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3 cases of serious neck injury diagnosis and treatment of penetrating


Road intravenous pressure infusion, blood transfusion, exploratory see most of the left anterior sternocleidomastoid muscle rupture, rupture of left common carotid vein, left common carotid artery at the bifurcation of about 1.5em rupture, esophageal rupture, neck 6 to 7 vertebral asked wounds bleeding, abnormal bleeding raging, finger pressure proximal left common carotid artery ligation of the ends, consistent with esophageal cleft, neck wounds from 6 to 7 vertebral blood coagulation asked. Due to cerebral ischemia and hypoxia after long time, the patient has been in a coma and died the afternoon of the surgical sub-Ft. Example 2 treatment, the blood pressure 13/8Kpa, conscious, face pain, limb movement is good, the mouth see a huge chip from the right molar region was inserted into the back end and incisors parallel to the front of the right oropharyngeal wall right through the occipital 3cm at the piercing on the hair, the exposed wood, mouth bleeding much. Consider the right cervical vascular injury may be, but dare not rashly removal of foreign bodies in the requirements and conditions to allow his family circumstances, escorted to a higher level hospital (Xiangfan Central Hospital) prophylactic tracheotomy, intubation, anesthesia and right sides of neck incision, the right common carotid artery, right jugular vein pre-ligature after paracentesis chips were foreign owned, wood chips about 20era × 4em × 2cm, fortunately no major vascular injury, postoperative recovery and no complications. Example 3 after injury, when in the local hospital for treatment, see the wound bleeding raging, pressure dressings to stop bleeding and referral line. When transferred to our hospital, was shock-like. Consider the left neck, and vascular injuries were penetrating, but not hastily release the pressure dressing, rushed to the operating room for general anesthesia, multi-channel intravenous fluids, blood transfusions, since the distal end free blood pressure surge occurs dressing. Proximal end of oppression of the proximal end of the release was no significant bleeding, see the left neck exploration transverse fragmentation wounds, about 6.0em, the left sternocleidomastoid muscle rupture, rupture of left common carotid vein, ligation of ends. After successful surgery, postoperative transfusion, where appropriate, anti-inflammatory, the condition improved by Ft, ll days cured and discharged without complications. 2 to discuss a serious neck injury with penetrating injury of the major cervical vessels often die in a short time, taken to hospital where a timely manner is often incomplete rupture of the vessel wall or blood clot oppression yet cases of fatal bleeding, on the neck Department of penetrating wound debridement suspected vascular injury and lack of knowledge or discovery principle not prepared,[link widoczny dla zalogowanych], no doubt accelerate the patient's death. Debridement exploration must be carried out under general anesthesia and intubation, keep the airway open. Generally considered to be in the following circumstances should the line duct exploration: (1) active bleeding wound; (2) history of hypotension associated with bleeding wounds; (3) oral active bleeding, but no dental trauma; (4) expanding hematoma of the neck; (5) mediastinal widening; (6) tracheal compression caused by the tracheal displacement; (7), upper extremity, superficial temporal, facial or retinal arterial pulse disappeared; ( and neck noise; (9 ) in central nervous dysfunction 【Il. Despite this injury cases 1:3 l treatment at the time no longer active bleeding, but its history of low blood pressure did not cause bleeding wound with clinicians attention until four hours before considering expanding hematoma after cervical vascular injury, missed rescue opportunity,[link widoczny dla zalogowanych], in sending way to move the operating room because of postural Fatal bleeding, although efforts to save them, but the end result of prolonged intracranial ischemia and hypoxia, which leads to death. Filling of cracks and bleeding from the foreign body lighter, not rashly pull out foreign bodies, to prevent the occurrence of massive hemorrhage leading to death-2J. Example 2 In this paper,[link widoczny dla zalogowanych], families of patients with the disease to be installed and enabled will transfer to higher level hospitals, in preventive tracheotomy, intubation, carotid artery ligation lines preset fully prepared for success after paracentesis foreign body. Emergency cervical vascular injury to take the most effective packing to stop bleeding 3. This Example 3 from the injured into the hospital to visit 2O kilometers, thanks to the successful treatment of an effective hemostasis local hospital. For treatment of broken blood vessels, in principle, the external carotid artery, vertebral artery and jugular vein ligation injury simply does not cause side effects. If the easy-to-jugular vein injury exposure, and should be repaired and then pass. Carotid artery,[link widoczny dla zalogowanych], carotid artery injury, reperfusion should be restored promptly, including the terminal end of the match, the side repair or vascular grafts. But central focal ischemic neurological deficit, because the blood flow after recanalization of the infarct area has increased the risk of neurological dysfunction, it is not appropriate line repair recanalization surgery, which can line vascular ligation. This Example 1 is not restricted by conditions of carotid artery anastomosis recanalization,[link widoczny dla zalogowanych], may also be one of the main rescue failed.