This week, we discuss penetrating neck trauma and some pearls and pitfalls in management.

REBEL EM: Penetrating Neck Injuries

Zone 1

Zone 2

Zone 3

Anatomic Landmarks

Clavicle/Sternum to Cricoid Cartilage

Cricoid Cartilage to the Angle of the Mandible

Superior to the Angle of the Mandible

Anatomic Structures in Zone

Proximal Common Carotid Artery

Carotid Artery

Vertebral Artery

Subclavian Artery

Vertebral Artery

Distal Carotid Artery

Vertebral Artery

Jugular Vein

Distal Jugular Vein

Lung Apices

Pharynx

Salivary and Parotid Glands

Trachea

Trachea

Cranial Nerves IX – XII

Thyroid

Esophagus

Spinal Cord

Esophagus

Larynx

Thoracic Duct

Vagus Nerve

Spinal Cord

Recurrent Laryngeal Nerve

Spinal Cord

Hard + Soft Signs of Major Aerodigestive or Neurovascular Injury

Hard Signs

Soft Signs

Airway Compromise

Hemoptysis

Expanding or Pulsatile Hematoma

Oropharyngeal Blood

Active, Brisk Bleeding

Dyspnea

Hemorrhagic Shock

Dysphagia

Hematemesis

Dysphonia

Neurologic Deficit

Nonexpanding Hematoma

Massive Subcutaneous Emphysema

Chest Tube Air Leak

Air Bubbling Through Wound

Subcutaneous or Mediastinal Air

Vascular Bruit or Thrill

Crepitus

WTA Management Algorithm for Penetrating Neck Injury (Sperry 2013)