Obvious arterial occlusion as evidenced by: “Soft” and “Hard” Signs of Vascular Injury It is important to form linkages between different lists in your brain before exam time, and this is the perfect example of where remembering one will help you remember much of the other. Given the similarities between the signs of penetrating neck and vascular injuries, we thought we’d give you a list here. List 5 hard and 5 soft signs of vascular injury The initial imaging study most commonly ordered is a CTA of the neck +/- head, but further investigations depending on the suspected structures injured (e.g., esophagus) require other testing. Soft signs, if present, require further diagnostic evaluation. If any hard signs are present, the patient should undergo expedited transport to the OR (depending on institutional factors). In general, knowing the hard and soft signs will help with immediate patient disposition decisions. “Soft” and “Hard” Signs of Penetrating Neck Trauma Please refer to the text for further clarification. The following table is adapted from Box 37.2 – “Soft” and “Hard” Signs of Penetrating Neck Trauma from Rosen’s 9th Edition. List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2) Vascular and Other Contents in Neck Zones The following table is adapted from Box 37.1 – Vascular and Other Contents in Neck Zones, from Rosen’s 9th Edition. Zone III – upper neck – extends from the angle of the mandible to the base of the skull Zone II – midneck – extends from the cricoid cartilage to the angle of the mandible Zone I – base of the neck – extends superiorly from the sternal notch and clavicles to the cricoid cartilage However, now that CT/CTA has become commonplace and the literature demonstrates that most significant penetrating neck injuries damage more than one zone, this classification system has fallen by the wayside in some centers. Prior to the advent of modern imaging technologies, the zones of the neck had real implications for ED clinicians and surgeons alike. (Box 37.1)Īhhhh, the zones of the neck – a classic question with questionable significance. Note: The anterior triangle is PACKED FULL of important structures, making an injury to this area far less favorable than to the posterior triangle Detail the borders and associated contents of the three zones of the neck. So, sit back, grab a cup of coffee, and enjoy the ride! O utline the anatomic borders of the anterior and posterior triangles of the neck. As always, we will pepper the episode with some classic exam fodder as per usual to make sure you got the skills to thrills on paper and in the trauma bay. We will break down the anatomy, outline relevant imaging and management decision points, and give you some additional pearls to help you in the event that this case (or one like it) rolls through your ED doors on your neck shift. Today’s episode reviews all of the relevant materials contained within Chapter 37 in Rosen’s 9th Edition. If this case fills you with dread, fear not. Your triage nurse looks at you and says “What are we gonna do?!” Your mind races trying to remember the zones of the neck, airway considerations, imaging specifics, and just as you start to make a plan, the patient rolls through the door. The paramedic describes the wound as bleeding profusely and that when they looked at it, it was “like an anatomy prosection”. In an attempt to take his own life, the patient took a butcher knife and slashed his throat. You receive a pre-alert from EMS that they are coming in with a 45Y male with a significant neck wound. You are working a shift at your local level one trauma centre. Today we will start out with a REAL case to get the adrenaline pumpin’. Find the show notes here: CRACKCast-E228-Neck DownloadĪlright podcast listeners, let’s get into another episode of CRACKCast.
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