Emergent Management of Neck Trauma

Abstract

Neck injuries are rare but carry significant morbidity and mortality. Airway injuries must be managed immediately and continued oxygenation and ventilation provided. The loss of a patent airway remains a significant cause of mortality, and clinicians must have a stepwise approach to these challenging cases. Esophageal injuries are difficult to predict and carry a high mortality when there is a delay to diagnosis. CT technology has advanced and should be performed in all stable patients with suspected aerodigestive injuries. Vascular injury should be suspected in patients with hard signs and evaluated further in patients with soft signs. CTA is becoming the imaging study of choice, especially for initial screening. Management of these injuries in the unstable patient should focus on hemostatic control. In stable patients, anticoagulation, endovascular repair, and open surgical techniques may be necessary to decrease the risk of stroke. Injuries to the cervical spine should be assumed in all trauma patients until CT imaging of bony structures is obtained. Institutional guidelines should be developed to maintain a consistent approach to the timing of cervical collar removal and when MRI is necessary to evaluate for ligamentous injury. This remains an area of some controversy. Ultimately, the goals of managing neck trauma are to maintain a patent airway, control hemorrhage, and avoid worsening any neurologic impact.