USMLE Forum Archives - USMLE Step 2 CK - surgery
surgery
HIV - 12-31-07 12:48
A young man sustains a gunshot wound to the base of his neck. He was shot point blank with a .38 caliber revolver. The entrance wound is above the left clavicle, below the level of the cricoid cartilage, and just lateral to the sternomastoid muscle. The exit wound is just above the spinous process of the right scapula. He has normal breath sounds on both sides, is awake and alert, is talking with a normal tone of voice, is neurologically intact, and is hemodynamically stable. Portable x-ray films of the neck and chest taken in the emergency department show some air in the tissues of the lower neck, but are otherwise non-diagnostic. Which of the following is the most appropriate next step in management?
A. Observation for several hours
B. CT scan of the lower neck and upper chest
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
D. Immediate surgical exploration of the lower neck through a collar incision
E. Immediate surgical exploration of the upper chest through a median sternotomy
HIV - 12-31-07 12:48
A young man sustains a gunshot wound to the base of his neck. He was shot point blank with a .38 caliber revolver. The entrance wound is above the left clavicle, below the level of the cricoid cartilage, and just lateral to the sternomastoid muscle. The exit wound is just above the spinous process of the right scapula. He has normal breath sounds on both sides, is awake and alert, is talking with a normal tone of voice, is neurologically intact, and is hemodynamically stable. Portable x-ray films of the neck and chest taken in the emergency department show some air in the tissues of the lower neck, but are otherwise non-diagnostic. Which of the following is the most appropriate next step in management?
A. Observation for several hours
B. CT scan of the lower neck and upper chest
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
D. Immediate surgical exploration of the lower neck through a collar incision
E. Immediate surgical exploration of the upper chest through a median sternotomy
Page 1
#1
Re: surgery TheOne - 01-02-08 15:12 This is a good question and needs discussion, I remember that the neck area is divided into 3 triangles and each of them have a special aproach. If anyone here can explain these variations, it will be great.
I will go with D. Immediate surgical exploration of the lower neck through a collar incision.
#2
Re: surgery belgamal - 01-06-08 07:42 It is C., as long as the patient is stable, we have to be sure what is the organs involved and the rightapproch.
#3
Re: surgery 8401glacieres - 01-06-08 12:25 As the wound is from a low velocity firearm, patient is stable, wound of entry and exit in ZONE1,,,,,,,,,,,,,,,,he should be proceeded for ANGIOGRAM followed by TRIPLE-SCOPY.
( REFERENCE-----http://www.emedicine.com/emerg/TOPIC331.HTM#section~Followup)
#7
Re: surgery radhamesramos - 02-03-08 19:48 but in practice, they would do D. Why waiting if you have the OR closeby?
#11
Re: surgery bingousmle - 06-30-10 12:29 this man has recieved a gunshot wound in zone 1 which extends from the clavicle to the angle of the mandible..the patient is stable.. i ll go with option C..
Page 1