Neck Trauma

Question 1

5 signs and symptoms Laryngotracheal injury

Answer 1

Stridor
Hoarseness
SubQ emphysema 
Loss of anatomical landmarks
Dyspnea
Hemoptysis

Question 2

Airway management of suspected LAryngotracheal injury

Answer 2

Intubate early for signs of edema or obstruction
Fiberoptic should be first line as can create false passage
Don’t paralyze unless have double set up

Question 3

Imaging modalities of choice in laryngotracheal injury

Answer 3

CT neck (less useful in peds as not calcified) and bronch for lower airway injury

Question 4

Pharyngoesophageal injury usually from penetrating trauma, caustic/FB ingestion, forceful vomiting

1. Clinical sign and symptoms?
2. Feared complication?

Answer 4

Hematemesis
SubQ emphysema
Blood in saliva /NGT

Complication: mediastinitis

Question 5

Pharyngoesophageal injuries imaging modalities and management

Answer 5

Plain X-ray for mediastinal air– esophogram, endoscopy

Broad spectrum antibiotics, NPO, no NG tube blinding

Question 6

11 risk factors for blunt cerebrovascular injury (vertebral or carotid)

Answer 6

Major TBI 
clothesline
Near hanging 
Basal skull fracture 
Mandibular fracture 
Occipital condyle fracture
C-spine fracture 
Scalp degloving 
Major thoracic injury 
Seatbelt sign w swelling 
Mid face displaced fracture

Question 7

6 hard signs suggesting blunt cerebrovascular injury

Answer 7

Tia/stroke
Expanding hematoma
Bruit
Airway compromise
Horner syndrome 
Active bleeding

Question 8

What are the mechanisms of injury in blunt cerebrovascular trauma leading to thrombosis or embolism?

Answer 8

Dissection, intimal tear and pseudoaneurysm formation

Question 9

8 hard signs of penetrating airway trauma

Answer 9

Focal neuro deficits
Expanding /pulsating hematoma
Severe Active bleed 
Bubbling wound  
Massive SubQ emphysema
Hematemesis 
Shock 
Airway compromise

Question 10

Zone 1:
Landmarks
Structures
Imaging

Answer 10

Sternal notch (or clavicles) to cricoid 
Trachea, esophagus, Lung apices,Carotids + vertebrals, Spinal cord, thyroid, 
CTA, endoscopy/esophagram, bronch

Question 11

Zone 2:
Landmarks
Structures
Imaging

Answer 11

Cricoid to angle of mandible
Larynx, trachea, esophagus, carotids, vertebral arteries, jugular veins
Surgery if hard signs, otherwise as per zone 1

Question 12

Zone 3:
Landmarks
Structures
Imaging

Answer 12

Angle of mandible to base of skull
Pharynx, Jugular veins, Vertebral and carotids, Base of skull
CTA