cricothyroidotomy) if laryngoscopy or endotracheal tube placement fails Have the neck prepared for front of neck access (i.e.Hematemesis and hemoptysis can make visualization of the airway structures challenging.Expanding hematomas can cause dynamic airway compromise.Early airway control should be considered in patients with hard signs.Tracheobronchial Injury occurs in up to 20% of patients ( Kendall 1998).Can apply direct pressure to bleeding wounds en route.Delays should only occur for securing the unstable airway.Hard signs associated with 90% rate of major injury ( Evans 2018).Any patient with hard signs of injury should be expeditiously brought to the operating room for further management.Focus on immediate life-threats: exsanguination and asphyxiation from airway obstruction.Hard and Soft Signs of Major Aerodigestive or Neurovascular Injury ( Sperry 2013 ) The platysma muscle sits between the superficial and deep cervical fascia: Violation of the platysma increases the likelihood of deep structure injury and should be explored in the operating room immediately.There is anatomic continuity in the fascial layers between the neck and the anterior mediastinum.Historically the zones were divided by easy accessibility for surgical exploration (Zone II) vs those that would likely need angiography to delineate vascular injury (Zones I, III).Zone system can be used to think about what structures may be injured but caution should be used as a penetrating injury can transverse zones.Neck Anatomy (Netter’s) Posterior Triangle of the Neck Anatomy () Zone III: Superior to the angle of the mandible to skull area.Zone II: Cricoid cartilage to the angle of the mandible.
Zone I: Clavicles/sternum to the cricoid cartilage.The neck is classically divided into three zones.Zones of the Neck and Anatomical Structures ~ 20% of mortality secondary to uncontrolled hemorrhage.80% of morality secondary to cerebral infarction.Represent 1% of all trauma admissions in the US and have a 5% mortality rate.Due to the large number of critical structures in the neck, a clear knowledge of the anatomy is necessary for proper evaluation and management. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. Background: Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury.