DECIDEZone I: notch to cricoid · Zone II: cricoid to mandible · Zone III: mandible to skull base. · Triage by hard and soft signs, not by zone. Use the zone to choose the imaging. · Hard signs → OR now, no imaging. · Soft signs → CTA workup, not the OR.
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
IMMEDIATE PRIORITIES
Airway: intubate early. No nasogastric or nasotracheal tubes.
Direct manual pressure. Never circumferential, never bilateral.
Do not probe, cannulate or clamp blindly. Leave an impaled object in place.
Foley tamponade: 16 Fr along the tract, balloon up with ~20 mL saline, gentle traction.◆ FOLEY TAMPONADE IN
No collar in isolated penetrating neck trauma.
EQUIPMENT
Surgical airway kit open and ready at the bedside before any intubation attempt.
16 Fr Foley + syringe. CTA-capable imaging, or a transfer arrangement.
IN THE KIT — 5 ITEMS · TRAUMA CART · DRAWER 3 · HEMORRHAGE CONTROL 1
Foley catheter 16 Fr — one to place, one spare ×2
20 mL syringe×1
Umbilical tape or clamp — to secure the catheter under tension ×1
Gauze packs×4
Occlusive dressing×1
ALSO NEEDED — NOT IN THE KIT
Surgical airway kit — open and ready at the bedside, from drawer 2 of the code cart. CTA-capable imaging and the transfer call run in parallel.
DRAFT — not yet assembled or signed off. This is temporary control, not a repair. The surgical airway kit is open at the bedside before any intubation attempt in a penetrating neck injury.
FIGURE
ZONE I: NOTCH→CRICOID · II: CRICOID→MANDIBLE · III: MANDIBLE→SKULL BASE
HARD SIGNS → OR · SOFT SIGNS → CTA
FOLEY TAMPONADE: 16 FR, ~20 ML BALLOON
PITFALLS & PEARLS
Blindly probing or clamping the wound — the most dangerous mistake on this card.
Removing an impaled object — leave it in place.
Circumferential or bilateral neck dressings.
Treating a "no hard signs" wound as trivial — it still needs CTA-based workup.