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NeckTrauma - : Sinai Hospital Department of Surgery Trauma...

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Penetrating Neck Injuries: Evaluation and Management
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Penetrating Neck Injuries: Evaluation and Management Sinai Hospital Department of Surgery Trauma Management Conference February 24, 2004 Case Presentations: Charles Galanis Review of Anatomy: Jason Williams Diagnostic Algorithm: Michael House Management of Specific Injuries: Dorry Segev
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Case Presentations
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Case 1: Initial Presentation 36 yo male, victim of single stab wound to L neck, zone II while  standing on the street corner minding his own business Airway intact, no respiratory distress. Room air sat 97%. Lungs CTAB. Hemodynamically stable. P 90, BP 120/90  GCS 15. No crainal nerve abnormalities.  CXR: No pneumothorax or subcutaneous air. Case Presentation: Stab Wound
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Case 1: Preoperative Management Conservative mgmt PO trial Progressive dysphagia  Low grade fever  CT scan HD#2:  pneumomediastinum SQ emphysema Ba swallow HD#3 Case Presentation: Stab Wound
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Case 1: Operation and Postop Course Neck exploration in OR Posterolateral esophageal leak Ba in retroesophageal space Irrigated and drained NPO / TPN / abx Serial Ba studies Leak contained, improving Diet advanced Home on hospital day 21 Case Presentation: Stab Wound
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Case 2: Initial Presentation 40 yo male, sustained multiple GSW while walking grandmother home  from church: R temporal skull, R forearm, zone II neck (apparent  entrance R exit L) Airway intact. No tracheal deviation. No respiratory distress. Oropharynx with moderate amount of blood.   Lungs CTAB. RA sat 97%. Palpable pulses 4 extremities. P 83 BP 94/35 GCS 15, no cranial nerve abnormalities. Stable hematoma left neck just anterior to SCM. Case Presentation: Gunshot Wound
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Case 2: Initial Imaging CXR no PTX CT head: Temporal skull fx Bullet in brain CT neck: L EJ hematoma R CCA possible flap Paraesophageal air Case Presentation: Gunshot Wound
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Case 2: Fluoroscopy Remained hemodynamically stable Water soluble contrast swallow and angiography Case Presentation: Gunshot Wound
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Case 2: Operation Neck exploration in OR R lateral esophageal leak Closed primarily and reinforced with nearby tissue Facial v and superior thyroid a ligated for exposure Carotid mobilized, shunted, and lumen explored Injured segment just proximal to bifurcation Circumferential excision and primary anastomosis Later: craniotomy/washout, ORIF radial fx Case Presentation: Gunshot Wound
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Case 2: Postoperative Course Intubated for 2 days, stable recovery Ba swallow POD#3, then diet advanced uneventfully Home POD#6 Case Presentation: Gunshot Wound
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Anatomy
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(Roon and Christensen Classification) Trauma Neck Zones Anatomy
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Zone I Thoracic vasculature Vertebral and proximal carotid arteries Lung Trachea Esophagus Spinal cord Major cervical nerve trunks Zone II Jugular Veins
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