PENETRATING NECK TRAUMA - 09/09/11

Doi : 10.1016/S0733-8627(05)70350-3

John L. Kendall, MD ^a, Deirdre Anglin, MD, MPH ^b,^d, Demetrious Demetriades, MD, PhD ^c,^d

^a Department of Emergency Medicine, Denver Health Medical Center (JLK), Denver, Colorado

^b Department of Emergency Medicine (DA)

^c Department of Surgery (DD)

^d Los Angeles County/University of Southern California Medical Center (DA, DD), Los Angeles, California

Résumé

Penetrating neck trauma may pose a diagnostic and therapeutic dilemma to emergency physicians and trauma surgeons. Approximately 5% to 10% of all trauma involves penetrating neck trauma,^{56 Thal E.R., Meyer D.M. Penetrating neck trauma Curr Probl Surg 1992 ; 29 : 10-55

Cliquez ici pour aller à la section Références} with multiple structures being injured in 30% of patients.^{13 Demetriades D., Skalkides J., Sofianos C. , et al. Carotid artery injuries: Experience with 124 cases J Trauma 1989 ; 29 : 91-94 [cross-ref]

Cliquez ici pour aller à la section Références} Thorough knowledge of the anatomy of the neck, physical assessment, and current recommendations for diagnostic and therapeutic interventions are necessary for appropriate management. Expeditious decision making often is required to prevent catastrophic airway, vascular, or neurologic sequelae.

Overall mortality because of penetrating neck trauma is as high as 11%.^{4 Asensio J.A., Valenziano C.P., Falcone R.E. , et al. Management of penetrating neck injuries: The controversy surrounding zone II injuries Surg Clin North Am 1991 ; 71 : 267-296

Cliquez ici pour aller à la section Références} Injury to certain anatomic structures (e.g., the carotid or subclavian vessels) may be fatal in two thirds of cases, however.^{13 Demetriades D., Skalkides J., Sofianos C. , et al. Carotid artery injuries: Experience with 124 cases J Trauma 1989 ; 29 : 91-94 [cross-ref]

Cliquez ici pour aller à la section Références} Compounding difficulties in evaluation and management is the complicated anatomy of the area, in which a dense concentration of vital vascular, aerodigestive, and nervous system structures are located within a very small space. In addition, there is a lack of consensus among trauma surgeons regarding injuries that mandate surgical exploration and those in which a conservative selective approach can be taken.

This article reviews the anatomy of the neck and provides guidelines for the initial assessment and management of penetrating neck trauma in the emergency department (ED). Methods for achieving airway control in difficult situations are presented, and controversies in the management of penetrating neck trauma are reviewed.

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Plan

ANATOMY

THE EVALUATION OF PENETRATING NECK INJURIES

Prehospital Care

Weapon Characteristics

Physical Examination

THE MANAGEMENT OF PENETRATING NECK INJURIES

Airway Management

General Management

CONTROVERSIES IN MANAGEMENT

Mandatory Exploration Versus Selective Conservatism

Angiography Versus Color Flow Doppler Imaging

Gunshot Wounds Versus Stab Wounds

Transcervical Gunshot Wounds

CONCLUSIONS

Address reprint requests to John L. Kendall, MD, Denver Health Medical Center, Department of Emergency Medicine, 777 Bannock Street, Denver, CO 80206