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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
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.
5.0
(3)
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