Clinical Practice Guideline: Penetrating Zone II Neck Trauma

Tisherman, Samuel A.; Bokhari, Faran; Collier, Bryan R.; Cumming, J.; Ebert, James; Holevar, Michele R.; Kurek, Stanley; Leon, Stuart; Rhee, Peter

doi:10.1097/ta.0b013e3181692116

Cited by 130 publications

(136 citation statements)

References 84 publications

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“…11 Although historically surgical exploration was recommended for all zone II PNIs, it has been shown more recently that conservative evaluation with panendoscopy and arteriography is appropriate in selected cases. 12 In contrast, the airway management of PNI is guided by clinical presentation rather than by zone. The principles of airway management in PNI are highlighted in the context of the available literature.…”

Section: Discussionmentioning

confidence: 99%

Airway management of an open penetrating neck injury

Youssef

Raymer

2015

CJEM

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Although penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. It is not known if RSI is safe in such patients, nor has there been reported use of videolaryngoscopy in patients with open PNI. Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such guiding principles apply to all patients with PNI until the nature of the injury is more accurately defined. In this report, we present the case of a patient who presented to the ED with a zone II open PNI, which occurred as a result of a stab wound. RÉ SUMÉBien que les plaies pé né trantes du cou (PPC) repré sentent un faible pourcentage des cas traité s dans les services d'urgence (SU), elles peuvent né anmoins entraîner une forte morbidité et une forte mortalité . Les interventions en vue du maintien de la permé abilité des voies aé riennes dans les cas de PPC varient é normé ment selon le tableau clinique et les pratiques locales, au point que les dé clarations sur la prise en charge gé né rale manquent. Si l'intubation en sé quence rapide (ISR) est sans danger chez la plupart des patients souffrant d'une PPC, le maintien de la permé abilité des voies aé riennes dans le sous-groupe de patients à risque é levé (10%) pré sentant des lé sions laryngotraché ales exige des interventions particuliè rement judicieuses. On ne sait pas si l'ISR est sû re chez ces patients, et la documentation ne fait pas é tat non plus de l'utilisation de la vidé olaryngoscopie chez les patients souffrant d'une PPC bé ante. Les principes dé jà é tablis du maintien de la permé abilité des voies aé riennes dans les cas de blessure bé ante des voies aé riennes comprennent le non-recours à la ventilation par masque et ballon à pression positive et à l'intubation à l'aveugle ainsi que la possibilité d'une ouverture chirurgicale pré coce des voies aé riennes. Comme les lé sions dans ce sous-groupe de patients à risque é levé peuvent ê tre non dé celables cliniquement à la premiè re consultation au SU, ces principes de conduite s'appliquent à tous les blessé s pré sentant une PPC jusqu'à ce que la nature du trauma soit davantage pré cisé e. Sera exposé ici le cas d'une patiente traité e au SU pour une PPC bé ante de la zone II, par suite d'une agression à l'arme blanche.

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Section: Discussionmentioning

confidence: 99%

Airway management of an open penetrating neck injury

Youssef

Raymer

2015

CJEM

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“…PNIs have a high mortality and complication rate [2,3], and appropriate and timely management of these junctional injuries is time critical [2,3], including the completion of adjunctive measures such as CT scan. DMP is suggested as a first line response to PNI [6][7][8][9], but is also associated with a low efficacy rate [7].…”

Section: Discussionmentioning

confidence: 99%

“…This lack of protection in the neck not only contributes to physician angst during treatment, but also to the high mortality and complication rate when injury occurs [2][3][4]. Airway compromise and exsanguination are both very high priorities and the time required to deal with one can be to the detriment of the other.…”

Section: Introductionmentioning

confidence: 99%

“…Rapidly controlling hemorrhage provides the time required to establish a definitive airway without further blood loss of an already depleted intravascular volume. Delays in establishing definitive control of the airway can make the task of subsequent airway control difficult or impossible because of hematoma formation or injury/resuscitation induced edema leading to subsequent catastrophic airway obstruction [2,5]. The Western Trauma Association (WTA) Critical Decisions in Trauma recommends direct manual pressure (DMP) be used as a first line response to penetrating neck injury [6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bridging the Gap: A Novel Method for Hemorrhage Control

Chovanes¹,

Schneider²,

McKee³

et al. 2017

J Health Edu Res Dev

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“…Pain, tenderness, and bloody saliva suggested a penetrating zone II neck perforation [1]. No signs of significant injury, such as severe active hemorrhage, bruit, pulse deficit, hoarseness, stridor, respiratory distress, hemiparesis, expanding hematoma, or subcutaneous emphysema, were observed clinically or found on computed tomography (CT) scanning.…”

mentioning

confidence: 99%