Injuries to the Neck

2015 ◽  
Author(s):  
David H. Wisner ◽  
Joseph M. Galante
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Life Support ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Neck Trauma ◽  
Anatomical Structures ◽  
Initial Management

Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated rates of morbidity and mortality. Airway management in trauma does not differ based on the mechanism of injury, and so the initial priority is to ensure an adequate airway through cricothyrotomy or tracheotomy. For penetrating neck trauma, initial management is evaluated in accordance with Advanced Trauma Life Support (ATLS) guidelines. Thereafter, the management of penetrating trauma of the stable patients is provided and includes carotid artery exploration and repair, vertebral artery exploration and repair, endovascular repair, jugular vein injuries, treatment of the pharynx and esophagus, and treatment of the larynx and trachea. Blunt trauma is described and includes injuries to the aerodigestive tract and cerebrovascular and vertebral injuries. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular vein, pharynx, and esophagus; the three separate zones of the neck; common incisions made along the sternocleidomastoid muscle; important anatomical structures of the neck; and an algorithm outlining management of known injuries to the vertebral artery. This chapter contains 31 references.

Injuries to the Neck

2015 ◽  
Author(s):  
Ian E Brown ◽  
Joseph M. Galante
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Cervical Vertebrae ◽  
Thyroid Cartilage ◽  
Penetrating Trauma ◽  
Sternocleidomastoid Muscle ◽  
External Carotid ◽  
Neck Trauma ◽  
Anterior Border ◽  
Blunt Cerebrovascular Injury

Approximately 5% of all cases of trauma involve injury to the neck. This relatively low incidence together with improvements in diagnostic modalities has led to continuing evolution in the management of neck trauma. Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated morbidity and mortality. This review examines the airway, penetrating neck trauma, and blunt trauma. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular veins, pharynx, and esophagus, a tracheotomy hook used to retract the thyroid cartilage cephalad to facilitate placing the airway, the traditional division of the neck into three separate zones, exposure of structures in the anterior areas of the neck through an incision oriented along the anterior border of the sternocleidomastoid muscle,  dissection of the sternocleidomastoid muscle carried down to the level of the carotid sheath, a balloon embolectomy  catheter used to occlude the distal internal carotid artery at the skull base, a number of important structures encountered during distal dissection of the internal and external carotid arteries, options for repair of the arteries in the neck, exposure of the vertebral artery and the vertebral veins surrounded by the transverse processes of the cervical vertebrae, exposure of the distal vertebral artery via an incision along the anterior border of the sternocleidomastoid muscle, control of bleeding from vertebral artery injuries located within the transverse process of the cervical, approaching proximal vertebral artery via a supraclavicular incision, and an algorithm outlining management of known injuries to the vertebral artery, which are most often discovered by angiography. The table lists screening criteria for blunt cerebrovascular injury.   This review contains 13 highly rendered figures, 1 table, and 37 references

Injuries to the Neck

2016 ◽  
Author(s):  
Joseph M. Galante ◽  
Ian E Brown
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Cervical Vertebrae ◽  
Thyroid Cartilage ◽  
Penetrating Trauma ◽  
Sternocleidomastoid Muscle ◽  
External Carotid ◽  
Neck Trauma ◽  
Anterior Border ◽  
Blunt Cerebrovascular Injury

Approximately 5% of all cases of trauma involve injury to the neck. This relatively low incidence together with improvements in diagnostic modalities has led to continuing evolution in the management of neck trauma. Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated morbidity and mortality. This review examines the airway, penetrating neck trauma, and blunt trauma. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular veins, pharynx, and esophagus, a tracheotomy hook used to retract the thyroid cartilage cephalad to facilitate placing the airway, the traditional division of the neck into three separate zones, exposure of structures in the anterior areas of the neck through an incision oriented along the anterior border of the sternocleidomastoid muscle,  dissection of the sternocleidomastoid muscle carried down to the level of the carotid sheath, a balloon embolectomy  catheter used to occlude the distal internal carotid artery at the skull base, a number of important structures encountered during distal dissection of the internal and external carotid arteries, options for repair of the arteries in the neck, exposure of the vertebral artery and the vertebral veins surrounded by the transverse processes of the cervical vertebrae, exposure of the distal vertebral artery via an incision along the anterior border of the sternocleidomastoid muscle, control of bleeding from vertebral artery injuries located within the transverse process of the cervical, approaching proximal vertebral artery via a supraclavicular incision, and an algorithm outlining management of known injuries to the vertebral artery, which are most often discovered by angiography. The table lists screening criteria for blunt cerebrovascular injury.   This review contains 13 highly rendered figures, 1 table, and 37 references

scholarly journals The Diagnostic Peritoneal Lavage: A Brief Review of the Current Literature and an Analysis of Its use and Teaching in Canada

2012 ◽  
Vol 1 (3) ◽  
pp. 150-153
Author(s):  
Colin A Clarkson ◽  
Darrell Boone
Keyword(s):  
Current Literature ◽  
General Surgery ◽  
Life Support ◽  
Peritoneal Lavage ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Advanced Trauma Life Support ◽  
Published Data ◽  
Grey Zone ◽  
Diagnostic Peritoneal Lavage

ABSTRACT Introduction The vast majority of the published data on the appropriate use of the diagnostic peritoneal lavage (DPL) is dated. Currently in Canada, there is a significant grey-zone surrounding the teaching and use of the DPL. The objectives of this article are to briefly review the recent literature, to analyze the patterns in the use of the DPL in Canada, and to determine whether general surgery residents are being taught the skill. Methods Literature review was conducted using PubMed and Ovid. The Canadian Institute for Health Information (CIHI) supplied the available data on DPL usage in Canada. General surgery program directors in Canada were contacted by e-mail to determine if the DPL was still being taught. Results Between the years of 2001 and 2006 in Canada, 38 DPLs were coded into the CIHI's database. Males accounted for 84.2% of the DPLs, and 23.7% of all DPLs resulted in a laparotomy. Motor vehicle crashes were the reason that 42% of the DPLs were performed. The majority of general surgery residency programs in Canada are not teaching the DPL outside of what is taught in the advanced trauma life support (ATLS) course. Discussion The literature reviewed shows that the DPL continues to play a role in the current management of patients suffering from both blunt and penetrating trauma, although a much more limited role than in the past. How to cite this article Boone D, Clarkson CA. The Diagnostic Peritoneal Lavage: A Brief Review of the Current Literature and an Analysis of Its use and Teaching in Canada. Panam J Trauma Critical Care Emerg Surg 2012;1(3):150-153.

scholarly journals Dr. James Styner and the development of Advanced Trauma Life Support

2021 ◽  
Author(s):  
Wesley Tin
Keyword(s):  
Trauma Patient ◽  
Educational System ◽  
Education System ◽  
Life Support ◽  
Standard Of Care ◽  
Support Program ◽  
Advanced Trauma Life Support ◽  
Significant Morbidity ◽  
Initial Management ◽  
Trauma Education

The Advanced Trauma Life Support program, or ATLS, is a trauma education system that has become the standard of care for initial management in emergent settings. Trauma is responsible for 10% of the world’s mortality, and comes at extensive cost, often with significant morbidity and rehabilitation1. ATLS provides an organized language and approach to the trauma patient that can be communicated globally and has been shown to significantly decrease mortality in the first hour post-admission2. It was originally designed for use in low resource settings after a devastating accident involving an orthopaedic surgeon’s family. The shortcomings in care that his family received spurred him to create an educational system that could be applied at any site.

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

2013 ◽  
Vol 33 (6) ◽  
pp. 18-24 ◽  
Author(s):  
Stavros Gourgiotis ◽  
George Gemenetzis ◽  
Hemant M. Kocher ◽  
Stavros Aloizos ◽  
Nikolaos S. Salemis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Life Support ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Randomized Controlled Clinical Trials ◽  
Resuscitation Fluid ◽  
Crystalloid Solutions ◽  
Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

scholarly journals Contemporary management of genitourinary injuries in a tertiary trauma centre in Nigeria

2018 ◽  
Vol 6 (4) ◽  
pp. 1134
Author(s):  
Chimaobi G. Ofoha ◽  
Samaila I. Shu'aibu ◽  
Victor E. Onowa ◽  
Zingkur Z. Galam
Keyword(s):  
Life Support ◽  
Complete Blood Count ◽  
Age Groups ◽  
Operative Management ◽  
Trauma Centre ◽  
University Teaching ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Mechanism Of Injury ◽  
Genitourinary Trauma

Background: The genitourinary system has been shown to be involved in 10% of patients presenting after trauma and is therefore a significant factor in trauma induced morbidity and mortality. It affects all age groups and both sexes. The aim of this study is to determine the aetiology, mechanism of injury and management of genitourinary injuries in a tertiary trauma centre.Methods: This is a prospective study carried out at the Jos University Teaching Hospital between 2012 and 2017. All patients who presented at the A and E with genitourinary trauma were recruited into the study. Initial assessment involved taking an AMPLE history and resuscitation, using the Advanced Trauma Life Support (ATLS) protocol of the American College of Surgeons. Physical examination and investigation were carried out to localize and determine extent of injury. Investigations carried out were complete blood count, blood grouping, serum electrolyte, urea and creatinine and radiography where applicable. Surgical intervention was carried out where indicated.Results: A total of 104 patients were involved in this study. The mean age was 32.14±15.5 years with a range of 3 to 75yrs. Median age was 28yrs. Eighty-nine (85.6%) were males while fifteen (14.4%) were females. The genitalia were the most affected in 34% (n=35) of the patients. Gunshot was the commonest mechanism of injury (37.5%, n=39). Operative and non-operative management were employed depending on mechanism and extent of injury.Conclusions: Gunshot was the commonest cause of genitourinary trauma. These injuries require specialized attention for proper assessment and management. 

scholarly journals Penetrating neck injuries: a guide to evaluation and management

2018 ◽  
Vol 100 (1) ◽  
pp. 6-11 ◽  
Author(s):  
JL Nowicki ◽  
B Stew ◽  
E Ooi
Keyword(s):  
Life Support ◽  
Neck Injury ◽  
Helical Computed Tomography ◽  
Advanced Trauma Life Support ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Injury Management ◽  
Operative Exploration ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

IntroductionPenetrating neck injury is a relatively uncommon trauma presentation with the potential for significant morbidity and possible mortality. There are no international consensus guidelines on penetrating neck injury management and published reviews tend to focus on traditional zonal approaches. Recent improvements in imaging modalities have altered the way in which penetrating neck injuries are now best approached with a more conservative stance. A literature review was completed to provide clinicians with a current practice guideline for evaluation and management of penetrating neck injuries.MethodsA comprehensive MEDLINE (PubMed) literature search was conducted using the search terms ‘penetrating neck injury’, ‘penetrating neck trauma’, ‘management’, ‘guidelines’ and approach. All articles in English were considered. Articles with only limited relevance to the review were subsequently discarded. All other articles which had clear relevance concerning the epidemiology, clinical features and surgical management of penetrating neck injuries were included.ResultsAfter initial resuscitation with Advanced Trauma Life Support principles, penetrating neck injury management depends on whether the patient is stable or unstable on clinical evaluation. Patients whose condition is unstable should undergo immediate operative exploration. Patients whose condition is stable who lack hard signs should undergo multidetector helical computed tomography with angiography for evaluation of the injury, regardless of the zone of injury.ConclusionsThe ‘no zonal approach’ to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional management principles. We present an evidence-based, algorithmic and practical guide for clinicians to use when assessing and managing penetrating neck injury.

Should the ‘C’ in ‘ABCDE’ Be Altered to Reflect the Trend towards Hypotensive Resuscitation?

2008 ◽  
Vol 97 (1) ◽  
pp. 4-11 ◽  
Author(s):  
W. Sapsford
Keyword(s):  
Emergency Room ◽  
Life Support ◽  
Penetrating Trauma ◽  
Experimental Models ◽  
Sufficient Evidence ◽  
Advanced Trauma Life Support ◽  
Hypotensive Resuscitation ◽  
Prehospital Phase ◽  
Clinical Scenarios ◽  
Urban Rural

Background: Fluid resuscitation of trauma victims currently differs, depending on whether the Advanced Trauma Life Support (ATLS), Prehospital Trauma Life Support (PHTLS) or Battlefield Advanced Trauma Life Support (BATLS) algorithm is utilised. Resuscitation protocol depends on the situation of the patient before definitive surgical control of the haemorrhage can be achieved, that is, in the prehospital phase (the urban, rural or battlefield setting) or in the emergency room. The principle difference is between hypotensive (PHTLS and BATLS, in the prehospital phase) and normotensive (ATLS, in the emergency room) resuscitation. The aim of this review was to determine if there is sufficient evidence to consider altering the ATLS resuscitation algorithm to a hypotensive model prior to definitive surgical control of haemorrhage. Method: A literature review was conducted of the experimental and clinical evidence for hypotensive resuscitation. Results: Uncontrolled haemorrhage models are too severe. They do not realistically mimic — And their results cannot easily be extrapolated into — Clinical scenarios. One important clinical trial, inspired by these experimental models, has rightly influenced resuscitation of shocked prehospital patients towards a ‘scoop and run’ approach and permissive hypotension but it is specific to patients with penetrating trauma alone. Conclusion: There is insufficient evidence to alter the current ATLS algorithm in the emergency room in favour of hypotensive resuscitation. The future of resuscitation is considered.

scholarly journals Single institutional experience of management of penetrating trauma chest

2021 ◽  
Vol 8 (10) ◽  
pp. 3122
Author(s):  
Niranjan Ulhasrao Jadhav ◽  
Subrata Pramanik ◽  
Ridhika Munjal ◽  
Anubhav Gupta ◽  
Anirudh Mathur ◽  
...  
Keyword(s):  
Chest Trauma ◽  
Life Support ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Warning Signs ◽  
Advanced Trauma Life Support ◽  
Early Evaluation ◽  
Penetrating Chest Trauma ◽  
Mammary Arteries ◽  
Operative Exploration

Chest trauma is now the second most common non-intentional traumatic injury. Chest trauma is associated with high mortality. Control of blood loss and stabilization of vital organs is of vital importance over diagnostic and therapeutic measures. Bleeding may arise from chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm or abdomen. Modified early warning signs (MEWS) score of >9 on presentation have shown higher rate of mortality. Diagnostic modalities such as extended-focused assessment with sonography in trauma (eFAST) have been effective. The type of surgical approach alters according to the site of injury. We here presented our experience with six such patients. All the six patients involved in this study had penetrating trauma chest with various sharp weapons including dagger, ice pick, flag post. Time of presentation of all these patients were delayed due to ours being a tertiary centre. The patients were explored on the basis of eFAST findings, intercostal drainage, hemodynamics. Out of the six patients two patients succumbed and the patients who died also had high MEWS score. All the patients were approached surgically with respect to the type of injury sustained. Penetrating chest trauma present a challenging clinical situation which warrants early evaluation and intervention. The cases of chest trauma then be it blunt or penetrating should always be treated within the advanced trauma life support (ATLS) guidelines followed by the definitive management. Regardless of any penetrating object, the foreign body should be left in situ and only to be removed under vision. If in case the penetrating object has already been removed the operative intervention is decided on the amount of drainage. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Hence, the operative exploration of the chest in penetrating chest trauma and should be done on emergent basis as the mechanism of injury, vital organ damage and hemodynamic status all equate to higher rate of mortality.

Pediatric Trauma

2017 ◽  
Author(s):  
Joanna C. Lim ◽  
Catherine Goodhue ◽  
Elizabeth Cleek ◽  
Erik R. Barthel ◽  
Barbara Gaines ◽  
...  
Keyword(s):  
Life Support ◽  
Pediatric Trauma ◽  
Penetrating Trauma ◽  
Initial Evaluation ◽  
Long Bone ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Assessment Protocol ◽  
Orderly Fashion ◽  
Life Threatening

Pediatric trauma is the leading cause of death in children 1 through 14 years old. This chapter includes key information focusing on initial evaluation, triage, and stabilization of children with blunt and penetrating trauma as well as burns (and the “rule of 9s”). The authors discuss specific injuries, including those to the head (traumatic brain injury), thorax, and abdomen; genitourinary area; and orthopedic/long-bone and nonaccidental trauma. Caring for injured children is best performed using advanced trauma life support protocols during the initial assessment. Protocol-driven examination, regardless of injury mechanism, ensures clinicians consider life-threatening injuries in an orderly fashion, starting with the primary survey and moving on to the secondary survey and definitive care. After injuries are identified, priorities shift toward involving the necessary specialists. Key mnemonics in trauma care are explained: the ABCDE initial evaluation, the AMPLE history, and the AVPU categorization of neurologic status.

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