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Penetrating Neck Injuries 

 

 

Considerations

 

  • Emergency case with little or no time to optimize

  • Trauma patient & need for ATLS approach 

  • Potential for serious & life threatening injuries:

    • Laryngeal/tracheobronchial tree disruption

    • Tension/open pneumothorax, massive hemothorax

    • Major vascular disruption

    • Esophageal tear

    • Spinal cord injury, nerve injury 

  • Difficult airway management & possible need for awake fiberoptic bronchoscopic intubation

 

 

Goals 

 

  • ATLS resuscitation & primary survey

  • Identify associated injuries

  • Key principles of airway management:

    • ​Avoid PPV & neuromuscular blockade until airway secured distal to injury

    • No cricoid pressure

    • Direct visualization probably the best method of airway management & double set-up always the safest option

 

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Conflicts 

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  • Full stomach/RSI vs potentially challenging airway

  • Uncooperative patient vs. awake fiberoptic bronchoscopic intubation

  • Securing airway vs. consequences of PPV

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Further Reading 

  • Capan L, Miller S, Scher C. Trauma and Burns. In: Barash P, Cahalan M, Cullen B, eds. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017. p. 1486-1536​.

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