Penetrating neck injuries are approximately 1% of all traumatic injuries in the US, yet the case fatality rate approaches 10%. All emergency physicians need to be able to expediently differentiate those requiring emergent interventions from those with less serious injuries. Initial management of penetrating neck injuries focuses on identification of patients requiring early airway management or emergent surgical evaluation. Due to bleeding, anatomic distortion, hemodynamic instability, or potential airway violation patients with penetrating neck trauma should be presumed to have difficult to manage airways. The emergency physician must be prepared to perform cricothyrotomy, and even tracheostomy, should orotracheal intubation attempts fail. Diagnosis of injury in the stable patient with evidence of violation of the platysma has moved away from the traditional zone based approach and now focuses on structured physical exam and the use of MDCTA. Further diagnostic testing may be required dependent on the results of the MDCTA and should be at the direction of a surgeon.
Keywords:
Penetrating Neck Trauma, Laryngotracheal Trauma, Carotid Artery Injury, Airway Management, Cricothyrotomy, Surgical Airway, CT Angiography
Role of Tracheostomy in Dealing with Penetrating Neck Trauma: A Double Edged Sword
