7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
SoCal ACS 2014 - Penetrating Neck Trauma
1. The Utility of Anatomic “Zones” of
the Neck in the Assessment of
Penetrating Neck Injury
Garren M. I. Low, MS, Kenji Inaba, MD, Konstantinos Chouliaras, MD,
Bernardino Branco, MD, Lydia Lam, MD, Elizabeth Benjamin, MD, Jay
Menaker, MD, Demetrios Demetriades, MD, PhD
January 17, 2014
3. Background
• After WWII
• Penetration of the platysma mandated
exploration
• 40-60% negative exploration
• Starting in the 1980’s
• Neck Zone approach
5. Utility of Neck Zone Approach
• Neck zones drive management
• Zone II
• Zones I & III
6. Problems with Zone Approach
• Classical imaging for zones I and III
• Expensive
• Time-consuming
• Often negative
• Zone II
• Often negative
• Ct angio
• Predictive value of external wound
7. Objective
• To characterize the association between
external wounds and the corresponding
internal injuries after penetrating neck
trauma.
• Identify clinical utility of anatomic neck zone
scheme
9. Methods
• All patients underwent structured clinical
examination documenting external wound
• Senior resident or attending
10. Hard Signs
Penetrating Neck
Injury
•
•
•
•
•
•
OR
Soft Signs
Diagnostic
Modalities
Observation
active hemorrhage No Signs
expanding or pulsatile hematoma
bruit or thrill in the area of injury
shock unresponsive to initial fluid resuscitation
massive hemoptysis or hematemesis
air bubbling through the injury site
13. Methods
• “Unexpected” internal injury
• Internal injury laid outside the borders of the
neck zone corresponding with the external
wound
• “Expected” internal injury
21. Conclusion
• There was a high incidence of non-
correlation (16%)
• 6% were not from external neck wounds
• The utility of the anatomic zone approach
is questionable.
• Clinical presentation
Notas del editor
Chicago paper (Cook county?)
Because of the easy surgical access zone 2Because of difficult access Zone 1,3
World’s largest CT angio study 2012
Replace with picture
Instead of using the zones, hard signs etc. approach to neck injury is better