The EM Educator Series: Neck trauma and myriad of hidden injuries

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Cases:

#1: A 24-year-old male presents with a bleeding anterior neck wound from a knife injury. He appears critically ill, tachycardic, and hypotensive. He is currently protecting his airway.

#2: A 23-year-old female presents with neck pain and ecchymoses around the neck. She states her boyfriend tried to choke her.

Considerations:

1. What are the zones of the neck and the key structures? When should you consider injuries outside of the neck?
2. Who does injury mechanism, blunt vs. penetrating, change your evaluation? Does it?
3. What about airway management: difficult airway / who needs immediate intubation / beware laryngotracheal injuries?
4. When should you consider pneumo/hemothorax / subcutaneous emphysema in the patient with neck trauma?
5. What’s the evaluation and management of vascular injuries in the neck – penetrating, blunt (carotid / jugular / vertebral / subclavian)?
6. When is a C-collar needed for blunt and penetrating injury? Is it needed in penetrating injury?
7. How do you evaluate and manage laryngotracheal injuries?
8. What about a suspected esophageal injury?
9. How does a patient with strangulation present? What exam findings suggest this? How should this be evaluated and managed?
10. What diagnostic tools do you have at your disposal?  CTA, endoscopy or esophagram, bronchoscopy?
11. What should raise your concern for intimate partner violence? What are your options?

From Dr. Katy Hanson at Hanson’s Anatomy:

Suggested Resources:

• Articles:
  • emDOCs – Neck Trauma: A Practice Update
  • E.B.E.L. EM – Penetrating Neck Injuries
  • emDOCs – A Spinchter Series: A Scary Airway Review
• Podcast/Vodcast:
  • CORE EM – Penetrating Neck Trauma
  • EMin5 – Penetrating Neck Trauma
  • EM Cases – BCE 65 Intimate Partner Violence – A Silent Epidemic