Penetrating neck trauma

Penetrating neck trauma - Penetrating Neck Trauma Vic V....

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Penetrating Neck Trauma Vic V. Vernenkar, D.O. St. Barnabas Hospital
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Introduction 5-10% of all trauma Overall mortality rate as high as 11% Major vessel injury fatal in 65%, including prehospital deaths Attending physician must have excellent knowledge of anatomy Multidisciplinary
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History Ligation of the major vessels described as early as 1522 by Ambrose Pare Ligation was the procedure of choice for vascular injury through WW 1 Associated mortality rates up to 60% Significant neurologic impairment in 30 %
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History Mandatory exploration of all penetrating neck wounds, through the platysma Fogelman and Stewart reported Parkland Memorial Hospital experience of early, mandatory exploration with mortality of 65 vs. . 35% for delayed exploration 40% to 60% rate of negative explorations with mandatory exploration Present mortality for civilian wounds is 4% to 6%
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Zone I Bound superiorly by the cricoid and inferiorly by the sternum and clavicles Contains the subclavian arteries and veins, the dome of the pleura, esophagus, great vessels of the neck, recurrent nerve, trachea Signs of significant injury may be hidden from inspection in the mediastinum or chest
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Zone II Bound inferiorly by the cricoid and superiorly by the angle of the mandible Contains the larynx, pharynx, base of tongue, carotid artery and jugular vein, phrenic, vagus, and hypoglossal nerves Injuries here are seldom occult Common site of carotid injury
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Zone III Lies above the angle of the mandible Contains the internal and external carotid arteries, the vertebral artery, and several cranial nerves Vascular and cranial nerve injuries common
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Ballistics Over 95% of penetrating neck wounds are from guns and knives, remainder from motor vehicle, household, and industrial accidents The amount of energy transferred to tissue is difference between the kinetic energy of the projectile when it enters the tissue, and the kinetic energy of any exiting fragments or projectiles The velocity of the projectile is the most significant aspect of energy transfer (K.E. = 1/2 mv^2)
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Penetrating neck trauma - Penetrating Neck Trauma Vic V....

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