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


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


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.