TRAUMA TO THE NECK

Yaowapha Siripakarn
ANATOMY
 *!

Triangle
•anterior triangle *most vital structure
•posterior triangle
 *

FASCIAL LAYERS OF THE NECK

 Superficial fascia
 Platysma
 Deep cervical fascia
 Investing layer
 Pretracheal layer
 Prevertebral layer
 Wounds that do not
penetrate the
platysma are not life
threatening
INITIAL MANAGEMENT
 !

AIRWAY*
 !

AIRWAY*
 !

AIRWAY*

 There is no published data that definitively outline the best

approach.

Always assume a difficult airway

in pt with neck trauma
 Intubation
 Orotracheal intubation
 Video laryngoscope-guided intubation
 Endotracheal intubation over fiberoptic
bronchoscope
 Cricothyroidotomy
 Avoid in children <8 yrs
 Relative contraindication : tracheal transection,
fracture larynx, laryngotracheal transection
 Tracheostomy
 open laryngeal disruption
> direct intubation through the wound
 BREATHING

 Proximity to thorax
 Pneumothorax
 Hemothorax
 Tension pneumothorax
 CIRCULATION*

 Direct pressure
 DO NOT clamp bleeding vessels

 Avoid insert NG tube during initial resuscitation

 DISABILIT Y*

 Neurologic deficits may indicate

 Direct nerves/spinal cord injury
 Cerebral ischemia (carotid artery injury)

 Immobilize C-spine
 Altered mental status
 Neurologic deficits
 Significant blunt trauma
 Uncommon in isolate penetrating neck injury
DIAGNOSTIC AND
TREATMENT
 penetrate

blunt
PENETRATING NECK
INJURY
 !

PENETRATING NECK INJURY

 Airway management
 Hemodynamic stabilization
 Wound examination
 Platysma
 Zone
 Vital structure
 Hard/soft signs
 Vascular injury = leading cause of
dead

No-zone targeted diagnostic workup

Vascular > MDCTA
=first line imaging
Gold standard

First line
BLUNT NECK INJURY
 BLUNT NECK INJURY

 C-spine immobilization
 Blunt carotid and vertebral
dissection
 Delayed onset.(hours to days)
 Mechanism : cervical
hyperextension and rotation or
hyperextension during rapid
deceleration
 Four-vessel cerebral angiography =
gold standard
 Treatment : Anti thrombotic agent,
surgical repair
STRANGULATION
 STRANGULATION

 Caused by
 Hanging
 Ligature strangulation
 Manual strangulation
 Hanging
 Complete/Incomplete
 Mechanisms of death differ depending on the method of hanging*

 Strangulation (ligature/manual)
 Mechnisms: Airway obstruction, Vascular occlusion
 STRANGULATION

 mechanism of death
 Neck vessel occlusion > cerebral anoxia **
 Laryngotracheal fracture
 C-spine injury
 Minor: air way obstruction, carotid body reflex -mediated
cardiac dysrhythmia
 CLINICAL FEATURES

 Abrasion, ecchymosis, compression groove

 Skin/conjunctival petechial hemorrhage
 Painful swallowing, hoarseness, stridor
 Long-term psychiatric manifestation*
 TREATMENT

 Airway
 ETT, C-spine immobilization
 Breathing, Oxygenation
 Circulation
 Cardiac monitoring
 Neurologic
 ICP monitoring
 Psychiatric support for long -term survivor

 Disposition: Admission for 24 hours

 Delayed neck injuries, Airway obstruction