Neck Trauma: Diagnosis and Management in the Emergency Department - Trauma EXTRA Supplement (Trauma CME) -
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Publication Date: April 2021 (Volume 23, Supplement 04)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 04/15/2024. This course is included with an Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Karen Lind, MD, MACM, FACEP

Attending Physician and Faculty Member, Department of Emergency Medicine, Highland Hospital, Oakland, CA

Amy Do-Nguyen, MD

Department of Emergency Medicine, Highland Hospital, Oakland, CA

Peer Reviewer

Michael P. Jones, MD, FACEP

Vice Chair for Education and Residency Director, Albert Einstein College of Medicine, Jacobi/Montefiore, Bronx, NY

Leslie V. Simon, DO, FACEP

Associate Professor, Mayo Clinic Alix School of Medicine; Chair, Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL

Editor-in-Chief

Kaushal Shah, MD, FACEP

Vice Chair for Education, Department of Emergency Medicine, Weill Cornell School of Medicine, New York, NY

Abstract

Neck trauma is an uncommon but serious presenting complaint in the emergency department. Many vital structures may be affected in a patient with a traumatic neck injury, including the airway, digestive tract, and carotid and vertebral arteries. Emergency clinicians must also be prepared to diagnose and manage occult and delayed presentations of injury related to neck trauma. This supplement reviews advances and best practices in the evaluation and management of patients with neck trauma, with a focus on evidencebased guidelines. A streamlined algorithm is provided as well as discussion of recent changes and controversies in neck trauma management in the prehospital and emergency department settings.

Case Presentations

CASE 1

A 16-year-old boy who was a restrained passenger in a motor vehicle crash is brought into the trauma bay by EMS…

The patient is tachycardic and tachypneic, and there are visible contusions and subcutaneous emphysema around a small, palpable defect near the patient’s sternal notch.
You request a surgical consult and order initial lab tests and imaging. As you proceed with the first steps in resuscitation, you consider the hard and soft signs of neck injury that may be found on physical examination…

CASE 2

A 33-year-old woman presents to the ED with multiple small stab wounds on her neck following a domestic violence incident…

The patient is otherwise healthy and well appearing.
She is hemodynamically stable with no signs of respiratory distress.
You ask yourself: should this patient go directly to the operating room, or should you order imaging studies first?

CASE 3

EMS arrives from the local prison with a 61-year-old man after a prison officer found him hanging by his neck from a rope in his cell…

The patient is conscious but confused. There are visible rope marks around his neck.
What are the appropriate next steps in diagnosing and treating this patient with a near-hanging strangulation injury?

Product Reviews

The no zone concept is new to me, thanks! Meanwhile, am still nervous with blunt neck injury, and will maintain a rather low threshold (or shared decision making) for CTA of the neck.
- 05/13/2021