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5 - Birnbaumer, Diane Neck
5 - Birnbaumer, Diane Neck
Trauma
Airway management?
Oxygen; suction as needed
Position of comfort if possible
Assist, intubate as needed
Venous access?
On opposite side of injury, if possible
Assessment of the Patient
Most
important
structures are
in the anterior
triangle
Posterior:
Spinal cord
Anatomy of the Neck: Triangles
Anterior Triangle
Midline anteriorly
Sternocleidomastoid
posteriorly
Clavicle inferiorly
Mandible superiorly
Posterior Triangle
Sternocleidomastoid
anteriorly
Trapezius posteriorly
Clavicle inferiorly
The Platysma
Is the injury
deep to the
platysma?
If not, just
close and go
1
Zones of the Neck
3
Anatomy of the Neck
Zone I
Between the sternal notch and clavicles inferiorly and the
cricoid cartilage superiorly
Zone II
Between the cricoid cartilage inferiorly and the angle of the
mandible superiorly
Zone III
Between the angle of the mandible inferiorly and the base of
the skull superiorly
Zone I Contains:
Airway Management
RSI with direct laryngoscopy
Most data available; usually a safe practice; have backup
airway available
Fiberoptic intubation
Awake fiberoptic an option
May be difficult / impossible in a bloody airway
Videoscopic devices
Little data published; success rates high
Airway Management
Airway Management
Extraglottic devices
Run the risk of worsening injury, dislodging clot, requires
paralysis if patient awake
Nasotracheal intubation
Relatively contraindicated due to blind procedure
Cricothyrotomy / tracheostomy may be necessary
Direct intubation
Put the tube in the open wound, directly into the trachea
Penetrating Neck Trauma
Airway Management
Mandavia, et al
USC, 1993-1996
78% GSW, 21% SW
748 patients
In 11%, airway emergently managed in ED
RSI – 39
Cricothyrotomy / tracheostomy - 2
No drugs – 5
Fiberoptic - 12
Penetrating Neck Trauma
The Traditional Approach
Angiography,
Esophagoscopy,
Emergent Bronchoscopy
Wound Care, Airway, then Zone I
Discharge OR
Observe
No No No
Observe
No
Obvious
Injury
No Yes
No obvious injury
and trajectory away
from vital structures
Observe/
Discharge
References/Images
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