“The patient presented with a severe penetrating head injury. I’m aware that brain edema is a big problem in these injuries, so I avoided giving IV fluids to him.” Under-resuscitation of head injury leads to hypotension and results in increased morbidity and mortality. Fluid resuscitation should not be withheld for fear of brain edema. If edema is a serious concern, resuscitation with hypertonic saline can be instituted.
“EMS brought in a young male with a gunshot wound to his neck and a GCS score of 6. It was obvious that the patient was not protecting his airway, but I was hesitant to secure the airway due to the possible complications.” Studies have shown that application of RSI to patients with penetrating neck injuries is safe and effective. The emergency clinician should not avoid securing the airway in the trauma patient if it is needed; however, backup airway devices should be available in case of complications.
“A young woman presented to the ED with a small puncture wound on her neck between her clavicle and her cricoid cartilage. The wound looked small, so I decided to suture up the wound and send her home.” Be wary of the penetrating neck injury. Unless you can definitively prove that the wound does not penetrate the platysma, the patient with a penetrating neck injury must undergo a series of imaging studies and/or a period of observation to ensure that no serious injury has occurred.