NECK TRAUMA PENETRATING

ZONES OF NECK INJURY

 

 

 


Mastoid

Angle of mandible


Cricoid

Clavicle

RESUSCITATION

Airway 

Breathing

Circulation

Disability

 

ONGOING MANAGEMENT Unstable vs Stable

  • Unstable
  • Airway bleeding
  • Uncontrolled bleeding
  • Shock

 

OT (Zone I/II)

Angio suite (Zone III)

  • Stable
  • Definite injury
    • Airway - airway bubbling, haemoptysis, dyspnea
    • Vascular expanding haematoma/bruit/thrill
    • Neuro Horners syndrome, paralysis, CN signs, hemiplegia

 

OT
  • Possible injury
  • Platysmal breach

 

 

Investigate

(see below)

  • Unlikely injury
  • No Platysmal breach

 

 

Observe in HDU/ICU

 

INVESTIGATIONS

 

SUSPECTED INJURY

INVESTIGATIONS

INDICATIONS

Vascular

4-vessel angiogram/Carotid Ultrasound

 

 

Aortography

Any Zone I/III injuries
Intracranial penetration
Basal skull #
Horners syndrome
Zone I injury
Haemothorax

Oesophageal

Rigid endoscopy & Oral contrast studies

Drooling
Dyspnoea
Hoarseness
Stridor
Cough
Haematemesis
Odynophagia
Decreased neck movement
Soft tissue emphysema
Pneumomediastinum
Retropharyngeal air

Airway

Laryngoscopy/Flexible nasopharyngoscopy

Haemoptysis
Dyspnoea
Pain with speaking
Pain with tongue movement
Hoarseness/Loss of voice
Tender larynx/trachea
Stridor
Soft tissue emphysema
Retropharyngeal air

OTHER MANAGEMENT

 

DISPOSITION

Operating theatre (monitor in ICU pre-operatively)

All unstable or definite injuries

Investigate and surgical opinion

All possible injuries

Observe (at least 24 hrs in HDU/ICU) for developing signs of injury

All patients (symptomatic or not)