Penetrating trauma to neck

Question 1

A 34 year old man has sustained a stab wound to his left neck. What structures are at risk and what are the indications for immediate exploration?

Answer 1

Impression
Key structures at risk include:
- airway, aspiration
- vascular (arterial, venous)
- neural (brachial plexus, vagus, phrenic, )

Concerned about haemodynamic instability secondary to blood loss, airway instability due to trauma

Goals
- Conduct primary and secondary survey, stabilise patient and take to theatres acutely for surgical exploration and fixation

Question 2

Penetrating neck trauma - Assessment + stabilising management

Answer 2

Assessment
Conduct A to E assessment
- call for senior help: ICU, senior colleagues
- NBM
- look for hard/soft signs of penetrating injury as indications for acute surgical exploration

History

• taken concurrently/collaterally
• MIST AMPLE given trauma

A - Patent, maintaining - airway manoeuvres
B - Sats, RR - supportive as req and depending on injuries sustained - ?intubation esp if surgical disposition
C - BP, HR. Gain 2xIVC, fluid resus (MTP if significant blood loss), pre-op bloods (group + cross match, coags, FBC). CXR
D - GCS
E - Exposure: other injuries, eFAST scan given trauma
F - Catheter
G - BSL

Conduct secondary survey

Question 3

Penetrating neck trauma - Hard and soft signs

Answer 3

Would look for hard and soft signs of penetrating injury , as hard signs are indications for immediate exploratory surgery.

Hard: haemoptysis, reduced GCS, Bruits, expanding haematoma, Haematemesis, active bleeding, bubbling, active bleeding

Soft: small bleeding, small haematoma, dysphagia, dysphonia, subcut air