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Review Question - QID 106365

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QID 106365 (Type "106365" in App Search)
An 25-year-old female is brought to the emergency room after what appears to be a self-inflicted slash wound to the neck. On physical exam, her vitals are as follows: BP 82/60, HR 118, RR 23, O2 Sat 96%. She is noted to have a 4.5 cm laceration at the level of the thyroid cartilage on the left side. After receiving full IV access she is started on fluids. After 3 L of saline and 2 units of blood her BP is 90/70. Which of the following is the most appropriate next step in the management of this patient?

Arteriogram

20%

17/86

Tracheostomy

7%

6/86

Neck CT

15%

13/86

Surgical exploration

53%

46/86

Observation

3%

3/86

Select Answer to see Preferred Response

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This patient has sustained a penetrating neck injury (PNI) to zone II, since the injury is between the angle of the mandible and the cricoid cartilage. This should be managed with a surgical neck exploration.

There are 3 defined zones with PNIs: above the angle of the mandible (Zone III), between the angle and the cricoid cartilage (Zone II) and below the cricoid cartilage (Zone I). Classically Zone I and III require endoscopy and angiography as surgical exploration of these zones surgically is challenging. Zone II is classically managed with a surgical exploration.

Incorrect Answers:
Answer 1: An arteriogram would be appropriate with a zone I or III injury.
Answer 2: This patient appears to be protecting her airway and does not require a tracheostomy at this time. Even if an airway was required, an emergency cricotomy not tracheostomy is the method of choice.
Answer 3: A neck CT is not appropriate here, although a neck CT angiogram may be useful in this patient if she were hemodynamically stable.
Answer 5: Observation would not be appropriate as this patient is hemodynamically unstable.

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