Neck Trauma

Question 1

neck trauma and platysma

Answer 1

“wounds that do not penetrate the platysma are not life threatening”

any wound deep to the platysma raises concern for damage to the vital structures of the neck

Question 2

most common cervical injury

Answer 2

vascular injuries
- also the leading cause of death from penetrating neck trauma

Question 3

most common pathophysiologic mechanism of death in strangulation

Answer 3

obstruction of cerebral venous return
- only limited pressure is needed for venous compression
- if both external and internal jugular veins are simultaneously occluded, cerebral vascular congestion, edema, and unconsciousness result
- next, loss of muscle tone allows arterial compression with subsequent CEREBRAL ANOXIA and DEATH

Question 4

remarks cervical spine and cord injuries in strangulation

Answer 4

except for judicial hangings, cervical spine and cord injuries are not frequently seen in patients who survive strangling

Question 5

in symptomatic strangulation patients, the most common complaints are

Answer 5

neck pain
voice changes
swallowing difficulty
breathing problems
- any of these can signal impending airway compromise and should be investigated

half of victims have no visible signs of neck trauma, and 2/3 are asymptomatic

Question 6

Perhaps the most difficult task in caring for strangled patients is

Answer 6

evaluating the “walking and talking” victim who lack physical signs of strangulation.
- physicians may be tempted to ascribe symptoms to anxiety and to discount the patient’s story
- there is a subset of seemingly asymptomatic patients who die after developing DELAYED CEREBRAL or PULMONARY EDEMA

Question 7

radiologic indications of strangulation injury

Answer 7

intramuscular hemorrhage or edema
swelling of the platysma
subcutaneous bleeding
hemorrhagic lymph nodes

Question 8

Some [nonintuitive] hard signs of strangulation injury

Answer 8

visual disturbances
arrhythmia
crackles or wheezes
seizures

Question 9

strangulation in children

Answer 9

during childhood, the diameter of the larynx is smaller and its mucosa is more loosely attached allowing edema and hematomas to progress

therefore, children are more likely to present with respiratory distress

Question 10

trial regarding tranexamic acid

Answer 10

CRASH-2 Trial
- tranexamic acid significantly reduces deaths from traumatic bleeding when given within 3 hours of the inciting injury