Penetrating Neck Injuries (PNI) – a few important reminders

23 Mar

REMEMBER THIS:NeckInjuryZones1

 

  • Penetrating neck injuries (PNI) are defined by injuries that violate the platysma
  • Zones of injury (see picture) have been defined to help the clinician describe the injury and attempt to predict degree of morbidity
  • PEARL: If clinical signs of vascular or aerodigestive injury or if hemodynamically unstable, then the treatment is operating room exploration
  • Otherwise, obtain CT angiogram and the following management depending on the corresponding zone:
    • Zone 1 -> esophageal imaging, bronchoscopy, angiography
    • Zone 2 -> angiography, esophageal imaging, bronchoscopy, operating room for mandatory exploration
    • Zone 3 -> angiography
  • PEARL: there are conflicting studies, but it is usually safe to clear the cervical spine in a patient with PNI and no focal neurologic deficits

 

  • Pitfalls:
    • Never remove objects impaled in the neck
    • Avoid probing neck wounds and clamping vessels in the neck
    • Never discharge a patient with PNI and no injuries identified on CTA; always admit these patients for observation
    • To avoid morbidity (mediastinitis, abscess, empyema), never delay esophageal imaging in patients with potential esophageal injury

 

 

Submitted by K Estes

 

References: Critical decisions in emergency medicine. October 2011, vol 26, number 2.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

%d bloggers like this: