Neck Trauma
There has been a shift towards removing the C-collar in many of these patients. The thought is that if there is no neurologic deficit and you can evaluate the spine (i.e. patient is not unconscious), then the C-collar can be removed by NEXUS criteria - Amaan Siddiqi MD
image by: Cureus
HWN Suggests
Neck Trauma: A Practice Update
The debate continues between the ideal methods of handling patients with neck trauma – mandatory surgical exploration vs. selective exploration? The old-school way of thinking was that violation of the platysma and/or Zone II neck injuries necessitated surgical exploration. More recently, however, literature has shown similar diagnostic accuracy in selective exploration. With the advent of high-resolution CTA, we can better assess vascular injury and whether the patient needs to go to the OR.
Even if CTA is negative and the patient is stable, strongly consider admitting these patients for observation.
Featured
NEXUS Criteria for C-Spine Imaging
Clears patients from cervical spine fracture clinically, without imaging.
Articles of Interest
Airway in Neck Trauma
Awake percutaneous cricothyroid puncture with insertion of an endotracheal tube – anatomy may be too abnormal - examine neck and attempt to palpate - apply anti-septic - infiltrate LA - make a punch stab through crico-thyroid membrane dilate with handle of scalpel - insert a size 6 or 7 cuffed ETT into trachea
Blunt Trauma to the Neck
Intubation is best performed under direct vision (preferably fiber-optic or rigid endoscopy). A smaller tube with a high-volume, low-pressure cuff is preferable.
Episode 173.0 – Blunt Neck Trauma
Blunt neck trauma comprises 5% of all neck trauma. Mortality due to loss of airway more so than hemorrhage.
Neck Trauma: Diagnosis and Management in the Emergency Department
Traumatic neck injuries can affect many vital structures and have a risk for occult or delayed presentations, including stroke.
Penetrating Neck Injury: What’s In and What’s Out?
The new approach combines some good ol’ physical examination skills with CT angiography, effectively doing away with the traditional zones. Patients who are hemodynamically stable and exhibit no hard signs may be initially managed by imaging (CTA) even when platysma violation is present. So what are the hard signs? We like this simple mnemonic: “HARD Bruit” (Figure): Hemodynamically unstable, Hemoptysis, Hematemesis, Arterial bleeding, Rapidly expanding hematoma, Deficit (whether vascular or neurologic), and a Bruit or thrill. If they have any of these findings, stop. Call your surgeon to take the patient straight to the OR. Do not collect $200.
Penetrating Neck Trauma
Patients with penetrating neck trauma can present with a variety of injury patterns including hemorrhagic shock, airway obstruction and neurologic injury. Serious injuries may not be clinically obvious making diagnosis and prompt treatment challenging. If the platysma is violated, it should be assumed that deeper structures have been injured until proven otherwise.
Resources
SAEM
Neck trauma poses a challenge to emergency providers secondary to the large amount vital structures that occupy a very small amount of real estate. The airway, vascular system, neurological system, and gastrointestinal tract are all found in this small area and can all be involved in a seemingly innocuous injury. Additionally, spinal injuries must always be considered in patients with multiple injuries, either blunt or penetrating.
