PENETRATING NECK TRAUMA REQUIRES DETAILED EXAMINATION

A patient presents with a stab wound to the neck. You examine the wound and see a 1 cm laceration. The patient reports no other symptoms. How can we best identify injuries?

 

Through the neck run longitudinal blood vessels, nerves, as well as organs of the respiratory and gastrointestinal systems. The mechanism is important – what is the direction of the wound tract?

 

Below is a template of a thorough examination of penetrating neck trauma, with more detail on pertinent items. This is based on the 1997 article by Demetriades et al.

 

Airway: No subcutaneous emphysema, hoarseness, or stridor, no bubbling from wound

Esophagus: No odynophagia, no pharyngeal blood, no hematemesis

Vascular: Normal pulses, no bruit, no hematoma, no active bleeding

Neurologic:

Motor/Sensory/Reflexes normal

Cranial nerves:

II – pupils equally reactive (no Horner’s syndrome)

III, IV, VI – EOMI

V – normal facial sensation

VII – symmetrical facial movements

IX – normal soft palate

X – no hoarseness/dysphonia, normal cough

XI – symmetrical shoulder lift

XII – tongue midline

Brachial plexus:

normal radial, ulnar, median function of hand

musculocutaneous – normal forearm flexion

axillary  – normal arm abduction

 

Summary:

In penetrating neck trauma, evaluate the airway and esophagus, in addition to the vascular and neurologic functions.

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