Definition
• Injuries soft tissue & structures of the neck
Approach
• Evaluate 3 main categories: Vascular, pharyngoesophageal, laryngotracheal (do not place NGT if esophageal/laryngeal injury suspected)
Inspection
• Violation of platysma (↑ incidence of underlying structure injury, may indicate need for surgical exploration) (Trauma 1979;19:391), pulsatile/expanding hematomas
Penetrating Trauma Zones
• Anterior triangle: Bordered by anterior SCM, midline, mandible. Posterior: Posterior to SCM, anterior to trapezius, superior to clavicle, most significant structures are anterior.
• Zone I: Below cricoid cartilage (highest mortality), Zone II: B/w cricoid & angle of mandible, Zone III: Above angle of mandible)
Penetrating Neck Trauma
Definition
• Injury to the neck from GSW, stabbings, projectile objects (shrapnel/glass)
Physical Findings
• Laryngotracheal injuries may have stridor, respiratory distress, hemoptysis, SQ air, dysphonia
• Esophageal injuries may have dysphagia, hematemesis, SQ air
• Vascular injuries may have neuro deficits, expanding/pulsatile hematoma/bleeding, bruit/thrill, hypotension
Evaluation
• CXR/(ptx/htx), lateral neck x-ray in trauma bay, CT, CTA
• Trauma labs: CBC, BMP, T/S or C, PTT/PT, ABG
Treatment
• Airway management (may be difficult airway), surgical consultation if platysma violation, abx (if ↑ risk contamination from aerodigestive perforation)
• Treat as trauma resuscitation (ABCs, transfusion, etc.)
Disposition
• Admit if surgical intervention/observation needed
Pearl
• Arrest due to penetrating neck trauma is indication for ED thoracotomy
Strangulation
Definition
• Neck trauma due to strangulation (3500 deaths/y)
History
• Strangulation, voice changes, attempt to obtain “height of drop” from EMS
Physical Findings
• Dysphonia/dyspnea (indicators serious injury), petechial hemorrhages (Tardieu spots), ligature/finger marks, neuro deficits/coma
Treatment
• Airway management (may be difficult airway), surgical consultation (if needed), abx (if ↑ risk contamination from aerodigestive perforation)
Disposition
• Admit if needed
Pearls
• ↑ incidence of ARDS & long-term neuropsychiatric sequelae (selective vulnerability of hippocampus to anoxic injury)
• Self-inflicted hanging rarely a/w C-spine injury, see hangman’s fracture (Chapter 18)