Airway
If integrity of larynx is in question trach may be safer than intubation
One attempt at intubation by most experienced provider with tube one size smaller
If failure, surgical airway should be performed
Emergency tracheostomy preferred to cricothyrotomy
Consider intubation if:
Stridor
Hemoptysis
Subcutaneous emphysema
Expanding hematoma
Breathing
Minimize BVM (positive pressure --> air into soft tissue plains)
Consider ultrasound or CXR to eval for PTX, especially if Zone I injury
Circulation
Place IV on contralateral side of injury
Disability
Neuro deficits may be secondary to direct cord injury or cerebral ischemia secondary to carotid injury
Place in C-collar only if:
ALOC, neuro deficits, or significant blunt injury
If integrity of larynx is in question trach may be safer than intubation
One attempt at intubation by most experienced provider with tube one size smaller
If failure, surgical airway should be performed
Emergency tracheostomy preferred to cricothyrotomy
Consider intubation if:
Stridor
Hemoptysis
Subcutaneous emphysema
Expanding hematoma
If failure, surgical airway should be performed
Emergency tracheostomy preferred to cricothyrotomy
Stridor
Hemoptysis
Subcutaneous emphysema
Expanding hematoma
Minimize BVM (positive pressure --> air into soft tissue plains)
Consider ultrasound or CXR to eval for PTX, especially if Zone I injury
Place IV on contralateral side of injury
Neuro deficits may be secondary to direct cord injury or cerebral ischemia secondary to carotid injury
Place in C-collar only if:
ALOC, neuro deficits, or significant blunt injury
ALOC, neuro deficits, or significant blunt injury
Portable CXR
Evaluation is generally by selective, nonoperative management
Vascular control can be difficult; requires thoracic surgical approach
Optimal management is controversial
Platysma penetration
No penetration → Observe, possible discharge
Penetration + Vitals/Airway stable → CTA of neck
Penetration + Vitals/Airway unstable, or other hard signs → OR for surgical exploration
All bleeding should be controlled with pressure, not with clamps
Platysma penetration
No penetration → Observe, possible discharge
Penetration + Vitals/Airway stable → CTA of neck
Penetration + Vitals/Airway unstable, or other hard signs → OR for surgical exploration
No penetration → Observe, possible discharge
Penetration + Vitals/Airway stable → CTA of neck
Penetration + Vitals/Airway unstable, or other hard signs → OR for surgical exploration
Treat as cranial injuries
Evaluation is generally by selective, nonoperative management
Routine exploration of zone III is not indicated
Routine exploration of zone III is not indicated
Injuries are often initially asymptomatic
If missed can lead to neck space infection, mediastinitis
Esophagoscopy or contrast esophagography indicated if:
CT is equivocal or abnormal
Missile trajectory places esophagus at risk for injury
Persistent symptoms
If missed can lead to neck space infection, mediastinitis
CT is equivocal or abnormal
Missile trajectory places esophagus at risk for injury
Persistent symptoms
Suspect if:
Air bubbling through wound
Dyspnea, stridor
Hemoptysis
Subcutaneous emphysema
Laryngoscopy is indicated if:
Suspect laryngotracheal injury even if CT is negative
Air bubbling through wound
Dyspnea, stridor
Hemoptysis
Subcutaneous emphysema
Suspect laryngotracheal injury even if CT is negative
Penetrating neck trauma
Dental avulsion
Blunt neck trauma
Vertebral and carotid artery dissection
Maxillofacial trauma
Strangulation
Dental fracture
Whiplash injury