Zone 3: Extending from the angle of the mandible to the base of the skull. Zone 2: Extending from the inferior margin of the cricoid cartilage to the angle of the mandible. Zone 1: Extending from the clavicles to the cricoid cartilage. The most commonly accepted classification of these zones is by Roon and Christiansen : For clinical evaluation, the anterior neck is divided in to three distinct zones.

These structures include airway, vascular, neurological, musculoskeletal and gastrointestinal components. The neck is a region of complex anatomy, with many vital structures located in very close proximity. These management principles may then be used to establish a standard of care for use by the pre-hospital clinical team attending to the patient, within both their scope of practice and their current service guidelines. The aim of this review is therefore to evaluate current practice and collate the current evidence for the management of PNIs before the patient reaches the emergency department. Īt the time of writing, there exists currently no consensus statement or agreed guidelines regarding the pre-hospital management of penetrating neck injuries that these authors are aware of. From this, recommendations and guidance have been implemented to guide decision-making regarding surgical exploration and the use of computed tomographic angiography. The majority of recent research has focused on the management of these injuries on arrival to the emergency department.

Previous studies have suggested these injuries account for up to 1% of all trauma patients with an associated mortality ranging from 3 to 6%. Optimal management within this immediate time critical setting is paramount to good clinical outcomes. Penetrating injuries to the neck pose a unique challenge to clinicians, especially within the resource-limited pre-hospital environment. Penetrating neck injury (PNI) is defined as any trauma to the neck that violates the platysma muscle layer. From this we plan to instigate a Delphi process to develop a consensus statement on the pre-hospital management of this challenging presentation. Based on the available reviewed evidence, we have proposed a management algorithm for this cohort of patients. The available research is discussed in sections based on the commonly used trauma management acronym ‘cABCD’ (catastrophic haemorrhage, Airway, Breathing, Circulation, Disability) to facilitate a systematic approach and clinical evaluation familiar to clinicians. A systematic scoping review of the literature was conducted to evaluate the current available research pertaining to managing this injury profile, prior to the patient arriving in the emergency department. These injuries are particularly difficult to manage in the resource poor, often austere and/or remote, pre-hospital environment. Respiratory, vascular, gastro-oesophageal and neurological structures may all be involved, either in isolation or combination. Injuries to this area, whilst low in incidence, are potentially devastating. Penetrating injuries to the neck pose a unique challenge to clinicians due to the proximity of multiple significant anatomical structures with little protective soft tissue coverage.

Hard signs neck trauma