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Stab wound in the root of the neck أبريل 2023 - Coggle Diagram
Stab wound in the root of the neck
أبريل 2023
Diagnosis
Examination
aims to assess the extent of the injury and identify any potential complications
Physical examination: A thorough physical examination is performed to assess the extent of the injury, including the depth and location of the stab wound.
Neurological examination:
Signs of nerve injury, as numbness, weakness, or loss of sensation in the upper extremities or face.
Pulmonary examination:
Diminished breath sounds or abnormal air entry, may indicate a pneumothorax or hemothorax
Vascular examination: assess absent or weak pulse, coolness, or pallor in the upper limb.
Wound evaluation:
Assessing its depth, size, and location.
Look for any signs of injury to underlying structures, such as gaping of the wound, exposure of deeper tissues, or the presence of foreign objects.
Assessment and stabilization (ABCs)
Airway assessment:
airway patency assessment, any signs of airway compromise, such as stridor (high-pitched breathing sound), difficulty breathing, or hoarseness.
Breathing Assessment:
Respiratory rate: look for signs of rapid or labored breathing.
Breath sounds: check for any abnormal sounds, such as decreased breath sounds or wheezing, which may indicate underlying lung injury or obstruction.
Circulation Assessment:
Pulse: at the carotid artery. Absent or weak pulse indicate vascular injury.
Bl. pressure: to assess hemodynamic stability. Hypotension is a sign of significant bl. loss.
Skin color & temperature: signs of pallor, cyanosis, or coolness, indicate poor circulation.
Swelling or bruising in the neck region: may indicate interal bleeding
Investigations
Imaging
CT : provides detailed information about the structures in the neck, such as blood vessels, airway, and vital organs.
Duplex US to assess integrity of bl. vessels
X-ray: It may be used to detect any fractures or foreign objects in the area.
Lab.
CBC : to assess bi. loss
ABG
TTT
Airway management:
If the airway is compromised, prompt intervention may be necessary to establish a clear airway.
This may involve techniques such as
manual airway maneuvers
placement of an oral or nasal airway, or even
emergency surgical airway (cricothyroidotomy or tracheostomy).
Breathing support:
If there are signs of respiratory distress or inadequate oxygenation, interventions such as oxygen supplementation or assisted ventilation may be provided.
Circulatory support:
severe bleeding or hemodynamic instability >>> immediate measures to control bleeding and restore circulation, as
direct pressure on the wound,
intravenous fluid resuscitation, or
blood transfusion.
Surgical intervention:
emergency surgery may be required to repair damaged structures, control bleeding, or remove any foreign objects. Surgeons may need to explore the wound and repair any injured blood vessels, nerves, or the airway.
Exploratory surgery:
In cases where the extent of the injury is unclear or there is a high suspicion of significant damage, an exploratory surgery may be performed.
This involves making an incision to directly visualize the wound and assess the underlying structures, including blood vessels, nerves, the trachea, and the esophagus.
Vascular repair:
If major blood vessels, such as the carotid arteries or jugular veins, are injured, surgical repair may be necessary.
This involves identifying and repairing the damaged blood vessels to restore blood flow and prevent excessive bleeding. In some cases, vascular grafts or bypass procedures may be required.
Tracheal or laryngeal repair:
If the trachea or larynx is injured, surgical repair may be performed to restore the integrity of these structures.
This can involve suturing or reconstructing damaged areas to ensure proper breathing and voice function.
Esophageal repair:
Stab wounds that involve the esophagus may require surgical repair to prevent leakage of food or fluids into the surrounding tissues.
This can involve suturing or reconstructing the injured portion of the esophagus.
Removal of foreign objects:
In cases where the stab wound involves the insertion of foreign objects, surgical exploration may be necessary to locate and remove these objects.
This is important to prevent infection, tissue damage, or further complications.
Drainage of abscesses or hematomas:
In some cases, stab wounds may lead to the formation of abscesses or hematomas .
These may require surgical drainage to prevent infection, promote healing, and relieve pressure on surrounding structures.
It's important to note that the specific surgical procedures performed will depend on the individual case and the expertise of the surgical team. These decisions are made based on a thorough evaluation of the injury and consideration of the potential risks and benefits of each surgical intervention.
Antibiotics: To prevent infection, the patient may receive antibiotics intravenously.
Supportive care:
Depending on the severity of the injury, the patient may require close monitoring in ICU.
Supportive measures may include pain management, wound care, and respiratory support.
Anatomy of the root of neck
The root of the neck, also known as the cervical region, is the area where the neck meets the skull. It is made up of seven cervical vertebrae (C1-C7) and several important structures, including:
Cervical vertebrae: These are the vertebrae that make up the neck. They are smaller and more mobile than the vertebrae in the upper back and chest.
Intervertebral discs: These are the cushions between the vertebrae that absorb shock and allow for movement.
Cervical spinal cord: This is the part of the spinal cord that is located in the cervical region. It is responsible for transmitting signals between the brain and the rest of the body.
Cervical nerves: These are the nerves that branch off the spinal cord in the cervical region. They carry signals to and from various parts of the body, including the arms, chest, and neck.
Muscles: The neck contains several important muscles, including the sternocleidomastoid, trapezius, and scalene muscles, which are involved in movement and posture.
Blood vessels: The carotid arteries and jugular veins pass through the neck, carrying blood to and from the brain and other parts of the body.
Lymph nodes: The neck contains several lymph nodes, which are part of the immune system and help to filter out bacteria and other foreign substances.