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Anatomy

Head and Neck

Question 159 of 180

A 31 year old male presents to ED with a penetrating wound to the neck. Imaging shows damage to the structure which run along the course of the anterior scalene muscle. Which of the following structures is most likely affected:

Answer:

Passing around the upper lateral border of each anterior scalene muscle, the phrenic nerves continue inferiorly across the anterior surface of the anterior scalene muscle within the prevertebral fascia.

Phrenic Nerve

Anatomy / Head and Neck / Neck

Last Updated: 11th February 2019

The phrenic nerves are branches of the cervical plexus, arising on each side as contributions from the anterior rami of C3 - C5 come together.

Passing around the upper lateral border of each anterior scalene muscle, the phrenic nerves continue inferiorly across the anterior surface of the anterior scalene muscle within the prevertebral fascia.

Leaving the lower edge of the anterior scalene muscle, each phrenic nerve passes between the subclavian vein and artery to enter the thorax to continue to the diaphragm.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Root of the Neck. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

 

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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