Neck Trauma

Question 1

What is the most common cause of a blunt laryngeal trauma?

Answer 1

Motor vehicle collisions (MVCs) are the most common cause of blunt laryngeal trauma

Question 2

What is the most common cause of a penetrating laryngeal trauma?

Answer 2

Gunshot or stab injuries are the most common cause of penetrating laryngeal trauma.

Question 3

What do you need to clear the cervical spine?

Answer 3

Alert, not intoxicated
Absence of neck pain
Absence of midline neck tenderness
Absence of distracting injury
Absence of sensory or motor complaint

Question 4

Definitions of spinal cord injury

Answer 4

Spinal cord injury may be categorized by severity as follows:
Incomplete paraplegia (incomplete thoracic injury)
Complete paraplegia (complete thoracic injury)
Incomplete quadriplegia (incomplete cervical injury)
Complete quadriplegia (complete cervical injury)

Question 5

Zones of penetrating neck trauma

Answer 5

Zone III-Above angle of mandible. Angiography
Zone II-Angle of mandible ® Explore, observe, growing role for CTA
Zone I-below cricoid cartilage; Angiography, highest mortality, EGD, esophagoscopy

Question 6

Blunt neck trauma physical exam

Answer 6

Inspiratory stridor (supraglottic) or expiratory stridor (subglottic)
Muffled voice
Difficulty handling secretions or hemoptysis
Ecchymosis
Subcutaneous emphysema
Absent thyroid prominence
Neck or facial crepitus
Cartilaginous step off
Expanding hematoma
Early findings may be subtle

Question 7

Neck trauma diagnostic measures

Answer 7

Larynx – CT is gold standard. CT angiography may be incorporated if vascular injury suspected.
Cervical spine-radiographs, CT. A chest X-ray should be obtained in all circumstances
Esophagus – endoscopy-contrast (water soluble)
Vascular Injury-Angiography if active bleed or pulse deficit; GI blood, hoarseness, subcutaneous air, respiratory distress