Abstract
Emergency Department Management of Penetrating Neck Trauma
Highlights
Penetrating neck trauma is relatively common, but associated with approximately 50% incidence of serious vascular, aerodigestive, or neurologic injuries, as well as significant risk of morbidity and mortality[1]
Penetrating neck trauma presents a complex set of challenges for emergency physicians[1,2,4,5], who are in a position to reduce morbidity and mortality by preparing to evaluate and manage these injuries in a timely and evidence-based manner[2,3,16]
Unstable patients or those with hard signs should be taken to the operating room (OR) emergently after a definitive airway is secured and hemorrhage is controlled[2,3,4]. Those who are stable without hard signs should be evaluated with computed tomography angiography (CTA)[1,3,7,8], and contrast esophogram or esophagoscopy if there is lingering concern for esophageal injury[1,3]
Summary
Penetrating neck trauma is relatively common, but associated with approximately 50% incidence of serious vascular, aerodigestive, or neurologic injuries, as well as significant risk of morbidity and mortality[1]. These injuries present several concomitant challenges for emergency physicians, as they require elements of airway management, hemorrhage control, hemodynamic resuscitation, performance of the trauma survey and other components of advanced trauma life support, knowledge about potential injuries and other complications of penetrating neck trauma, and the ability to perform rapid evaluation and initial management of penetrating neck trauma[2,3]. One quarter will have aerodigestive injuries, which are plagued by a lack of initial physical findings and markedly increased morbidity and mortality associated with delayed diagnosis[1]
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