJV ```

Which zones of the neck are most at risk of obstructing the airway and having the greatest risk of morbidity and mortality?

Zones I and II Highly vascular areas than can occlude the area with severe bleeding. Resuscitation priority needs to be given to these injuries until the airway is safely secured.

What are the most commonly injured structures by gunshots to the neck

Blood vessels - | carotid artery has an overall mortality of about 60%

15 year old male is stabbed to the left side of his neck, there is no bleeding and the wound doesn't appear to be deep. Two days later he appears to have a left sided stroke. How?

Dissected internal carotid artery - | thrombus formed -> emboli -> middle cerebral artery

17 year old male stabbed to right side of neck. O/E: constricted right pupil and droopy eye lid. How?

Interruption to the sympathetic chain which runs in proximity with the ICA and lung apices before ascending centrally to the thalamus

What is Horner's syndrome triad?

1. Ptosis (unable to fully retract eyelids) 2. Miosis (constricted pupils) 3. Anhidrosis (lack of sweating)

Why should you not use a 'head tilt' managing the airway of a trauma patient?

To maintain alignment of the cervical spine

Name 3 airway adjuncts

1. Nasopharyngeal 2. Oropharyngeal 3. Laryngeal mask airway (LMA)

What is the name of technique where a tube is passed into position over a guide wire?

Seldinger technique

What structures are adjacent to the larynx?

Posteriorly: oesophagus Anteriorly: Thyroid gland Superiorly: vocal cords, epiglottis

What is the nerve supply to the larynx?

CNX (vagus) - recurrent and superior laryngeal nerves