PNI penetrating neck injury part2

A stab wound to the neck rolls into your trauma bay. Do you press, intubate, scan, or go straight to theatre? This deep-dive discussion walks through the modern emergency approach to penetrating neck injury (PNI), from the first seconds in the trauma bay to definitive care. It's built on Tintinalli's and Rosen's and on current trauma guidelines. You'll learn: ✅ Why the platysma is the line that defines a true penetrating neck injury ✅ The three neck zones, and why zones I and III change the surgical plan ✅ ATLS 11th edition xABCDE: why bleeding control now comes before the airway ✅ Foley balloon tamponade as a bridge to definitive control ✅ Why there's no cervical collar and no wound probing in PNI ✅ When to secure the airway early, and how the "double set-up" works ✅ The shift from zone-based to sign-driven ("no-zone") management ✅ Hard signs vs soft signs vs no signs, and where each patient goes ✅ CT angiography's strengths and its blind spot: the oesophagus ✅ Venous air embolism and why you keep the patient flat ✅ Two clinical cases to test your decision-making ⏱️ *Chapters* 00:00 Introduction 01:04 A small target with lethal density 01:36 Thinking under pressure 02:28 The platysma: line in the sand 03:51 The three zones 06:07 Zones I and III: hard-to-reach bleeding 06:49 Primary survey: xABCDE 08:03 Hemorrhage control and Foley tamponade 09:16 No cervical collar 10:26 No probing 11:01 The ticking airway 11:39 The double set-up 12:32 From zones to signs 13:49 Hard signs 14:42 Why a 10% negative exploration rate 15:14 Gunshot wounds and cavitation 16:11 Soft signs and no signs 17:02 CT angiography and its blind spot 17:25 Hunt the oesophagus 19:38 Venous air embolism 20:58 Case 1 22:09 Case 2 23:32 Recap 24:38 What comes next 👨‍⚕️ *About the author* Slides and teaching content by Dr. Nasser Hassan Abdalrady, Emergency Medicine Consultant & Educator. Part of the EDME (Emergency & Disaster Made Easy) resident teaching series. 📚 *References* 1. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th ed. (2020): Neck Injuries 2. Rosen's Emergency Medicine: Concepts and Clinical Practice, 10th ed. (2023): Neck 3. American College of Surgeons. Advanced Trauma Life Support (ATLS), 11th ed. (2025) 4. Sperry JL, et al. WTA critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013 5. Tisherman SA, et al. EAST practice management guideline: penetrating zone II neck trauma. J Trauma. 2008 6. Inaba K, et al. Multidetector CT for penetrating neck injury: a prospective multicenter study. J Trauma Acute Care Surg. 2012 7. Ibraheem K, et al. "No zone" approach in penetrating neck trauma. J Surg Res. 2018 8. ESVS 2025 Clinical Practice Guidelines on the Management of Vascular Trauma ⚠️ *Disclaimer* This video is for medical education only and is not a substitute for clinical judgement or local protocols. Thresholds and figures are teaching reference points. Always follow your institution's trauma guidelines. 👍 If this helped, like, subscribe and share it with your residency group. Questions or case discussions are welcome in the comments. #EmergencyMedicine #TraumaSurgery #PenetratingNeckInjury #ATLS #MedEd #FOAMed #EMResidents #TraumaBay #EDME