Hard signs neck trauma4/17/2024 ![]() 9 - 14 The emergence of helical CT scanning with greater speed and resolution may offer a reasonable method of triaging penetrating neck injury. Recently, the role of computed tomography (CT) in the evaluation of patients with penetrating trauma to the abdomen, flank, chest, and mediastinum has been described. This, combined with the concern regarding patients with multiple wounding patterns and multiple zone penetration, has encouraged us to identify an intermediate approach between physical examination alone and invasive studies and/or surgical exploration. 7, 8 In contrast to the widely practiced noninvasive evaluation of lower extremity penetrating trauma, the concern over occult neck injury, especially vascular injuries of the carotid or vertebral arteries and the inherent cerebral sequelae, has led to considerably less acceptance of noninvasive evaluation of penetrating neck trauma. 1 - 6 Recently, a more conservative observational approach using physical examination for penetrating neck injury has been suggested. ![]() Surgical exploration for deep zone II injuries or protracted noninvasive studies involving angiography and endoscopy have been traditionally used to triage and treat these injuries. PENETRATING NECK trauma can pose difficult diagnostic dilemmas in the verification of injury. Further prospective study of CT scan after penetrating neck trauma is needed. As a result, efficient evaluation and early discharge from the trauma bay or emergency department can be realized. Invasive studies can often be eliminated from the diagnostic algorithm when CT demonstrates trajectories remote from vital structures. No adverse patient events occurred before, during, or after CT scan.Ĭonclusions Computed tomography in stable selected patients with penetrating neck trauma appears safe. Four patients were discharged from the emergency department 7 other patients were discharged within 24 hours. Only 2 underwent bronchoscopy and esophagoscopy. Thirteen patients were identified by CT to have trajectories remote from vital structures and required no further evaluation. Three isolated zone I, 1 isolated zone II, 9 isolated zone III, and 10 multiple neck zone trajectories were evaluated. One patient died of a cranial gunshot wound. Nineteen patients sustained gunshot wounds 3, shotgun wounds and 1, a stab wound. Results Twenty-three patients were identified during the 30-month period. Main Outcome Measures Number of invasive studies performed. Further invasive studies were directed by CT findings. Interventions Patients underwent a spiral CT as an initial diagnostic study after initial evaluation in the trauma bay. Patients Hemodynamically stable patients without hard signs of vascular injury or aerodigestive violation who had sustained penetrating trauma to the neck. Setting Academic, urban, level I trauma center. We hypothesized that computed tomography (CT), used as an early diagnostic tool to accurately determine trajectory, would direct or eliminate further studies or procedures in stable patients with penetrating neck trauma. Hypothesis Penetrating neck trauma has traditionally been evaluated by surgical exploration and/or invasive diagnostic studies. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |