II. Pathophysiology
- Anterior neck and throat is exposed to direct Trauma
- Mechanism
- Clothesline Injury
- Near-Hanging
- Attempted Strangulation
- Sporting events or fights (e.g. punched in throat)
- Motor Vehicle Accidents (e.g. steering wheel blunt injury)
- Potential Injuries
- Vascular Injury (esp. Carotid Artery injury)
- Laryngeal Injury (e.g. Laryngeal Fracture)
- Risk of airway compromise
- Thyroid Injury (esp. anterior triangle injury)
- Risk of expanding Hematoma with airway compression
- Higher risk if pre-existing Thyroid Goiter or tumor, and in pediatric patients
- Other findings
- Neck free air
III. Diagnostics
-
Laryngoscopy or Nasolaryngoscopy indications
- CT Imaging with swelling or airway displacement
IV. Imaging
- Neck CT Angiogram
- Indicated in significant blunt force injury
- See Denver Screening Criteria for Blunt Cerebrovascular Injury
- See Neck Vascular Injury in Blunt Force Trauma
- Accuracy of CT angiography is imperfect
-
Chest XRay
- Evaluate for mediastinal air (Pneumomediastinum) and other contiguous findings
V. Management
- Vascular injury
- Airway compromise (Stridor, voice changes)
- Nebulized Lidocaine may allow for an initial laryngeal evaluation
- Consider early Endotracheal Intubation
- Consider Awake Nasotracheal Intubation
- Ready for Emergency Cricothyrotomy
- May be difficult if Trauma disrupted Laryngeal Anatomy
VI. References
- Herbert and Mallon in Herbert (2018) EM:Rap 18(5):6-8