Management of penetrating neck injury in the emergency department: a structured literature review

Brywczynski, Jeremy; Barrett, Tyler W.; Lyon, Jennifer; Cotton, Bryan A.

doi:10.1136/emj.2008.058792

Cited by 72 publications

(68 citation statements)

References 33 publications

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“…The literature suggests that spinal immobilization should be considered only in cases of PNI when the mechanism of injury and/or physical findings suggest spinal cord involvement. [18][19][20][21][22][23] Rapid sequence intubation (RSI) can be considered in cases where the airway is felt to be threatened but normal anatomy and structure relationship are well preserved. 18,24,25 In a retrospective study of more than 700 patients with PNI, Mandavia and colleagues found RSI to be safe and effective, with all of the 39 patients successfully intubated in this manner, compared to awake fibre-optic intubation, which was successful in 9 of 12 patients (three failures being rescued with RSI).…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22][23] Rapid sequence intubation (RSI) can be considered in cases where the airway is felt to be threatened but normal anatomy and structure relationship are well preserved. 18,24,25 In a retrospective study of more than 700 patients with PNI, Mandavia and colleagues found RSI to be safe and effective, with all of the 39 patients successfully intubated in this manner, compared to awake fibre-optic intubation, which was successful in 9 of 12 patients (three failures being rescued with RSI). 24 Although the results of this study would seem to support the safety of RSI in PNI, they may not apply to the 10% of patients with PNI who have a primary airway injury, 5 a subset that may not be identified on initial presentation.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Airway management of an open penetrating neck injury

Youssef

Raymer

2015

CJEM

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“…8 However, recent literature supports the use of physical examination as a reliable tool for ruling in and out serious injuries from PNI. [1][2][3][4]6,9 Serial physical examination with auscultation of the carotid arteries is reported to be 95% sensitive 6 for ruling out major injuries and may be as high as 100% specific. 10,11 The largest and most relevant studies on the role of physical examinaton in stable PNI are outlined in Table 2. 1.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The anatomy of the neck is complex, and many vital structures reside in close proximity, sometimes within millimetres, to one another ( Figure 1). …”

mentioning

confidence: 99%

Conservative management of laryngeal perforation in a rural setting: case report and review of the literature on penetrating neck injuries

Kolber

Aspler

Sequeira³

2011

CJEM

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Penetrating neck injuries (PNIs) are infrequent but can result in significant morbidity and mortality. Although surgical management of unstable patients with penetrating neck trauma is the standard of care, management of stable patients remains controversial owing to the possibility of occult injuries. Recent studies suggest that physical examination and ancillary imaging may be sufficiently accurate to diagnose or rule out surgically significant injuries in PNI. We report a patient with a laryngeal perforation who was managed conservatively in a rural hospital without complications and review the literature pertinent to cases of this nature. RÉ SUMÉLes traumatismes pé né trants de la ré gion du cou sont rares, mais peuvent entraîner une morbidité et une mortalité importantes. Bien que la prise en charge chirurgicale de patients instables pré sentant un traumatisme pé né trant de la ré gion du cou soit la norme, la prise en charge des patients stables demeure controversé e en raison de la possibilité de blessures latentes. De ré centes é tudes suggè rent que l'examen physique et l'imagerie auxiliaire peuvent ê tre suffisamment pré cis pour poser un diagnostic ou exclure des blessures importantes sur le plan chirurgical dans les cas de traumatismes pé né trants du cou. Nous pré sentons le cas d'un patient au larynx perforé qui a fait l'objet d'un traitement conservateur dans un hô pital rural sans complications. Nous passons aussi en revue la litté rature pertinente de cas semblables.

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“…The car suddenly slowed and the cyclist was thrown into the car by the rear window. Bystanders extricated him and a severe bleeding from a penetrating injury of right zone 1 of the neck started [7]. Hemorrhage was suddenly controlled by direct compression while an ambulance and HEMS were on the way.…”

Section: Case Presentationmentioning

confidence: 99%

Impossible primary referral to the major trauma center of an integrated trauma system: a case of exsanguinating trauma treated in a Spoke hospital

Gamberini¹,

Potalivo²,

Benni³

et al. 2017

Trauma Emerg Care

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Background: Major trauma is a leading cause of death all over the world. Integrated trauma systems have been widely built up on a hub and spoke model by identification of a Major Trauma Centers (Hub) and secondary acute care hospital (Spokes) covering various population amount. Helicopter Emergency Medical System where involved in organization and learning programs. According to literature, primary referral to Major Trauma Centers of severely injured trauma victims, whenever possible, is associated with better outcomes. Trauma System in Emilia-Romagna region (Italy) is based on 3 Integrated Trauma Systems called SIAT with a Major Trauma Center each. Romagna-SIAT covers the east coast towards the Adriatic Sea, with an estimated population of 1.250.000.

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Management of penetrating neck injury in the emergency department: a structured literature review

Cited by 72 publications

References 33 publications

Airway management of an open penetrating neck injury

Airway management of an open penetrating neck injury

Conservative management of laryngeal perforation in a rural setting: case report and review of the literature on penetrating neck injuries

Impossible primary referral to the major trauma center of an integrated trauma system: a case of exsanguinating trauma treated in a Spoke hospital

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