Airway management is always given priority in trauma patients, partic-
ularly when neck structures are involved because of the potential for rapid
airway compromise. Active bleeding sites or wounds with blood clots should
not be probed because massive hemorrhage can occur. Bleeding should be
controlled by direct pressure. Blind clamping should be avoided because of
the high concentration of neurovascular structures in the neck.
(a)Blind clamping should be avoided because of the high concentra-
tion of neurovascular structures in the neck. (b)Active bleeding sites or
wounds with blood clots should not be probed because massive hemor-
rhage can occur. Bleeding should be controlled by direct pressure.
(c and e)The injury is in Zone II of the neck.
140.The answer is d.(Rosen, pp 337-340.)The hangman’s fracture, or
traumatic spondylolysis of C2, occurs when the head is thrown into
extreme hyperextensionas a result of abrupt deceleration, resulting in
bilateral fractures of the pedicles. The name “hangman’s fracture” was
derived from judicial hangings, where the knot of the noose was placed
under the chin which caused extreme hyperextension of the head on the
neck, resulting in a fracture at C2. However, many hangings resulted in
death from strangulation rather than spinal cord damage. Today, the most
common cause of a hangman’s fracture is the result of head-on automobile
collisions.
(a)Colles fracture is the most common wrist fracture seen in adults.
It is a transverse fracture of the distal radial metaphysis, which is dorsally
displaced and angulated. These fractures usually occur from a fall on an
outstretched hand. (b)A boxer’s fracture is a fracture of the neck of the fifth
metacarpal. It is one of the most common fractures of the hand and usually
occurs from a direct impact to the hand (eg, a punch with a closed fist).
(c)A fracture of C1 is called a Jefferson fracture, which is typically pro-
duced by a vertical compression force. (e)Clay-shoveler’s fracture occurs
secondary to cervical hyperextension or direct trauma to the posterior neck
resulting in an avulsion fracture of the spinous process.
141.The answer is b.(Tintinalli, pp 1565-1566.)The skull base comprises
the floors of the anterior, middle, and posterior cranial fossae. Fractures in
this region typically do not have localized symptoms. However, indirect
signs of injury may include visible evidence of bleeding from the fracture
into surrounding soft tissue. Ecchymosis around the mastoid bone is often
described as Battle signand periorbital ecchymosis is often described as
158 Emergency Medicine