4/11/2024 0 Comments Hard soft signs neck trauma![]() Shownotes Written By: Miguel Reyes, MD (Twitter: Peer Reviewed By: Salim R. EM: RAP: Penetrating Neck Trauma Part 1 and Part 2.Blood products means starting massive transfusion protocol.If community / rural -> stabilize and transfer.If at trauma center -> get your trauma surgeon.Get IV access, give oxygen, prepare to take the airway and get blood products.Apply direct pressure to the wound / bleeding site.What to do if injury involves pulsatile bleeding When it may come into play is once you’ve diagnosed particular vascular / organ injury depending on what zone the injury is it could affect surgical intervention.However studies have not borne that out and now patients can undergo imaging if no hard signs. Zone 2 injury used to be immediate OR indication.In practice, it’s not all that important to know the different zones.Contains the distal carotid and vertebral arteries and the pharynx.Zone 3 – area between the angle of the mandible and the base of the skull.Contains the carotid and vertebral arteries, the internal jugular veins, trachea, and esophagus.Zone 2 – area between the cricoid cartilage and the angle of the mandible.Contains the innominate vessels, the origin of the common carotid artery, the subclavian vessels and the vertebral artery, the brachial plexus, the trachea, the esophagus, the apex of the lung, and the thoracic duct.Zone 1 – area between the clavicles and the cricoid cartilage.If altered mental status – keep the collar on.The disadvantage of the collar is you’re now limiting a more thorough exam, could be obstructing the extent of the wound, if bleeding wont be able to apply pressure and airway management with collar is significantly more difficult.The advantage of the collar is protecting patient with unstable C-spine injury (based on literature its a low occurrence).Hard signs – Patient needs to go to the OR Have backups in place and be prepared for surgical airway Hard signs reflect the presence of a serious injury that generally requires immediate transfer to the operating room.If blood in airway -> direct laryngoscopy North et al 61 reviewed the records of 139 stable patients with penetrating neck trauma.If you have fiber optics and the skill for it – go for it.Remember to lead with suction catheter and the du canto approach. ![]() Resuscitate, get imaging and continue to monitor the patient for any changes. For the other patients, you’ll have some time.Indications to take it right away are severe distress, immediate airway compromise on presentation, exposed larynx or trachea.Practice good basic airway management and resuscitate before you intubate. Due to the trauma, the airway can be quite challenging.Plan for a surgical airway and bring different size ETT and bougies. Click here for Direct Download of Podcast
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