Neck Trauma 2007

Neck trauma

Department of Surgery UST Faculty of Medicine and Surgery PCS Metro Manila

PCS Metro Manila

Neck trauma - represents only 5-10 % of all injuries - penetrating more common - may be life-threatening - Fatality rates: 1-2 % - stab wounds 5-12% - gunshot wounds 50% - rifle/shotgun PCS Metro Manila

Neck Trauma Organ systems involved: - respiratory [ trachea] - digestive [esophagus] - vascular - nervous

PCS Metro Manila

Neck trauma :Mechanisms of Injury BLUNT - direct blows -

fall frontal impact “whiplash” “clothesline” “head banging” chiropractic

- soccer

PENETRATING - stab knife/icepick pencil - gunshot wounds small caliber rifle/shotgun PCS Metro Manila

PCS Metro Manila

Whiplash injury

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

Neck trauma

PCS Metro Manila

Neck trauma

PCS Metro Manila

Neck trauma: Anatomic landmarks

PCS Metro Manila

Neck trauma: Zone I • Between clavicle /cricoid cartilage • thoracic outlet - hemothorax • Stable patients – angiography – esophagoraphy/ endoscopy – bronchoscopy

• Unstable patients – immediate exploration

PCS Metro Manila

Zone 1 injury

PCS Metro Manila

Neck trauma: Zone II • Between cricoid /mandibular angle • neck proper - easiest evaluation • wound exploration – platysmal penetration

• stable asymptomatic patients – observed

• symptomatic patients – explored PCS Metro Manila

Zone 2 injury

PCS Metro Manila

Neck trauma: Zone III • Above angle of mandible • require carotid/vertebral angiograms • neurologic injuries

PCS Metro Manila

Zone 3 injury

PCS Metro Manila

Zone 3 injury

PCS Metro Manila

Angiogram

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

Signs /Symptoms of Neck Injury Shock

Dyspnea

Hemoptysis

Active Bleeding

Stridor

Dysphagia

Expanding hematoma

Hoarseness/ dysphonia

Hematemesis

Focal / Lateralized deficit

Subcutaneous Subcutaneous emphysema emphysema

Vascular

Airway

Esophagus

Neurologic

PCS Metro Manila

Diagnostic Procedures Vascular Injury - angiography - Doppler imaging Aero-digestive tract injury - Laryngoscopy/bronchoscopy - Esophagoscopy/graphy - CT scan PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

Neck trauma: Management algorithm Injury Bleeding

Stable patient

airway obstruction expanding hematoma

penetrated platysma

immediate exploration

Barium swallow/ arteriography

(+) arteriography (+) swallow (-)

Explore Observe

Explore

(+/-) Swallow

Endoscopy (-) PCS Metro Manila

(+) explore

Both

PCS Metro Manila

PCS Metro Manila

PCS Metro Manila

Neck trauma A 28 year old male, hold-up victim is admitted to the ER because of a punctured wound to the neck. VS: BP: 130/90 PR: 98/min RR: 22/min ; a 3mm punctured wound is noted over the left anterior triangle of the neck,beside the thyroid cartilage. While taking his history, the patient starts to panic and complains of severe dyspnea. PCS Metro Manila

Neck trauma A 42 yr old female is thrown against the front seat of a car during a high speed vehicular accident. She is unconscious, BP: 60 palpatory, pulse is faint and thready; both clavicles are fractured; there are no breath sounds over the left hemithorax

PCS Metro Manila