Evaluation and management of neck trauma

Blunt and penetrating trauma to the neck can result in life-threatening injuries that demand immediate attention and intervention on the part of the emergency physician and trauma surgeon. This article provides a literature-based update of the evaluation and management of injuries to aerodigestive and vascular organs of the neck. A brief review of cervical spine injuries related to penetrating neck trauma is also included. Airway injuries challenge even the most skilled practitioners; familiarity with multiple approaches to securing a definitive airway is required because success is not guaranteed with any single technique. Esophageal injuries often present in subtle fashion initially, but more than a 24-hour delay in diagnosis is associated with a marked increase in mortality. In total, 7% of injuries to critical structures of the neck involve major arterial vascular structures, including the subclavian and internal, external, and common carotid arteries [1]. Arterial injuries are a major source of morbidity and mortality for these patients. Currently, spinal cord injuries and thrombosis of the common and internal carotid arteries account for 50% of all deaths attributable to blunt and penetrating neck trauma.