NOT Board Review

You’re kicking back in an empty CCT when you hear a ruckus in the hallway. In comes in a young man with a penetrating injury to the neck. He’s stridorous and diaphoretic on arrival.

What do you do?

Step 1: Intubate immediately

After step 1, what's the next step in the work-up of this imaginary patient?

CT angiogram of the neck

What if it's a zone 2 injury?

CT angiogram of the neck. In the old days, zone 2 went to the OR. Now, even EAST guidelines recommend CTA for all.

What are the 'hard signs' of neck trauma?

Expanding hematoma, stridor, signs of hemorrhagic shock, CVA, airway obstruction.

What are the 'soft signs' of neck trauma?

hemoptosis, subq air, non-expanding hematoma, dyspnea

What physical exam finding indicates a penetrating neck injury that requires further work-up?

If the wound violates the platysmus

By Dr. Andrew Grock and Dr. Sally Bogoch

References

East Guidelines

Lecture by Dr. Diane Birnbaumer

Tintinalli’s, 7th ed

Inaba K¹, Branco BC, Menaker J, Scalea TM, Crane S, DuBose JJ, Tung L, Reddy S, Demetriades D. Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicenter study. J Trauma Acute Care Surg. 2012 Mar;72(3):576-83; discussion 583-4; quiz 803-4. doi: 10.1097/TA.0b013e31824badf7.