TRUNCAL TRAUMA PENETRATING

ZONES OF TRUNCAL INJURY

Predicts likelihood of combined or isolated thoracic or abdominal penetration
More useful with stabbings
If gunshot or long-implement then assume both

Nipple line

Lateral Costal margin

ZONE I

ZONE II

ZONE III

RESUSCITATION

Breathing

Needle thoracocentesis if tension pneumothorax
UWSD if haemothorax (avoid site of penetration)

Circulation

If arrested (thoracotomy/cross clamp aorta)
Establish IV access contra-lateral to thoracic injury
Insert CVC (if required) to side of thoracic injury [avoids two pneumothoraces]
Blood grouping
If unstable, consider limited resuscitation and urgent OT

Upright CXR (if possible)
AXR - AP/lat (if implement in situ or to locate missile)
FAST U/S (including sub-xiphoid view)

NGT
IDC

ONGOING MANAGEMENT Unstable vs Stable

Unstable
Zone I		OT (for thoracotomy)
Zone II		OT (for laparotomy or thoracotomy depending on FAST U/S and CXR)
Zone III		OT (for laparotomy)
Stable

Zone I

see Thoracic Penetration

Zone II

see Thoracic Penetration

AND

see Abdominal Penetration

Zone III

see Abdominal Penetration