Neck Trauma: Diagnosis and Management in the Emergency Department - Trauma EXTRA Supplement

Points & Pearls Excerpt

• Neck trauma is a relatively uncommon presentation in the ED but it is associated with the risk of significant morbidity and mortality. Penetrating neck trauma occurs more frequently than blunt neck trauma, but both types of injury have mortality rates of up to 10%.⁵
• Understanding which structures are at risk in each of the 3 zones of the neck helps to establish a thorough differential for associated injuries. (See Figure 1 and Table 1.)
• The goals of prehospital management of neck trauma patients include immediate recognition of unstable patients, correct positioning and spinal precautions, and transportation to the most appropriate facility. Rapid assessment of the patient’s airway stability is the first priority.
• A collar should not be placed on patients with penetrating trauma if the neurologic examination is normal and there is no suspicion for cervical spine trauma, as collar placement has been shown to obscure subtle penetrating injuries and make airway management more difficult.¹⁷
• In the “no zone” approach to management of neck trauma, imaging decisions are based on the patient’s history, stability, and physical examination findings, rather than on a strict zonal approach. The shift to the “no zone” approach over the past 2 decades has reduced unnecessary CTA of the neck as well as negative surgical explorations.²⁵