Risk of whiplash
Immediate diagnosis and proper treatment damage of respiratory tract are crucial for survival. The best way for a quicktsenki airway obstruction - ask the patient to speak. If the patient can speak legible, the airways are not damaged, they have enough reserve capacity of the lungs to generate sound. If the patient is unable to speak, respiratory need of emergency assistance. Injuries of the face and neck can be extremely dangerous for the life andit is difficult to be treated. When checking the airway provide immobilitsiyu cervical spine in patients with head and neck injuries. Stopping bleeding with direct clamping begins. If this way can not stop the bleeding, requires immediate surgery. Do not blindly clamp blood vessels in the area aboveand. And remember that to happened displacement of the vertebrae, it is necessary to wear a certain time.
What is provide a neck injury?
neck is divided into three zones, to facilitate the diagnostic tests and the surgical treatment strategy:
- Zone I (from the collarbone to the annular cartilage): structure of the site include the large thoracic vessels holes (subclavian artery and Vienna, common carotid artery), the larynx and the brachial plexus;
- Zone II (of the annular cartilage to the angle of the mandible) site structure include the common carotid artery, internal jugular vein, the esophagusand trachea;
- Zone III (the angle of the mandible to the skull base) includes a carotid artery.
Important clinical signs indicating possible damage to all three areas:
- The symptoms of vascular injury:
- Heavy bleeding or a history;
- A hematoma, which increases;
- Noisy or thrill in the neck;
- Hypotension;
- Shortness of breath, hoarseness or wheezing;
- Missing or slow pulse on the vessels of the neck or arms;
- The focal neurological deficits, or a change in mental status.
Strategysurgery.
neck wounds with suspected violations platysma should be examined only in the operating conditions. Surgery is not necessary if the subcutaneous neck muscle is not damaged. If the patient has a permeable neck injury, then you need to probing wounds (wound symptomatic). If the patient is asymptomatic trauma, it is necessary to make CT vessels panendoskopiyu (direct laryngoscopy, bronchoscopy, and oesophagoscopy) and contrast esophagography. If the survey reveals any abnormalities, you should explore the area of ??the neck.
For all patients with permeable neck injury followingie to apply a selective approach of treatment based on clinical signs and symptoms, regardless of uryazhennoy zone. In stable patients with negative surveys mentioned above can be applied non-operational treatment in case of injury of the second zone with damage platysma. Selective treatment approaches may be conducted only in the Headeniyah where you can carry out all necessary inspections and ensure proper monitoring of the patient.
The surgical access to the zone I and III complex skills of the surgeon should be high. Prefer non-operational treatment in patients with stable lesions zones I and III. Trauma patients without clinicaleskih signs of damage can avoid surgery if appropriate examinations (CT vessels, Mr. endoscopy, contrast esophagography) negative.
