II. Pathophysiology

  1. Anterior neck and throat is exposed to direct Trauma
  2. Mechanism
    1. Clothesline Injury
    2. Near-Hanging
    3. Attempted Strangulation
    4. Sporting events or fights (e.g. punched in throat)
    5. Motor Vehicle Accidents (e.g. steering wheel blunt injury)
  3. Potential Injuries
    1. Vascular Injury (esp. Carotid Artery injury)
      1. See Carotid Artery Injury in Blunt Neck Trauma
      2. See Vertebral Artery Injury in Blunt Neck Trauma
    2. Laryngeal Injury (e.g. Laryngeal Fracture)
      1. Risk of airway compromise
    3. Thyroid Injury (esp. anterior triangle injury)
      1. Risk of expanding Hematoma with airway compression
      2. Higher risk if pre-existing Thyroid Goiter or tumor, and in pediatric patients
  4. Other findings
    1. Neck free air

III. Diagnostics

  1. Laryngoscopy or Nasolaryngoscopy indications
    1. CT Imaging with swelling or airway displacement

IV. Imaging

  1. Neck CT Angiogram
    1. Indicated in significant blunt force injury
    2. See Denver Screening Criteria for Blunt Cerebrovascular Injury
    3. See Neck Vascular Injury in Blunt Force Trauma
    4. Accuracy of CT angiography is imperfect
      1. Malhotra (2007) Ann Surg 246(4): 632-43 [PubMed]
  2. Chest XRay
    1. Evaluate for mediastinal air (Pneumomediastinum) and other contiguous findings

V. Management

  1. Vascular injury
    1. See Neck Vascular Injury in Blunt Force Trauma
  2. Airway compromise (Stridor, voice changes)
    1. Nebulized Lidocaine may allow for an initial laryngeal evaluation
    2. Consider early Endotracheal Intubation
      1. Consider Awake Nasotracheal Intubation
    3. Ready for Emergency Cricothyrotomy
      1. May be difficult if Trauma disrupted Laryngeal Anatomy

VI. References

  1. Herbert and Mallon in Herbert (2018) EM:Rap 18(5):6-8

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