5.1 P) Iv) Surgical Trauma Neck Trauma Vascular Injury

Front 1

Which of the following is incorrect regarding blunt trauma to the neck and vascular injury?

1. Carotid artery dissection may follow even trivial neck trauma.
2. Blunt cervical vascular injuries are rare.
3. The most common mechanism for blunt internal carotid artery injury is a sudden , forceful, hyperflexion, medial rotation of the neck.
4. Intraoral trauma, particularly in children, can cause internal carotid artery injury.

Back 1

3. Sudden , forceful hyperextension and lateral rotation of the neck

Front 2

List the causes of blunt carotid artery injuries? [5]

Back 2

1. MVA ** -seatbelt injuries
2. Fights
3. Athletic events
4. Clothesline injuries
5. Near hangings.

Front 3

Blunt vascular injury of the neck should be

suspected in patients with what injuries? [4]

Back 3

1. Flexion - extension mechanisms
2. Neck seat belt sign
3. Fractures
a. Basilar skull
b. Midface
c. Mandibular
4. Diffuse axonal brain injury.

Front 4

What type of arterial injuries can occur with blunt neck trauma? [4]

Back 4

1. Intimal tears
2. Thrombosis [and embolisation}
3. Dissection
4. Pseudoaneurysm

Front 5

List the signs and symptoms of vascular injury from blunt trauma to the neck? [7]

Back 5

1. Pulsatile haematoma
2. Bruits
3. Pulse deficit
4. Airway compromise
5. Haemothorax
6. Shock
7. Neurologic deficits **

Front 6

Criteria for screening for cerebrovascular

injuries in blunt trauma? { 6}

Back 6

1. Seatbelt mark signs
2. Any bruising / haematoma to neck after trauma
3. Unexplained Neurological deficit
4. Severe maxillofacial injuries
5. Cervical spine fractures with subluxation

[especially if transverse foramina are involved]
6. Skull fracture of base of skull [with carotid canal involvement]

Front 7

Most common site for blunt carotid artery

trauma?

Back 7

Proximal internal carotid artery near

bifurcation

Front 8

Range in Clinical picture of blunt vascular

injury?

Back 8

Asymptomatic seatbelt mark

--> neck haematoma

--> hemiparesis / hemiplegia

--> coma

Front 9

Best screening tool / Imaging choice for blunt vascular injury of neck?

Back 9

Multislice CT Angiography {CTA}

Front 10

Which is incorrect regarding vascular injury post blunt trauma to the neck?
1. Most cases of blunt carotid artery trauma are managed with

anticoagulation.
2. Thrombosis and stroke is a risk of delayed diagnosis of blunt vascular injury to the carotid vessels.
3. Blunt vertebral artery trauma is managed with antiplatelet therapy.
4. The most common site of blunt carotid artery trauma is the internal carotid at the level of C2.

Back 10

4. Most common site is is the proximal

internal carotid, near the bifurcation.

The second most common is at the level of C2- where the vessel stretches over the

transverse process of C2, after neck

hyperextension.

Front 11

In regards to Penetrating neck injuries, which of the following is incorrect ?
A. Zone II is from the cricoid cartilage to the angle of the mandible.
B. The highest incidence of significant injury occurs in both Zone II and III ( 25% incidence each).
C. Surgical intervention occurs highest in Zone III injuries.
D. The options for Investigation for penetrating neck injuries include CT angiography / Bronchoscopy and oesophagoscopy.

Back 11

C. Zone II (14%)

Zone III : 5%

Zone I : 12%

Front 12

List the range of Investigation options for

penetrating injuries to the neck ? [ 4 ]

Back 12

1. CT angiography ( CTA)
2. Oesophagoscopy
3. Bronchoscopy
4. Mandatory exploration ( ** Zone II injuries)

Front 13

Detail the 3 zones of the neck in penetrating

injuries. [ Roon and Christensen Classification ]

Back 13

Zone I : inferior aspect of cricoid cartilage to the thoracic outlet.
Zone II : Cricoid cartilage to angle of mandible.
Zone III : Angle of mandible to Base of skull.

Front 14

All of the following are considered

"HARD SIGNS " of airway involvement in

Penetrating trauma to the neck, except

for which one ?
A. Respiratory distress
B. Subcutaneous emphysema
C. Airway compromise.
D. Air bubbling through the wound.

Back 14

B.

Front 15

What are the most commonly injured

structures in Penetrating neck injury, and in what order of frequency ? (4)

Back 15

1. Vascular - carotid - 22%
2. Spinal cord 7%
3. Aerodigestive tract 7%
4. Nerves 7%

Front 16

In regards to Penetrating Neck trauma, which of the following is incorrect ?

A. The highest incidence for injury is in both Zone II and III injuries.

B. CT angiography is the first choice of investigation in all 3 zone types.

C. Mandatory exploration only really exists for Zone II injuries,

D. Oesophagoscopy +/- Bronchoscopy are only considered in Zone I

injuries.

Back 16

D. Zone I and II injuries have oesophagoscopy +/- bronchoscopy in their Investigative pathways.

Front 17

List the % order of incidence / frequency of significant injury , from highest to lowest , for Zone I , II and III

penetrating neck injuries.

Back 17

Zone II : 25%

Zone III : 25%

Zone I : 15%

Front 18

List the % order of surgical intervention for Zone I, II and III penetrating neck injuries, from highest to lowest.

Back 18

Zone II : 14%

Zone I : 12%

Zone III : 5%

Front 19

Tintinalli

List the hard vascular signs in neck injuries. (7)

Back 19

Hard Vascular Hard Signs

1. Active arterial bleeding

2. Expanding haematoma

3. Thrill / bruit

4. Unexplained hypotension

5. Diminished carotid pulse

6. Lateralising signs

7. Haemothorax > 1000mL

Front 20

Tintinalli

List the Soft vascular signs in neck injuries. (5)

Back 20

Soft Vascular Signs

1. Hypotension in field

2. History of arterial bleeding

3. Large haematoma - Non-expanding

4. Unexplained bradycardia

( without CNS injury)

5. Apical capping on CXR

Front 21

Tintinalli

List the Hard Aerodigestive signs in neck injury.

Back 21

Hard Aerodigestive Signs

1. Air / bubbling in wound

2. Haemoptysis

3. Haematemesis

4. Trachel deviation

Front 22

Tintinalli

List the Soft Aerodigestive Signs in neck injury.

Back 22

Soft Aerodigestive signs

1. Stridor

2. Hoarseness

3. Vocal cord paralysis

4. Subcutaneous emphysema

5. Seventh cranial nerve injury

Front 23

Tintinalli

List the Clinical Factors Indicating a need for

Aggressive Airway Management in Neck

injuries. ( 6)

Back 23

1. Airway obstruction from blood / secretions

2. Massive subcutaneous emphysema of neck

3. Tracheal shift

4. Acute respiratory distress

5. Alteration in mental status

6. Expanding neck haematoma.

Front 24

Tintinalli

In regards to the fascial layers of the neck, which of the following is incorrect ?

A. The deep cervical fascia divides into investing, pre tracheal and

prevertebral layers.

B. The carotid sheath is a combination of all 3 layers of the deep cervical fascia.

C. The platysma surrounds the superficial fascia.

D. The investing fascial layer encloses the sternocleidomastoid and trapezius muscles.

Back 24

C. The superficial fascial layer surrounds the platysma

Front 25

Tintinalli

In regards to penetrating neck injury, which of the following is incorrect ?

A. If the platysma is violated, it must be assumed that significant injury has occurred.

B. Physical examination can rule out aerodigestive injuries.

C. Helical CT angiography is the initial diagnostic screening study for

stable patients with penetrating injury violating the platysma.

D. Penetrating oesophageal injuries are often initially asymptomatic.

Back 25

B. Physical examination is not accurate for detecting oesophageal injuries

[EAST Guidelines ]