Kumar and Weaver use a flow diagram for evaluating a patient with penetrating trauma of the neck.
Anatomic zones of the neck:
(1) Zone I: below and about the clavicles and sternal notch
(2) Zone III: above the angle of the mandible (just above the carotid bifurcation)
(3) Zone II: between Zone I and III
Sequential Patient Evaluation
Management
Does the patient show:
(1) active cervical bleeding
(2) an expanding hematoma
(3) airway compromise
Take the patient to the operating room
Zone II injury with bruit, thrill, pulsatile mass or a widened mediastinum
If color flow duplex ultrasonography is abnormal, perform arteriography. If ultrasonography is normal, observe.
Zone II injury without bruit, thrill, pulsatile mass or a widened mediastinum
Observe.
No Zone II injuries.
Perform arteriography.
NOTE: While preparing the spreadsheet, one question was handling multiple penetrating injuries with more than 1 zone involved. If a single injury is present in Zone I or III, arteriography is performed. If injuries are present in Zone II AND Zones I or III, then arteriography might not be performed.
To read more or access our algorithms and calculators, please log in or register.
