Neck emergencies

Question 1

what is it?

Answer 1

a penetrating injury - knife/GSW/MVA
industrial accidents 
household accidents 
blunt 
MVA
sports injuries (clothesline tackle)

Question 2

who gets it?

Answer 2

males>females - adolescents and young adults
Glasgow 2nd most violent city in UK
903 knife incidents pa
penetrating trauma mortality rate - 2-6%
It is all dependent on the part of the neck

Question 3

how does it present?

Answer 3

mechanism of injury
Pain - location, nature, intensity, onset, radiation
Aerodigestive tract - dyspnoea, hoarseness, dysphonia, dysphagia - haemoptysis
CNS problems - paraesthesias, weakness

Question 4

what is in zone I of the neck?

Answer 4

very dangerous 
bottom of the neck 
oesophagus 
thoracic duct 
thyroid 
vessels - brachiocephalic, subclavian, common carotid, thyrocervical trunk 
spinal cord

Question 5

what is in zone II of the neck?

Answer 5

more manageable issue 
larynx 
hypopharynx 
CN 10, 11, 12
vessels - carotids, internal jugular 
spinal cord

Question 6

what is in zone III of the neck?

Answer 6

pharynx
cranial nerves
vessels - carotids, IJV, vertebral
spinal cord

Question 7

how is it managed?

Answer 7

ABCDE - emergency look for other injuries across the body
FBC, G&S/ XM
AP/lateral neck - ?Full body
CXR - haem-pneumothorax, emphysema
CT angiogram - vascular, pseudoaneurysm. laryngeal, aerodigestive tract?
MR angiogram
urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in the aerodigestive tract
laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
angiography - embolize, occlude