Neck Emergencies

Question 1

What would you want to ask a patient presenting with neck trauma

Answer 1

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

Question 2

Neck trauma initial treatment

Answer 2

A – airway (stridor, hoarseness)
B – breathing (RR, accessory muscles)
C – circulation (BP, HR, palpable pulse)
D – disability
E – full exposure

Question 3

Neck trauma definitive management, why would you carry out the following tests?

• Bloods (FBC, G+S/XM): ___________________
• CXR: _________________, _________________
• CT angiogram: ______________________________
• Laryngoscopy, bronchoscopy, pharyngoscopy, and oesophagoscopy: ______________________

Answer 3

• Bloods: FBC, G+S/XM, in case need transfusion
• CXR: haemopneumothorax, emphysema
• CT angiogram: check blood supply & embolisms
• Laryngoscopy etc : assess structures for damage

Question 4

What is quinsy

Answer 4

peritonsilar abscess, complication of quinsy

Question 5

Quinsy pathophysiology

Answer 5

Bacteria gets between the muscle and the tonsil =>
Production of puss in this area

Question 6

Quinsy clinical presentation

Answer 6

Symptoms
- Unilateral throat pain & odynophagia
- Trismus
- 3-7 days of preceding acute tonsillitis

Signs
- Medial displacement of tonsil and uvula
- Concavity of palate lost

Question 7

Quinsy treatment

Answer 7

Aspiration and IV antibiotics

Question 8

Deep neck space infection aetiology/ pathophysiology

Answer 8

Extension of infection from tonsil or oropharynx into deeper tissues e.g. from quinsy

Question 9

Deep neck space infection clinical features

Answer 9

General: Systemically unwell with fever
Throat: Sore throat and trismus
Neck: Limited neck movement with red/tender neck

Question 10

Deep neck space treatment

Answer 10

• IV access, bloods, fluid rehydration
• IV antibiotics - co-amoxiclav or clinamycin
• If small - conservative treatment alone
• If large or not responding - surgical incision & drainage

Question 11

Certain patients presenting with neck trauma should be sent straight for exploration/ surgery. What 4 clinical features make this the most appropriate treatment?

Answer 11

• expanding haematoma,
• hypovolaemic shock,
• airway obstruction,
• blood in aerodigestive tract