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Neck Trauma (Penetrating Trauma (New way is pt stable? Hard signs?,…

- - - - Hard signs = emergent sx
        airway compromise
        
        gurgling
        
        stridor 💨
        
        pending airway collapse
        
        loss of airway
        
        Vascular
        
        expanding hematoma
        
        pulsatile bleeding (arterial)
        
        stroke
        
        frank shock :zap:
        
        Pretest Sx:
        Brachial Plexus
        Neuro s/s referred to Carotid injury
        Visceral tissue damage (hemoptysis & soft signs…fml)
        
        grain of salt: Pretest uses zones
    - - Symtomatic
        CT angiogram :radioactive_sign:
        
        multidetector
        
        (-) CT :radioactive_sign:
        Observation
        
        f/u w/ CT scan :radioactive_sign:if new soft/hard signs
        
        (+) CT scan
        Tx: Sx :hocho:
      - Asymptomatic
        
        no soft signs
        
        Tx: watch & wait :eyes: :timer_clock:
        
        Soft signs
        signs of air/digestive/vascular injury that aren't that bad = no sx
        
        dysphonia 🗣
        
        dysphagia
        
        subQ air: emphysema, crepitus
        
        any form of hard signs that are mild
        
        bleeding non-pulsatile
        
        hematoma non-expanding
        
        patent airway w/ some emphysema
- - - - Complete transection
        
        lose everything
        UMN & LMN lesions
        no sensation
        no pain temp
        
        Cord Compression
        FND
        
        erectile dysfunction
        
        urinary/ bowel dysfunction
        
        incontinence
        
        Path: edema in a closed space compressing the cord
        Dx: MRI, but give steroids first
        Tx: Dexamethasone
        may be a penetrating injury, thats ok, give steroids on top
        
        Partial cord lesions
        
        Central cord
        2 ways
        
        slow erosion / growth
        
        syringomyelia
        
        loss of ALS : px & temp in cape-like distribution
        
        explosive destruction :explode: from central cord
        
        old person :older_man::skin-tone-5: w/ hyperextension of neck (trauma :explode:)
        
        loss of px & temp
        
        loss of motor in cape like distribution.
        
        only 1 dermatome affected
        
        looks like a floating lesion, below and above is spared
        
        Anterior cord
        lose everything
        maintain DCMLS
        
        good proprioception
        
        no pain temp
        
        no motor
        
        path: spinal artery occlusion
        
        Posterial cord
        only lose vibration proprioception
        Path: irrelevant!