Neck Trauma (Penetrating)


Diagnosis

  1. History: instrument used & distance from assailant
  2. Airway injury
  3. Vascular injury
  4. Esophageal injury
  5. Neuro injury
  6. R/O C-spine injury: very rare unless assoc. w/fall
  7. +/- bleeding laceration
  8. CXR; soft tissue neck films
  9. Never probe wound or remove penetrating object

Pathophysiology

  1. Most common mechanisms = knives & firearms
  2. Neck divided into 3 zones based on accessibility to vascular structures
  3. Major arterial injuries occur in approx 18% of cases
  4. Platysma important landmark

Treatment

  1. Primary Survey = ABCDE, IV, O2, monitor
  2. Consult surgery: management is controversial
  3. Stable patients with zone I or III injuries 
  4. Zone II injuries 
  5. Any penetration with evidence of significant injury requires OR repair
  6. Antibiotics prn (i.e. Unasyn 3.0 g IVPB) gross contamination or esophageal inj.

Disposition

  1. OR as needed for injuries
  2. Otherwise observation
  3. Maintain high suspicion for esophageal injuries
  4. Injuries above platysma require only wound care & observation, may be d/c if stable