Neck Junctional Injuries: Zones, Pressure, and Placement

<p>Max and Dennis walk through neck and upper-chest junctional injuries, the pattern he expects more of with top-down penetrating trauma.</p><p>The neck is divided into three zones for a reason. Zone 1 (sternal notch to cricoid) raises immediate concern for chest involvement and the need for sternotomy or similar exposure. Zone 2 (cricoid to the angle of the jaw) is the most accessible surgically; the anterior border of the sternocleidomastoid is the landmark for the trail of safety. Zone 3 (angle of the jaw to the base of the skull) is difficult to control because vessels dive into the skull and space for packing is limited. The subclavian and axillary vessels run deep under the clavicle toward the deltopectoral groove; proximal control is not quick.</p><p>Prehospital priorities stay simple and sequential. Get a third person whose only job is to hold pressure or pack with a finger. Protect the airway early, because hematoma can compromise it and force a cycle of pressure and release. Once the airway is secure, reassess whether external pressure is effective. If the hole is small and bleeding is not massive, a whip stitch may buy time. If pressure is failing and the hematoma is large, the wound may need to be enlarged for packing. The Kentucky Ballistics video is used as an open-source example of effective finger packing in a zone-1 injury that held long enough to reach the operating room.</p><p><br></p><p>PFC Podcast · prolongedfieldcare.org · @prolonged_field_care</p><p><br></p><p><strong>Takeaways</strong></p><ol><li><strong>Neck and upper-chest junctional injuries are harder to control than groin injuries.</strong> Anatomy is tighter, vessels are deeper, and proximal control is not a quick maneuver.</li><li><strong>Know the three zones.</strong> Zone 1 (sternal notch to cricoid) implies possible chest involvement. Zone 2 is the most accessible. Zone 3 dives into the skull and is difficult to pack.</li><li><strong>The landmark is the anterior border of the sternocleidomastoid.</strong> Medial is safer for airway work. Lateral is where the major vessels and nerves run.</li><li><strong>Use a three-person battle drill.</strong> One person is the finger (pressure or packing). The medic secures the airway, then addresses access, blood, and chest tube as needed.</li><li><strong>Airway comes early.</strong> Expanding hematoma can obstruct the airway. Get it before you are forced into cycles of pressure and release. The Kentucky Ballistics case shows effective