Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 17 2021

Neck Trauma

Images
https://upload.medbullets.com/topic/122022/images/zone of neck trauma.jpg
https://upload.medbullets.com/topic/122022/images/123123132vanessa.jpg
  • Snapshot
    • A 27-year-old male is brought in to the ED after being found down in front of his apartment. The neighbors report that the patient was a stabbing victim, and a small knife was found on the left neck by EMS and left in place. En route, the patient’s blood pressure is 91/53 mmHg, pulse is 110/min, respirations are 21/min, and oxygen saturation is 95% on room air with GCS of 15. On exam, there is a small knife on the lateral left neck above the sternal notch with a large hematoma that feels pulsatile. There are decreased breath sounds on the left apical lung. There are also multiple stab wounds and lacerations on his back.
  • Introduction
    • Neck trauma can be described neck zones
      • zone I: base of neck (thoracic inlet to cricoid cartilage)
      • zone II: midportion of neck (cricoid to angle of mandible)
      • zone III: superior aspect of neck
    • Mechanism of injury can determine zones and layers of neck involved
  • Presentation
    • Airway injury
      • larynx
        • history: strangulation, direct blow, blunt trauma, any penetrating injury involving platysma
        • triad: hoarseness, subcutaneous emphysema, palpable fracture crepitus
        • other symptoms: hemoptysis, dyspnea, dysphonia
      • trachea/bronchus
        • history: deceleration, penetration, increased intrathoracic pressure
        • symptoms: dyspnea, hemoptysis
        • exam: subcutaneous emphysema, Hamman's sign (crunching sound synchronized to heart beat)
    • Pharynx/esophageal injury
      • hematemesis, difficulty swallowing, saliva exiting out of the wound, pneumomediastinum
    • Vascular injury
      • most common injury with penetrating neck trauma
      • hematoma, absent carotid pulse, bruit, shock
    • Nerve injury
      • vagus, spinal accessory, hypoglossal, phrenic nerves are at risk
      • symptoms associated with the specific nerve damaged
  • Management
    • General approach
      • patient should be transported to a trauma center. Meanwhile, immobilize neck to prevent further injury
      • primary survey
        • if penetrating neck trauma present, do NOT:
          • clamp structures (high risk of nerve damage)
          • probe with finger
          • insert nasogastric tube (risk of perforation/bleeding)
          • remove weapon/impaled object in the ED
        • presence of hemodynamic instability or “hard signs” of tissue injury prompt surgical intervention
          • hard signs include
            • vascular injury
              • pulsatile bleeding, expanding hematoma, bruit, signs of cerebral ischemia, absent carotid pulse
            • aerodigestive injury
              • bubbling from the wound, hoarseness, stridor, subcutaneous emphysema, respiratory distress
      • secondary survey
        • imaging
          • CXR and CT scan
          • asymptomatic patients may have time for CT angiogram, esophagoscopy or bronchoscopy to fully characterize extent of injury and dictate further management
Card
1 of 0
Question
1 of 3
Private Note