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Penetrating Neck Trauma: Simulation Case Debriefing

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Penetrating Neck Trauma: Simulation Case Debriefing Cullen B. Hegarty, M.D. Regions Hospital Department of Emergency Medicine Debriefing: How did the case feel? – PowerPoint PPT presentation

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Title: Penetrating Neck Trauma: Simulation Case Debriefing


1
Penetrating Neck TraumaSimulation Case
Debriefing
  • Cullen B. Hegarty, M.D.
  • Regions Hospital
  • Department of Emergency Medicine

2
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

3
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

4
Penetrating Neck Trauma
  • Penetrating Neck InjuryKarim Brohi, trauma.org
    76, June 2002

5
Injuries
  • Stab wounds to the neck can result in
  • -Vascular
  • -Neurologic
  • -Laryngotracheal and/or
  • -GI injuries

6
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

7
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

8
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

9
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.
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