Penetrating Neck Trauma: Simulation Case Debriefing

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Penetrating Neck TraumaSimulation Case
Debriefing

• Cullen B. Hegarty, M.D.
• Regions Hospital
• Department of Emergency Medicine

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Debriefing

• How did the case feel?
• What went well?
• What would you change/do differently?
• Crisis Resource Management review
• Review of objectives and optimal management of
  the case

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Case checklist

• Address IV access, fluids
• Order appropriate labs/blood products
• Complete primary and secondary survey with full
  exposure/skin exam and vascular exam noted
• Pain management
• Early airway management with rescue technique(s)
  if needed
• Coordinate final disposition for patient

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Penetrating Neck Trauma

• Penetrating Neck InjuryKarim Brohi, trauma.org
  76, June 2002

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Injuries

• Stab wounds to the neck can result in
• -Vascular
• -Neurologic
• -Laryngotracheal and/or
• -GI injuries

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ED Management

• Basic stabilization techniques
• -ATLS Primary/Secondary surveys
• -emphasis on exposure for other injuries
• -screening x-rays (ex CXR)
• -early airway management
• Diagnostic workup of injury

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Diagnostic work-up

• Zone III angiography if stable
• Zone I CXR, angiography, GI study (esophagoscopy
  vs contrast study) if stable
• Zone II OR for exploration versus (if stable)
• -studies of potential injuries angiogram,
  bronchoscopy, and GI study
• -CT soft tissue neck
• -clinical observation for signs/symptoms
• All Zones if unstable may need OR

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Summary

• Review of case, performance of clinical
  management and team
• Review of penetrating neck injury
• -Zones of neck
• -Basic trauma stabilization techniques
• -Management of injuries based on location of
  wound/zone

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References

• Penetrating Neck InjuryKarim Brohi, trauma.org
  76, June 2002
• http//www.trauma.org/vascular/neckneur.html
• Hamilton et al Chapter 48 Head and Neck
  Trauma, pp 843-869. Emergency Medicine- An
  Approach to Clinical Problem-Solving, 2nd
  Edition,Philladelphia, W.B. Saunders Company,
  2003.