Initial management
Airway
- Surgical emphysema or air bubbling may indicate a breach in larynx/ trachea
- Stridor due to haematoma both may require surgical airway
- (c-spine precautions not necessary unless mechanism suggests fracture or cord injury. Also, neck swelling with a collar may cause jugular venous hypertension) Ref 1
Breathing
- Pneumothorax especially with lower zone injuries
Circulation
- External haemorrhage or expanding haematoma, venous air embolus, dissection (bruit/ Horner's)
Disability
- Evolving CVA, spinal cord injury, brachial plexus injury
Exposure
- Oesophageal injury- local infection or mediastinitis
Anatomical zones
Management algorithm
In CUH, neck wounds requiring exploration should be admitted under the care of the general surgical consultant on call. The surgical team may refer on to vascular / radiology / ENT / plastics as required.
Links & References
Ref 1 Arishita GI, Vayer JS, Bellamy RF: Cervical spine immobilization of penetrating neck wounds in a hostile environment, J Trauma 29(3):332, 1989