Diagnosis and management of evacuated casualties with cervical vascular injuries resulting from combat-related explosive blasts Colin A. Meghoo, MD,

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Diagnosis and management of evacuated casualties with cervical vascular injuries resulting from combat-related explosive blasts Colin A. Meghoo, MD, James W. Dennis, MD, Caroline Tuman, RN, Raymond Fang, MD Journal of Vascular Surgery Volume 55, Issue 5, Pages 1329-1337 (May 2012) DOI: 10.1016/j.jvs.2011.11.125 Copyright © 2012 Terms and Conditions

Fig 1 United States military levels of care for combat casualties: casualty evacuation (CASEVAC) is transport from the battlefield to a military medical facility, medical evacuation (MEDEVAC) is rotary-wing patient movement between medical facilities, aeromedical evacuation (AEROVAC) is fixed-wing patient movement between medical facilities, tactical refers to in-theater missions, and strategic refers to inter-theater missions. Times shown for patient movement are typical from the time of injury but vary due to patient condition and availability of transport. ATLS, Advanced trauma life support; CT, computed tomography; CTA, computed tomography angiography. Journal of Vascular Surgery 2012 55, 1329-1337DOI: (10.1016/j.jvs.2011.11.125) Copyright © 2012 Terms and Conditions

Fig 2 Computed tomography (CT) imaging studies in patients with cervical vascular injuries. A, A 24-year-old man with right zone 2 injury and a nonexpanding, nonpulsatile hematoma overlying left sternocleidomastoid muscle. Neck exploration was negative. B, A 22-year-old man with left neck zone 2 punctate wounds. Neck wound superficial irrigation and debridement was performed. C, A 24-year-old man with left zone 3 laceration, bright red bleeding, and a left neck hematoma. Preoperative CT neck imaging showed loss of the left external carotid artery. The left external carotid artery was ligated during exploration, and there were no other injuries. D, A 28-year-old man with right zone 2 neck laceration. CT angiography showed subcutaneous air in the right neck but no deeper fragment penetration. Journal of Vascular Surgery 2012 55, 1329-1337DOI: (10.1016/j.jvs.2011.11.125) Copyright © 2012 Terms and Conditions

Fig 3 Flow chart shows overall casualty management after penetrating injury to the neck. CT, Computed tomography; CTA, computed tomography angiography; FN, false negative; FP, false positive; TN, true negative; TP, true positive. Journal of Vascular Surgery 2012 55, 1329-1337DOI: (10.1016/j.jvs.2011.11.125) Copyright © 2012 Terms and Conditions