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
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
normal radial, ulnar, median function of hand
musculocutaneous – normal forearm flexion
axillary – normal arm abduction
In penetrating neck trauma, evaluate the airway and esophagus, in addition to the vascular and neurologic functions.