How to manage a penetrating neck injury on the Step 2 CK
Penetrating neck injuries are high-yield on the CK exam. It is essential that you can identify the zones of the neck, which structures are housed within these zones, and how to manage injuries to each zone.
This algorithm describes what should be done for specific injuries.
Neck injuries can be life threatening. There are 3 zones of the neck and each zones contains different structures. The zones are as follows:
ZONE 1: From the clavicle to the cricoid cartilage. Structures such as great vessels and the aortic arch are at greatest risk of injury in ZONE 1
ZONE 2: From the cricoid cartilage to the angle of the mandible. This zone contains the carotid and vertebral arteries, the jugular veins, the pharynx, larynx, trachea, esophagus, C-spine, and spinal cord. This zone, whether patient is stable or not, is always explored (especially if the platysma is pierced)
ZONE 3: From the angle of the mandible to the base of the skull. This zone contains the salivary and parotid glands, esophagus, trachea, C-spine, carotid arteries, jugular veins, and major cranial nerves.
Assessing neck injuries in a stable patient is: 4-vessel angiography is done for penetrating injuries to zones 1 and 3, especially if the platysma is pierced.
– All ZONE 2 injuries are routinely explored
– Never send an unstable patient to radiology (stabilize first)
– If you cannot get access to a bleeding vessel, embolization or occlusion may be warranted
For a few easy points on your Step 2 CK exam, be sure you are comfortable with questions pertaining to neck injuries of all kinds, especially surgical emergency situations such as this.