Bryan St John here is some I just read 18 Q. All right. Now, someone with a neck 19 injury like she had, in that area of the neck, what is 20 that called? What area of the neck do yall refer to 21 that as? 22 A. We divide the neck into three zones, 23 and that is how we manage them, and that is what we call 24 a zone two injury. 25 Q. Okay. And how do you manage a zone Sandra M. Halsey, CSR, Official Court Reporter 853 1 two injury? 2 A. Its just -- these kinds of injuries 3 are divided up, either for penetrating injuries, either 4 by a stab wound or a gunshot wound. And, theres a -- 5 you can either manage them selectively or go to the 6 operating room. You can do studies or go to the 7 operating room. 8 Its sort of a clinical judgment, of 9 what we do. And we base criterion if theyve penetrated 10 a muscle called the platysma, which is below the skin. 11 And in her case the wound was clearly through the 12 platysma on superficial examination. And thats as far 13 as you want to go. 20 Q. So the best way to control that is to 21 take her into the operating room and do some exploratory 22 surgery? 23 A. Yes. Take her to the operating room 6 Q. Okay. And can you describe that 7 surgery to the jury, please? 8 A. Well, when she was obviously put to 9 sleep and prepped with sterile solutions, the incision 10 that we typically make is along the edge of the 11 sternomastoid muscle, which is this muscle in your neck 12 if you turn it to the side. Her incision was basically 13 made already. 14 So what we did is we undermined the 15 skin a little bit to expose it and retracted the skin 16 back and just looked and ligated the vessels that were 17 bleeding. And looked for -- 18 Q. What does that mean? 19 A. That means tying them off, to stop 20 them from bleeding with a suture. 21 Q. Okay. And then what? Whats the next 22 thing you saw? 23 A. Well, when we looked at her we saw 24 several very small veins bleeding, which we tied off. 1 internal jugular vein, which is a large vein, so they 2 were bleeding. And once we stopped those, the wound was 3 what we call hemostatic, the bleeding had stopped. And 4 then we just irrigated it and looked around for anything 5 that looked suspicious, for a major vessel injury, an 6 injury to the windpipe, injury to the esophagus, and we 7 didnt see anything. 23 A. I mean by a superficial wound that it 24 did not penetrate any of the deeper structures, youd 25 call a deep wound would penetrate the muscles, the Sandra M. Halsey, CSR, Official Court Reporter 856 1 vessels. It just penetrated basically the skin and the 2 subcutaneous tissue, which is what we refer to as the 3 fat, underlying the skin. And theres a muscle in the 4 subcutaneous tissue in that area of the neck called the 5 platysma, which it also penetrated. That was the extent 6 of the injury.
Posted on: Wed, 03 Sep 2014 13:30:04 +0000
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